Selling Birth Control Over the Counter Might Actually be Worse for Women

The American College of Obstetricians and Gynecologists (ACOG) is making a push for hormonal birth control pills to be sold over the counter, without a prescription. At first glance, this seems like a great way to increase access and encourage more women to take the pill. But it’s more complicated than that – there could be downsides, as well.

First, the benefits: Obviously, buying birth control over the counter along with Tylenol and cold medicine would simplify the process. Women wouldn’t have to deal with going to the doctor first, which would save time and money. And for uninsured women, it would dramatically decrease the cost, when the price of a visit to the doctor is included. For similar reasons, use of the patch and nicotine gum to quit smoking nearly doubled when they became available over the counter, according to the Center for Disease Control and Prevention.

There are important reasons that doctors monitor birth control use, such as increased risk of blood clots and the differences between the many brands of oral contraceptives, , some better for certain women than others. But, the ACOG suggests, these issues could be addressed with a simple questionnaire and the vigilance of women taking the pill.

But an important potential drawback that needs to be addressed is the fact that health insurance doesn’t cover over-the-counter medication. There’s already a struggle to get some insurance companies and employers to cover the cost of birth control when it’s prescribed by a doctor along with other, equally necessary medications. So if it were sold over the counter, the burden of paying for birth control would lie entirely with the patient, with no chance of assistance from either private or government insurance.

The goal of the ACOG plan is a great one: Make birth control easily accessible to more women. But without serious consideration of the cost, providing birth control over the counter could end up having the opposite effect. Sure, it would be right there in the drug store for anyone to buy, but low income women, who often face the most obstacles in obtaining birth control may not be able to afford it, which would make its theoretical availability irrelevant.

I’m intrigued by the potential good over the counter birth control could do, but I’m going to reserve my enthusiasm for after I see some data on the effects on prices. If the pill was to be available for prices comparable to the over-the-counter pain killers and sleep aids next to which it would be sold, I would start campaigning for the change right now. But if costs remain at their prohibitive levels with over the counter sales, I’d say we should put that idea on hold for now until cheaper options are available, and focus instead on getting prescription birth control covered by insurance.