The Birth Control Pill Available Over-the-Counter

Photo by nateOne

In the UK, that is.

[Did you really, even for a moment, think that US politicians would put the health of women of repro age above the interests of assorted religionists by allowing women to make their own medical decisions? Silly, silly you!]

So, back to London:

Pilot schemes to enable pharmacists to give women the Pill without the need for a GP prescription will go ahead next year.

Two London primary care trusts (PCTs) have received cash to act as pilot sites to see if the scheme is suitable for rolling out across England.

Women will be able to obtain the oral contraceptive after an interview with a qualified pharmacist.

If the pilots are successful, the Pill could be put on the same footing as the morning-after pill, which is already available at pharmacies without direct authorisation from a doctor.

Health minister Lord Darzi insisted last year that "robust" standards would be put in place to ensure that staff were up to the job.

...

A spokeswoman for the Department of Health said: "We will be receiving quarterly updates from SHAs on improving access to contraceptive services and will be working with them to assess the success of the schemes in their areas."

She added: "Any woman who receives contraception from a pharmacy without a prescription can still expect a full consultation with a health professional such as pharmacist or a nurse. We want to improve women's access to contraception and help reduce the number of unintended pregnancies without undermining patient safety."

Needless to say, I think this is a very good idea. Start out small, evaluate as you go along, work out the inevitable kinks and tweak as needed, and see if the intervention has the desired effect. You know, reality-based health care.

If you recall, a study that looked at the ability of US women to self-screen for contraindications to Pill use concluded that:

The percentage of women who incorrectly self-identified as not contraindicated (6.7%) is similar to the proportion of actual pill users in the US who are contraindicated for use (6%). Over-the-counter provision of COCs [combination Pill] would likely be safe, especially for younger women and if independent blood pressure screening were encouraged.

The sad part is that it's hard to imagine a scenario in this country where science and the female patients' best medical interest would be considered legitimate reasons to make the Pill available over-the-counter.

OTC Birth Control Pills In The UK

UK health minister Lord Darzi has introduced a Pilot Scheme, due to start in 2008, that would allow women to purchase the Pill from pharmacies without a doctor's prescription.

Sort of.

If you look at the fine print, it appears this initiative isn't so much about making the Pill OTC as it is about shifting the gatekeeper job from doctors to pharmacists. According to the BBC (emphasis mine):

A spokesperson for the Department of Health said pharmacies could play an increased role in the provision of contraception and other sexual health services, because of their accessibility and convenient opening hours.

There is no firm commitment to roll out the scheme nationally but any women receiving the contraceptive pill from a pharmacist would have to go through the same process if they were to receive it through a prescription issued by a GP, they said.

"We will work with the pharmacy profession to ensure robust standard setting and appropriate training to ensure pharmacists are competent to safely provide this service."

Having OTC access to the Pill means you walk into a pharmacy and are able to buy the Pill, no questions asked.

Having to "go through the same process [as] if [you] were to receive it through a prescription issued by a GP" means you have to go over your gyn history (and, maybe, undergo a physical exam) right there at the pharmacy counter. The middle of a store is not the proper place to have a medical exam. [Sure, the store could set aside a private area to conduct screenings for Pill eligibility, but that would defeat the purpose of the undertaking. If you're still required to undergo an exam to obtain the Pill, there's no advantage to having the screening done by a stranger, in a store vs. by your own Ob/Gyn in his/her office.]

True OTC access to the Pill means you trust that women are capable of making their own medical decisions. And since this is science we're talking about, we can look at the evidence to support the proposition that women have, you know, the ability to make decisions that are in their best interest.

For example, when researchers looked at the ability of women to self-screen for contraindications to Pill use, they found that 6.7% of women incorrectly thought they could use the Pill when, in fact, they couldn't. Compare that with the ~6% of Pill users who, despite undergoing screening by an MD, are still contraindicated for use. There's basically no difference.

So, the UK's Pilot Scheme is somewhat of a first step, but it's not yet clear if it will lead to OTC Pill availability. Meanwhile, here in the US, we're still proudly and prudently protecting women from themselves, only allowing them to obtain the Pill with a prescription.