Providers back access for EC, but not for OCs
While medical and reproductive rights groups have petitioned the Food and Drug Administration to make emergency contraception (EC) available over the counter (OTC),1 many clinicians are less than enthusiastic when it comes to such availability for oral contraceptives (OCs). Why?
"I am not in favor of making OCs over the counter, because even with instruction, I see many women taking pills incorrectly, resulting in side effects, as well as pregnancy," states Deborah Wright, OGNP, a nurse practitioner at the Marsh-field Clinic, a private, multispecialty group practice in Eau Claire, WI. "Also by having to come in, they are more likely to receive STD [sexually transmitted disease] screening and education."
She says she will prescribe pills without an exam if the exam is the barrier to taking contraception.
"Education related to correct use is the biggest stumbling block related to the OTC issue of OCs for me," observes Ruth Napolitan, RNC, BSN, WHNP, a nurse practitioner at the St. Clair County Health Department in Port Huron, MI.
While OCs are not going to cause severe health problems in the majority of women, the side effects related to initial use can be more than troublesome, Napolitan says.
"Many women who visit our clinic have stopped pills and state they can’t use them, [but] after our interview, we can usually dispel the reason of can’t use’ as a side effect or misuse," she says.
The clinician’s ability to counsel and test women for STDs is "paramount" for the fertility of many women, who would otherwise not seek medical care, Napolitan states. "I tell our clients all the time that [prescription] for contraception is a form of medical blackmail," she notes. "How many women would make an annual appointment for a pelvic exam if they didn’t have to?"
Most participants in Contraceptive Technology Update’s 2003 Contraception Survey voted "thumbs down" for OTC access to birth control pills. Almost 69% indicated they were not in favor in such a move, which reflected an increase from 2002’s 62.9% figures.
"I take a public health, preventive medicine approach to this issue: I am convinced that unplanned pregnancy is a major public health issue and that OCs are safe for the vast majority of women," states Christine Peterson, MD, director of gynecology in the department of student health at the Charlottesville-based University of Virginia. "Yet I also believe that what we have to offer by way of the screening and education that should take place during an OC-related visit addresses additional, equally important, long-term health outcomes for virtually all women."
Such screening should not be limited to sexual activity-related issues, but also to nutrition, exercise, safety, stress, substance use, and other lifestyle matters, she comments.
"I do not think women would be well served if their contraceptive needs were separated from their overall health needs," states Peterson. "Rather than making OCs available over the counter, we should work to make superb comprehensive women’s health care accessible and affordable for all women."
1. Foubister V. OTC emergency contraceptives pushed, but not imminent. AMNews; March 5, 2001. Accessed at http://www.ama-assn.org/amednews/2001/03/05/prsc0305.htm.