Women using the contraceptive pill currently require a prescription from a doctor and to return once a year to renew it. But recent research suggests the relative safety of this oral contraceptive means we should consider making it more freely available.
For many women the current model can involve a fair bit of effort – significant forward planning to get an appointment before the prescription runs out, an often lengthy wait to see the doctor and a hefty consultation fee – for a few minutes in the doctor’s surgery to have a prescription renewed.
A recent research article has stimulated debate about the value of providing women with oral contraceptives, without having to go through all this.
But why shouldn’t women be in charge of their own contraception if it’s safe for them to do so? Let’s consider some of the arguments for and against providing oral contraceptive pills over the counter.
Why getting prescriptions for the pill are a good idea – access
The requirement to keep returning to the doctor for repeat prescriptions can be expensive, and time consuming.
For young women, those who are socioeconomically disadvantaged, and others who find it difficult to access the health system, these barriers can be considerable. Both doctors and patients can be embarrassed about discussing sexual matters.
Without easy access to effective hormonal contraception women may not use any birth control at all, or they may rely on less effective methods (such as condoms or the withdrawal method).
And anyway, the emergency contraceptive pill is already available over the counter at pharmacies in Australia, so why not include other oral contraceptives as well?
In the United States, up to 30% of women who don’t currently use contraception, or use a less effective method say they would probably start taking the pill if they could get it without a prescription.
For some women, the doctor’s visit is a significant barrier to using hormonal contraception, so making it available in pharmacies will lead to more, and more effective, contraceptive use, and fewer unintended pregnancies.
Why prescriptions for the pill are a bad idea – health risks
Taking combined oral contraceptive pills has potentially serious health consequences.
The most dangerous of these is blood clots. Although rare, the sudden death of a healthy young woman because of a blood clot is shocking. Sadly this can happen even with the current requirement for a doctor’s prescription.
Although many doctors thoroughly screen women and inform them about oral contraceptive use, the quality of consultations is variable. Reasons why a woman shouldn’t take the pill can be missed, or simply be unknown, particularly for young women.
Thorough Medical Eligibility Criteria have been developed to minimise the risk of serious adverse events from using oral contraceptives. Women with hypertension, migraines with aura, a history of venous thromboembolism, or smokers at age 35 years or older, for instance, are at higher risk of adverse events and should not take the combined oral contraceptive pill.
Without proper screening by a doctor, there’s a risk that factors that should stop women from taking the pill will be missed.