Should the contraceptive pill be available without prescription? Yes

My perspective as an American- allow hormonal contraception available
without a prescription. American women already have one of the highest of
rates of unintended pregnancy and teen pregnancy among developed nations,
and the recent Health and Human Services (HHS) “conscience” regulation,
which I hope will eventually be overturned, allows healthcare providers
increased opportunities to refuse to provide contraceptives and accurate
health information to women (so much for the importance of the patient-
clinician relationship).

Hormonal contraception meets the Food & Drug Administration (FDA)
standards for non-prescription status: clinicians are unnecessary,
potential for misappropriate use is low, consumers can easily identify
indications and assess contraindications, directions for use are
uncomplicated, and the benefits outweighs the risks. Yet not only is
hormonal contraception still not available without a prescription, many
clinicians force unnecessary medical examinations before allowing women
access, and now have the right to outright withhold prescriptions and even
give patients inaccurate medical information, if they so choose.

Hormonal contraception has been proven to be safe (the health risks
of pregnancy are far greater than the risks of using contraception).
Pills can bring about a stroke or heart attack, as can other
nonprescription drugs, but this is extremely rare. Acetaminophen,
available without a prescription, is much more likely to cause liver
damage than pills are likely to cause stroke or heart attack. Requiring a
trip to the doctor's office for access to contraception creates an
unnecessary obstacle for women, thus reduces contraception access, puts
women at risk, and perpetuates the idea that either 1.birth control is
dangerous or 2.women aren’t competent enough to assess their needs and
make informed choices.

Not only is hormonal contraception being denied to women without
prescriptions, women are often forced to have unnecessary physical
examinations and tests in order to receive their prescriptions. The World
Health Organization’s medical eligibility criteria for hormonal
contraception doesn’t require breast and pelvic examinations, yet many
clinicians in the United States require these exams before allowing
patients their prescriptions. Regular physicals, including breast exams,
pelvic exams, and pap smears, are recommended in order to maintain good
health, but they do not provide medical information regarding hormonal
contraceptives.

One concern is that women will stop going for annual exams and pap
tests if health centers do not have a policy of withholding contraception.
According to that logic, no one should be allowed any medications unless
they have all recommended physical exams. Over 50 and haven’t had a
colonoscopy? Sorry, no flu shot for you. Since pelvic exams and a pap
smears are medically unnecessary in order to prescribe birth control, a
better standard of care would be for health care providers to recommend
that their patients have physicals, but ultimately respect their patients’
decisions.

There are, of course, women who want to have the examinations and
give their consent voluntarily, but telling women that examinations and
pap tests are mandatory to receive birth control is a form of coercion,
not informed consent. Informed and voluntary decision making is
instrumental to patients’ rights. Don’t patients, including women of child
-bearing age, have the right to autonomy and bodily integrity? Withholding
contraception from a woman if she does not wish to submit to unnecessary
physical exams and tests is nothing short of provider bias and
paternalism. This is medically unethical.

Another concern is that women might not understand how to take their
contraception or they might choose the wrong kind if they don’t first
consult with a physician. Medical information is readily accessible these
days and women are capable of making sophisticated choices about their
health. According to research conducted by Family Health International and
published in the journal Studies in Family Planning, “over-the-counter
provision of oral contraceptives by pharmacists is a safe, effective, and
practical way to distribute this popular contraceptive method in Jamaica.”
Are American (or British) women any less capable of making informed
decisions about their health than Jamaican women? Let’s let women decide
what contraception they need, especially since we can’t feel confident
that we are getting accurate information from our health care providers
now anyway.

Lift the prescription status of hormonal contraception, allow women
easier access to contraception, and the right to decide for themselves if
they wish to have medical examinations. Not doing so is unethical,
violating to women, and counterproductive.

Competing interests:
None declared