Make Hormonal Contraceptives Available OTC, ACOG Says

Troy Brown, RN

September 25, 2019

Women should be able to purchase several different hormonal contraceptives ― not just oral contraceptives ― over the counter (OTC), according to updated guidance from the American College of Obstetricians and Gynecologists (ACOG). In addition, the authors say there is no medical or scientific justification for limiting access to OTC contraception on the basis of age.

The ACOG's Committee on Gynecologic Practice, together with committee members Michelle Isley, MD, MPH, and Rebecca H. Allen, MD, MPH, authored the updated committee opinion, which was published online September 24 and in the October issue of Obstetrics and Gynecology. It replaces ACOG Committee Opinion Number 544, which recommended OTC availability of oral contraceptives only.

The authors acknowledge that regulatory action is needed to allow OTC access. In addition, issues related to cost, including costs for women with insurance that currently pays for their preferred method, would have to be worked out. It may be necessary, as an intermediate step, for women to get these contraceptives through a pharmacist. In some states, direct access to hormonal contraception is already available at pharmacies or by ordering online; however, OTC availability "should be the ultimate goal," the authors write.

"A prescription is an unnecessary obstacle for some women to get their preferred contraceptive method. Over-the-counter hormonal birth control would be a step toward greater access to an essential component of women's health care and give adolescents and women more options to manage their reproductive health," Allen said in an ACOG news release.

"Over-the-counter access to hormonal contraception will improve availability, but it should not be at the expense of affordability," she continued. "Insurance coverage and other financial support for contraception should still apply. Each woman should be able to select the contraception that works best for her, including over-the-counter hormonal contraceptives, a long-acting reversible contraceptive provided by her health care provider, or other methods."

Recommendations, Conclusions

Continuation rates of OTC hormonal contraception are comparable to those of prescription-based hormonal contraception, and OTC access could potentially decrease unintended pregnancy. Evidence shows that women prefer OTC availability of hormonal contraception because it makes contraception easier to obtain.

With respect to the risk for venous thromboembolism (VTE), data show that progestin-only hormonal contraception is "generally safe" and has little or no risk. The risk for VTE in association with use of oral contraceptives is small in comparison with the risk during pregnancy and the postpartum period.

The committee notes that women still require pelvic and breast examinations and screening for cervical cancer and sexually transmitted infection; however, these are not necessary before beginning hormonal contraception, and the need for these should not prevent a woman from obtaining hormonal contraceptives OTC.

Research has shown that women can use self-screening tools to determine whether hormonal contraceptives are appropriate for them.

OTC access to hormonal contraceptives should not make them unaffordable, and a plan to improve access should deal with problems related to cost. OTC access to hormonal contraceptives "should be the ultimate goal"; however, pharmacist-provided contraception may be needed as an intermediate measure.

Use of depot medroxyprogesterone acetate (DMPA) requires that the woman be taught to self-administer subcutaneous injections. The authors point out, however, that individuals who use injections for other health conditions, such as diabetes and infertility, must also learn how to do this.

"The need to consistently obtain a prescription, get a refill approval, or schedule an appointment can lead to inconsistent use of a preferred birth control method," Isley said in the news release. "Making more methods available over the counter would lead to reliable, equitable access for more women. A move to over-the-counter status would complement, not replace, policies that ensure availability of the full range of contraceptive options and safeguard access to a robust network of qualified family planning providers."

ACOG. ACOG Committee Opinion No. 788. Published online September 24, 2019. Full text

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