Over-The-Counter Birth Control Pills Would Be Safe For Teens, Researchers Say

Mar 16, 2017
Originally published on March 16, 2017 9:35 pm

Nearly five years ago, the nation's leading group of obstetricians and gynecologists issued a policy statement saying the time had come for oral contraception to be available without a prescription.

We wrote about it and everything.

In the intervening years, some states have changed their laws. California authorized pharmacists to distribute most types of hormonal birth control. Oregon passed a similar law covering both pills and patches.

But neither law changed the status of birth control pills from prescription to over-the-counter. Only the Food and Drug Administration can do that. And in Oregon's case, the law does not apply to people of all ages. People under 18 are still required to get their first contraceptive prescription from a doctor.

But researchers say there is no evidence that adolescents are at greater risk from birth control pills than adult women.

A review of oral contraceptive research presents the most comprehensive evidence yet that, as the authors state, "There is no scientific rationale for limiting access to a future over-the-counter oral contraceptive product by age."

"There is a growing body of evidence that the safety risks are low and benefits are large," says Krishna Upadhya, an assistant professor of pediatrics at the Johns Hopkins University School of Medicine and the lead author of the review, which was published this week in the Journal of Adolescent Health.

In fact, she says, some of the potential negative side effects of oral contraception are less likely in younger people. For example, birth control pills that contain both estrogen and progestin come with an increased risk of a type of blood clot called a venous thromboembolism, but that risk is lower in teenagers than in older women.

As a result, the pill is "potentially safer the younger you are," says Upadhya.

The review also found no evidence that increased access to birth control would lead teenagers to have more sex or engage in riskier sex, a concern voiced by some critics of oral contraception access.

Teen pregnancy rates are way down in the U.S., and teenagers are using contraceptives more often. Between 2007 and 2013, the number of 15 to 19-year-olds giving birth dropped 36 percent. The abortion rate has also fallen.

"These pills are safe and effective and we should reduce barriers to using them. And teens should benefit just as adult women do," Upadhya says.

One reason more girls and women are using birth control is that the Affordable Care Act requires insurers to fully cover prescribed contraception. That includes the pill, implanted hormonal birth control and intrauterine devices.

So what would happen if oral contraception no longer required a prescription? The Affordable Care Act does not require insurance companies to cover over-the-counter birth control like condoms, sponges and spermicide. If hormonal birth control was available over the counter, it too would fall outside the law's coverage mandate.

Sen. Patty Murray, D-Wash., introduced a bill in 2015 that would automatically amend the language of the ACA to require insurance companies to pay for any contraceptive approved for over-the-counter sale by the FDA. Sen. Kelly Ayotte, R-N.H., introduced a separate bill that proposed giving priority to any request from a birth control manufacturer asking the FDA to consider over-the-counter status for its drug, as long as it only applied to women over 18. Neither bill has made it out of committee.

The current Republican proposal to repeal part of the ACA would not affect mandatory coverage for prescription contraceptives, as we have reported.

The American College of Obstetricians and Gynecologists has issued multiple statements in the past year stressing that, while the group still supports making oral contraception available without a prescription to teens as well as adults, such a change is not enough on its own for making birth control available to everyone who needs it.

"Over-the-counter contraception is not an acceptable substitute for the ACA contraceptive coverage mandate," the group wrote in a statement issued in February.

Of course, there is currently no version of the pill has been approved by the FDA for use without a prescription.

An FDA spokesperson said the agency "generally cannot confirm or deny the existence of a pending product application," so it is difficult to know whether any birth control manufacturers have requested that that their products be considered for over-the-counter status.

If a manufacturer did apply, the FDA would consider many of the same things Upadhya and her team looked at, including safety and efficacy data and potential age restrictions.

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AUDIE CORNISH, HOST:

A new study suggests that birth control pills be made available nationwide over the counter and that teenagers could safely and effectively use oral contraceptives without a prescription. The study builds on more than a decade of medical research. NPR's Rebecca Hersher reports.

REBECCA HERSHER, BYLINE: Fewer American women are getting pregnant without meaning to these days. Lucia DiVenere is with the American College of Obstetricians and Gynecologists.

LUCIA DIVENERE: Right now we are at a 30-year low in unintended pregnancies. We have the lowest rate of abortion since Roe and the lowest rate of teen pregnancies.

HERSHER: Access to contraceptives is a big part of that, and nearly five years ago, DiVenere's organization announced they believed the time had come to make oral contraceptives even more easily available with over-the-counter sales. Since then, California and Oregon have passed laws allowing pharmacists to distribute the pill. In Oregon, the law applies differently to adults and to adolescents. If you're under 18, you still need a prescription to get the pill for the first time. A new study suggests the science doesn't back that up.

KRISHNA UPADHY: Birth control pills are generally safer in teenagers than in older women because teenagers tend to have fewer other health problems in general compared to older women.

HERSHER: Krishna Upadhy specializes in adolescent medicine at Johns Hopkins. She led the study which reviewed dozens of research papers and regulatory documents and says there are very few risk factors for adolescents taking the pill. And unlike some over-the-counter meds, you can't overdose on the pill, she says. In fact...

UPADHY: The most concerning thing that would happen is if someone doesn't take it correctly - that they could become pregnant when they don't want to.

HERSHER: One concern that critics have raised is that increased access to birth control could lead teenagers to have more sex or that taking the pill could lead them to stop using condoms, risking sexually transmitted diseases. Upadhy says there's no evidence of that in her study.

UPADHY: Teens and other women decide to have sex based on a number of factors, and access to contraception doesn't increase their risk of having more sex or riskier sex.

HERSHER: Of course the entire issue is still hypothetical. The FDA has not approved any birth control pills for sale over the counter and cannot confirm or deny whether it's currently considering any applications to do so. Rebecca Hersher, NPR News.

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