The 15 Questions
If you answer “yes” to any of these questions, talk with a health care provider before using the pill:
1. Are you a smoker age 35 or older?
2. Do you think you might be pregnant?
3. Have you had a baby in the past 3 weeks?
4. Are you currently breastfeeding and is your baby less than 6 months old?
5. Do you have high blood pressure?
6. Have you had a heart attack or stroke?
7. Do you have heart disease?
8. Have you had a blood clot (thrombosis) in your lung or in your leg (NOT just varicose veins)?
9. Do you have diabetes?
10. Do you have migraine headaches?
11. Do you have liver disease or have you had liver cancer?
12. Do you have gall bladder disease?
13. Have you had breast cancer?
14. Do you take medicine for high cholesterol?
15. Do you take medicine for seizures or tuberculosis (TB)?
A nationwide survey of reproductive-age women in the U.S. found that over two-thirds (68%) would buy contraceptives from a pharmacist and skip the doctor’s appointment. Women with lower incomes and women without health insurance were particularly interested in this option. Clearly, getting to and paying for clinic visits can make accessing prescription-only pills more hassle than it’s worth for some women. The majority of women surveyed agreed that the pill should be available without a prescription if a pharmacist would help women decide whether it was safe for them.
Women in other countries have been buying the pill OTC from pharmacies or community distribution centers for decades. So, are they more likely than women who get the pill by prescription to use it when it’s not safe for them? One study compared women in Mexico who got the pill from a clinic versus those who got it from a pharmacy and found no difference between the two groups—a small percentage of women in both groups (2%) shouldn’t have been using the pill. That suggests going to a clinic doesn’t guarantee that women are screened for health conditions before getting the pill.
And screening seems to be skipped in the U.S., too. A national study showed that 6% of U.S. women who use the pill probably shouldn’t. In this study, the majority of women who shouldn’t have been using the pill were over 35 and smoked heavily, or had a history of breast, cervical, or uterine cancer. Ironically, selling the pill behind-the-counter with pharmacists trained to screen women for safe pill use could ensure that fewer women slip through the screening cracks.
If this is such a great idea, why hasn’t it happened yet?
There is one potential downside to selling the pill OTC. Some women now have access to free or low cost prescription pills via Medicaid and private health insurance. Health insurance doesn’t typically cover OTC drugs like ibuprofen and cough syrup. If the pill were sold OTC, women now covered by Medicaid—who most need affordable methods of birth control—could be faced with higher prices. But there are several ways to address this problem:
- In some states, Medicaid covers existing OTC methods like condoms, and this coverage could be expanded to OTC pills.
- Not all brands of the pill would make the switch to being sold OTC at once, and it’s likely that at least some of the prescription-only brands would still be covered by Medicaid and private health insurance.
There is another potential downside that some people talk about, but it’s actually a red herring. The argument is that the pill should stay prescription-only because it reinforces yearly Pap tests and pelvic exams for women. The truth is that neither of these tests is required to use the pill. As Dr. David Grimes wrote in 1995, “women should not have contraception held hostage because of unrelated screening tests.” Despite that, many health care providers still require the tests before prescribing the pill, and the majority aren’t using the new national guidelines that call for less frequent Pap tests. The final nail in the coffin of this argument is that there is no evidence that women who use OTC birth control stop going to clinics or doctors for care.