By: Katie Cimmino, Pharm D. Candidate c/o 2015

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With the start of the New Year the French government is enacting a new law concerning contraceptives. Now girls between the ages of 15 to 18 will be able to obtain free birth control.  Not only will they have access to it, but the French government will provide the drugs free of parental notification.  The new laws are an attempt to reduce pregnancy in this age group. In addition the new regulations will hopefully reduce any ignorance and stigma around the topic.  With the old laws, teenagers did not have absolute anonymity and if they wanted to have the privacy to obtain birth control, the young women would have to pay for the visit in cash and not submit a claim to their insurance company.  Now the French government is promising to pay for all birth control, which will give all of their women citizens’ equal access to these types of drugs.²

France is not the only country to make new laws effecting women’s healthcare.  In the United States beginning in August 2012 most new and renewing health insurance plans must offer an assortment of women’s preventative services at no cost.^1,7  While many different services for women are now offered and covered, the only controversial topic is the issue of contraceptives.⁷  Although the government is mandating that insurance companies pay for birth control, they are taking into consideration religious views by allowing any religious organization that provides health insurance to refrain from offering contraceptive coverage only if these drugs are inconsistent with the organization’s original beliefs.^{1, 5}  However, the government accommodates people in that situation so that women who have those insurances still have access to care.¹

Now that insurance companies are directed to cover birth control, many individuals want to change how much access and autonomy people have with obtaining different contraceptives.  Currently the morning-after-pills, also known as Plan B, can be obtained without a prescription.  However, there are some restrictions; only people over the age of 16 can obtain Plan B without a prescription after they provide ID to a pharmacist.  The American Congress of Obstetricians and Gynecologists (ACOG) is recommending that all birth controls be sold completely over the counter, while the American Academy of Pediatrics has recommended that teen girls should obtain routine advanced prescription of the morning- after pill.⁶  The Food and Drug Administration is looking for ways to increase access of many medications, including oral contraceptives, to the general public.  For contraceptives, some ideas being thrown around are obtaining a one-time-prescription or even allowing the drug to be in an electronic kiosk that will be able to screen the patient through automated promps.⁴

All these new ideas and recommendations are being made to allow easier access to contraceptives.  Since Plan B is most effective when it is taken 24 hours after intercourse, these restrictions may provide some issues to those trying to obtain them.  Much like the reasoning behind the new law in France, supporters of moving the pill to OTC want to do so to avoid any unwanted questions or arguments that patients may receive while trying to purchase the product.  For instance, there are many cases where pharmacists refuse to sell the product to people.  Personal beliefs aside, Plan B is suppose to be available without a prescription to any male or female over the age of 16.⁶

Even though many people are supportive of allowing more and freer access to contraceptives, the task of completely moving these drugs OTC should not be considered lightly.  While contraceptives are relatively safe, there are still some risks attached to these drugs.  It has been shown that oral contraceptives can lead to an increased risk for blood clots and venous thromboembolism (VTE), a condition where a clot can travel to the lungs and cause serious complications including death.  According to the FDA, the newer birth control pills that contain the hormone drospirenone as oppose to estrogen and progestin have an ever greater risk for clots. The ACOG acknowledges these risks but still recommend to having easier access because the risk of VTE is lower compared to those who are pregnant or just had a child.  Approximately three to ten out of every 10,000 women will experience a VTE while on birth control.³  Given the possible serious side effects, concern should be raised about the accessibility to different contraceptives.

Besides the possible side effects profile being an issue, moving contraceptives to an OTC status would mean that women would not need a doctor to get a prescription.  Although people can self-screen for contraindications, many people are concerned with the potential serious risks if a physician is not consulted.  In addition, since women will no longer need to see a doctor, this raises concerns that women will miss out on other important health services including screening for sexual transmitted diseases and cancer.  While the ACOG recommends that women receive an annual check-up, the fact is a prescription ensures that a person will come in for the visit.³  Another concern is that the status of drugs like Plan B will change. Wendy Wright the vice president of that Catholic Family and Human Rights Institute states, “The reality is if it’s easier to obtain, then it becomes not ‘Plan B’ but ‘Plan A”.⁶

There are many different opinions on how contraceptives should be accessed and used in the United States.  While both sides make valid points, currently there appears to be no move to change anything other than having insurance companies cover the cost of contraceptives.  Over a year ago Health and Human Services Secretary Kathleen Sebelius decided to leave the age restrictions on Plan B.  It has been a year since that decision and even with the recommendations from ACOG the Obama administration has made no comment on if they plan to revisit the issue. ⁶

SOURCES:

1. Affordable Care Act Rules on Expanding Access to Preventive Services for Women. Healthcare.gov. http://www.healthcare.gov/news/factsheets/2011/08/womensprevention08012011a.html. July 31, 2012. Accessed on Dec 29, 2012
2. Beardsley E. In France, Free Birth Control For Girls At Age 15. NPR. http://www.npr.org/2012/12/18/167253336/in-france-free-birth-control-for-girls-at-age-15. Dec 18, 2012. Accessed Dec 26, 2012
3. Jaslow R. OB/GYN society says birth control pill should be sold over-the-counter. CBS. http://www.cbsnews.com/8301-204_162-57552743/ob-gyn-society-says-birth-control-pill-should-be-sold-over-the-counter/.  Nov 20, 2012. Accessed Dec 29, 2012.
4. Quijano E. Doctors call for birth control to be sold over the counter. CBS. http://www.cbsnews.com/8301-18563_162-57552835/doctors-call-for-birth-control-to-be-sold-over-the-counter/. Nov 20, 2012. Accessed Dec 29, 2012.
5. Rovner J. Feds Order Insurers To Cover Birth Control Free Of Charge To Women. NPR. http://www.npr.org/blogs/health/2011/08/01/138893475/feds-order-insurers-to-cover-birth-control-free-of-charge-to-women. August 01, 2011. Accessed Dec 28, 2012.
6. Rovner J. Post-Election, ‘Morning After’ Pill Advocates Want Age Rules Revisited. NPR. http://www.npr.org/blogs/health/2012/12/07/166694221/post-election-morning-after-pill-advocates-want-age-rules-revisited. Dec 07, 2012. Accessed Dec 28, 2012.
7. Rovner J. Under Health Law, ‘No-Cost’ Birth Control Starts Today. NPR. http://www.npr.org/blogs/health/2012/08/02/157674061/under-health-law-no-cost-birth-control-starts-today. August 01, 2012. Accessed Dec 28, 2012.

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