The Food and Drug Administration recently approved another over-the-counter emergency contraceptive pill called EContra EZ. It’s one of more than a dozen “morning after” pharmaceutical contraceptives that have been made available, without a prescription, to be purchased by women of any age in pharmacies, at clinics or even online.

It’s another hormone pill that can be taken to prevent pregnancy after sex, similar to others already on the market. Birth control pills are hormones too — in fact, the same ones as the emergency pills, just in a more consistent dose.

But while anyone can purchase emergency contraception pills, why do monthly birth control pills require a prescription? Has the FDA created a double standard here?


Birth control pills, like emergency contraceptives, are hormone pills, just with a consistently delivered dose.

Parenting Patch via Wikimedia Commons

This debate is not a new one. The American College of Obstetricians and Gynecologists agree that it would be appropriate to allow monthly birth control pills to be purchased without a prescription. It would provide a convenient way for women to access birth control and avoid unintended pregnancy.

So what’s the hold up?

Last summer, the U.S. Supreme Court ruled in the “Hobby Lobby” case concerning the Affordable Care Act’s mandatory coverage requirement for prescription birth control by insurance companies. The court said closely held businesses can’t be compelled to comply with provisions of the law that violate their religious preferences. Some businesses and universities subsequently sued, stating they also should not be forced to cover birth control means that go against their religious beliefs.

But if birth control pills were available over the counter, or OTC, with no prescription, at a cost reasonable enough for women to afford, why bother with mandated coverage at all? Why not put the choice into the hands of women to decide their own reproductive future?

As it stands now, studies have shown that one in two pregnancies is unintended. Of these, 43 percent will end in abortion. Given all the controversies regarding abortion clinics, and the ever-present threat of worsening restrictions on access, doesn’t it make sense to have better options for birth control to avoid unintended pregnancies entirely?

Studies have shown women are more likely to continue on birth control if they have easy access, multiple packs available at a time and can easily take their medication without having to see a doctor to get prescription refills.

Anyone can purchase emergency contraception pills, so why do monthly birth control pills require a prescription?

In addition, there is no mandatory testing needed to take birth control pills. Women can easily determine if they are a candidate for the pills by completing a quick questionnaire. As long as they don’t smoke, don’t have high blood pressure, don’t have a history of blood clots and are not currently pregnant, they can use birth control pills with minimal risks.

Granted, testing for sexually transmitted infections is prudent, as is cervical cancer screening. But these should not be a barrier to giving women the access to birth control. It’s like requiring someone to check their cholesterol before they can treat their asthma.

Yearly PAP smears are not even indicated, according to the U.S. Preventative Services Task Force. One every three years is considered the appropriate interval for women with no symptoms. Add to that the discovery of the connection between cervical cancer and the human papilloma virus, or HPV. With the use of the HPV vaccine, the chances of developing cervical cancer are even lower. All this leads to a lack of medical necessity to see a doctor just for birth control pills.

Cost may be a barrier, given the fact that if the ACA stands, all new health plans are required to cover all forms of FDA-approved birth control, and selling these over the counter might cost more than going to see the doctor. But having access may cost less in the long run. Taking time off to see the doctor, paying any visit co-pays and finding childcare all represent hidden costs that can add up quickly.

Most women pay $15 to $20 per pack of birth control pills. Insurance covers the rest of the cost. But given the availability of generic birth control pills, competition may result in an even lower cost.

For those who are still uninsured, OTC availability would also ensure continued access without restrictions. Job changes, loss of coverage, all of these life events can result in temporarily being without insurance, but should that mean being without birth control, too?

Other countries have offered birth control pills over the counter, such as Thailand, Mexico, China, India and many more. There have not been any worldwide reports of serious medical consequences as a result of providing greater access.

It just makes sense that after all this time the FDA should look seriously at making these hormonal forms of contraception easily accessible to all women, regardless of age, and without a prescription. Plenty of other previously prescribed medication has gone OTC — Prilosec, Nexium, Allegra, Pepcid, Claritin, Nasonex, Tagamet and many, many more. It’s time estrogen and progesterone were made available, too.

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