- The Washington Times - Tuesday, November 20, 2012

The nation’s largest organization of women’s health professionals said Tuesday that it now supports allowing over-the-counter sales of all oral contraceptives.

The American College of Obstetricians and Gynecologists (ACOG) said in a policy statement released Tuesday evening that making birth control available for women without a doctor’s prescription would help decrease the rate of unplanned pregnancies in the United States, which has remained stubbornly high in recent decades.

Given the group’s prestige and influence, the statement — a step beyond ACOG’s recommendation last month to make emergency contraceptives readily available — is considered a significant boost for reproductive rights advocates in easing rules that require women to obtain doctor’s prescriptions to purchase oral contraceptives.

Critics warn that the ACOG shift raises health and safety issues and could undermine parental oversight and authority.

With an estimated 50 percent of all U.S. pregnancies unplanned, doctors who backed the move said the current more restrictive access rules are fueling a larger health care problem for the country.

“It’s supported by a great deal of medical evidence that the pill is safe enough for over-the-counter sale,” said Dr. Daniel Grossman, an OB-GYN and vice president of research at Cambridge, Mass.-based Ibis Reproductive Health. “Women are able to use simple checklists to determine if they might have conditions that are dangerous, and some studies show women stay on the pill longer when they have access to over-the-counter availability. It’s a great move.”

“It’s unfortunate that in this country where we have all these contraceptive methods available, unintended pregnancy is still a major public health problem,” North Carolina OB-GYN Dr. Kavita Nanda, a co-author of the report, told The Associated Press in an interview.

But ACOG member Donna Harrison, an OB-GYN, called the decision a “step back for women’s health.”

“Birth control pills are powerful hormones and those powerful hormones can cause problems like blood clots and strokes and, in some cases, increased risk of heart attack,” said Dr. Harrison, a leading member of a group of physicians within ACOG who are pro-life. “This is not a contraceptive issue as much as it is a women’s health and safety issue.”

Hurdles ahead

Although ACOG’s findings carry weight with government groups such as the Food and Drug Administration and the Department of Health and Human Services, there are still hurdles to overcome before birth control pills can be stocked next to condoms in American pharmacies.

Under current law, all forms of oral contraception require prescriptions except for the Plan B One-Step or the “morning-after” pill — and even that calls for a doctor’s signature for purchasers younger than 17.

Analysts predicted that the move by the physicians group would not change the availability of oral contraceptives overnight.

FDA rules require drug companies to conduct studies proving that their offerings are safe for over-the-counter use, and must provide clear guidelines for women on potential side effects and the circumstances under which they should not take the pill.

Even so, Janice Shaw Crouse of Concerned Women for America called the ACOG recommendation “reckless,” saying the use of birth control by girls without a doctor’s supervision could prove dangerous.

“Any guy who is older and taking advantage of a younger girl could put her on a pill,” Ms. Crouse said. Because birth control doesn’t prevent sexually transmitted diseases, she added, a girl not under a doctor’s care might contract a disease without knowing it.

“We are in an era where people are supposed to care about women, yet we’re being very cavalier about women’s health,” she said.

But ACOG officials said women can effectively protect themselves from side effects of oral contraceptives by “self-screening” using checklists.

“I think there is a lot of value in preventing unplanned pregnancy in the first instance,” said Jon O’Brien, president of Catholics for Choice. “And I think making emergency contraception available to women is a positive step forward for all of us.”

Pro-life pushback

According to the report, 50 percent of pregnancies in the United States are unplanned. After weighing the risks and benefits, ACOG said, members found that making oral contraceptives available over the counter would be the best move for women’s health.

But since abortifacients — which are designed to cause a newly impregnated egg to miscarry — are among the medications in question, Dr. Harrison said, ACOG is doing its member doctors a disservice by failing to determine whether or not most are pro-choice or pro-life.

She serves as research director for one of the organization’s largest interest groups — the American Association of Pro-Life Obstetricians and Gynecologists.

ACOG has never polled its membership on [their] position on abortion, and yet they throw the whole weight of the membership into pro-abortion activism.”

But Mr. O’Brien called the move “a very common-sense, practical recommendation by doctors.”

“It makes no difference if you’re a Democrat or Republican — we should see it from a woman’s point of view and depoliticize contraception,” he said.

The ACOG recommendation didn’t address teen use of contraception. Despite protests from reproductive health specialists, current U.S. policy requires a girl younger than 17 to produce a prescription for the morning-after pill, meaning pharmacists must check customers’ ages. Regular birth control pills presumably would be treated the same way.

Prescription-only oral contraceptives have long been the rule in the U.S., Canada, Western Europe, Australia and a few other places, but many countries don’t require prescriptions.

This article is based in part on wire service reports.