The risks associated with hormonal contraception are lower than the risk of pregnancy itself and comparable to those of other over-the-counter drugs
As the U.S. Supreme Court prepares to announce a decision that could severely restrict abortion rights in the country, access to contraception has taken on renewed importance. Birth control pills and other hormonal contraceptives—including patches, injections and vaginal rings—have been fully covered by almost all health insurance plans since the Affordable Care Act designated them as preventive health care.
Hormonal contraceptives meet these requirements. First, the need to prevent pregnancy is clearly self-identifiable. “It’s very easy for someone to understand that they could potentially get pregnant and that they don’t want to be,” says physician Krishna Upadhya, an adolescent medicine expert and vice president of quality care and health equity at Planned Parenthood Federation of America. “Most people who use contraception can figure that out on their own.
“There [are] a lot of medications available over the counter that are much higher risk than birth control pills,” says Sally Rafie, a pharmacist at the University of California, San Diego, Health. Common painkillers such as aspirin and ibuprofen may have serious side effects, including gastrointestinal bleeding, and acetaminophen has been associated with acute liver failure.
During a consultation, the clinician will also explain how to use the contraceptive, which is a pretty straightforward instruction. “I think it’s actually a bit insulting to women to say that they need this sort of paternalistic figure to explain to them that they need to take one pill every day at the same time,” says Anna Glasier, an honorary professor at the University of Edinburgh’s department of obstetrics and gynecology and an expert in reproductive health and contraception.
Regulatory Hurdles If birth control pills check all the requirements, why are they still not available over the counter? A potential reason is that most medicines that can be obtained without a prescription in countries such as the U.S. and the U.K. are for short-term conditions. “There’s a leap to go from aspirin for headache to an oral contraceptive pill, which you expect women to take for a large chunk of their reproductive lives,” Glasier says.
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