A new study out today from Ibis Reproductive Health, in partnership with New York University and University of Texas, examines what over-the-counter (OTC) access to birth control (BC) might mean for women’s health.
The study is based on a group of women in El Paso/Juarez, a border area in Southwestern Texas.
In Mexico (and many other Latin American countries) you can walk into a farmacia (pharmacy) and get pretty much any prescription drug over the counter, without a prescription from a doctor. I’ve done this myself while traveling.
This reality gave researchers an opportunity to examine what it might look like for women if birth control (specifically oral contraceptives) were available in the US without prescription at pharmacies. This has been a topic of interest in the reproductive health community for some time as a possible way to improve access to contraception, particularly for low-income women and youth.
The study found two things:
1) Women who got their birth control directly from a pharmacy without a prescription were more likely to keep taking it consistently and not fall behind on pills;
2) The same women were also more likely to be taking the wrong birth control type, aka the wrong combination of hormones, for someone of their health status as compared to women who got their BC from a clinic with a prescription. This meant more negative side effects and health consequences for this group.
The first is great news. The more easily women are able to get their BC, the more likely they are to keep taking it and not fall behind or miss months. This makes a lot of sense, especially when you learn that the group they followed for this study was primarily uninsured and low-income. Having to pay for a doctor’s visit every time you need more pills is a HUGE financial burden. Not to mention other issues that might impact clinic access: transportation, language, ability to get off from work, family knowledge.
We know that birth control sabotage is a problem, and having to make an appointment and make excuses to a partner or family member about your whereabouts is much harder than walking into a pharmacy and picking up your pills. I could imagine for young people this also might be a huge benefit.
The second, not so great. It indicates that women who get their BC straight from a pharmacist are getting a lower quality of care because they aren’t being properly advised as to what BC is best for them. Trading access for quality of care isn’t an okay solution.
So what do we do? I think we should still advocate for birth control over the counter, but also figure out ways to improve the education mechanism with pharmacist interactions. It’s probable that a pharmacist could be equipped to guide a woman toward the right birth control choice, although follow-up and further tweaking would be harder (we know a lot of women take months to find the right drug combination for them.
I also think the second issue wouldn’t be such a problem for women who are insured (which, I believe, we should be working toward for all people). For example, folks with insurance are likely to go for a yearly exam, where they could get guidance on what BC to choose. They just wouldn’t have to go back every time they needed more pills–improving their access and likely usage of birth control.
I do think we should advocate for BC OTC–eliminating the doctor middleman is a good thing in the long run–be then we also need to make sure our education and counseling channels don’t leave some women with a lower quality of care. The study suggests starting with progestin-only pills OTC, because they have fewer side effects. While that’s a possibility, it might also encourage more women to use that type of pill, even if it wasn’t the best for them, because it was easier to access.