Birth control pills are so safe and important to women that they should be sold on drugstore shelves, without a doctor's prescription, says a group representing many of the doctors who prescribe them.
The American College of Obstetricians and Gynecologists (ACOG) takes the perhaps-surprising stance in an opinion released today and published in the December issue of Obstetrics & Gynecology.
The group says its aim is to reduce unintended pregnancies. And it says it does not expect to lose patients if the switch ever occurs - something that experts agree will not happen quickly.
"Oral contraceptives are very safe, and data show women can make these decisions for themselves," says Kavita Nanda, a physician with FHI 360 (formerly known as Family Health International) in Durham, N.C., and a member of the committee that wrote the opinion.
Many reproductive health advocates are "pleasantly surprised and excited" that a major physicians group is endorsing an idea some have been pushing for years, says Kirsten Moore, president of the non-profit Reproductive Health Technologies Project, Washington, D.C.
Some doctors have expressed reservations about the idea in the past, citing concerns that women might skip Pap smears and other care if they don't need to go to doctors for reliable birth control. Others have expressed safety concerns.
"I am mystified as to why ACOG would make a recommendation like this, because birth control pills do have some significant side effects," says Donna Harrison, a physician in Berrien Center, Mich., and director of policy and research at the American Association of Pro-life Obstetricians and Gynecologists.
The new opinion says birth control pills have some risks, but so do aspirin and acetaminophen, which are sold over the counter.
Pills that contain both estrogen and progestin, which are the most popular kind, can raise the risk of blood clots and stroke. Yet those risks are much higher for women who get pregnant, Nanda says. And studies show women can use self-administered questionnaires about their health and habits to determine if the pills are safe enough for them, she says. The checklists could be on labels or on posters or computer screens at drugstores.
The committee also considered the risk that women getting pills over the counter might stop coming to doctors for other care. Studies suggest that won't happen, the group says. In one study, U.S. women who went to Mexico to buy birth control pills without prescriptions were nearly as likely as those who got prescriptions to stay up to date with Pap smears, breast exams and screening for sexually transmitted diseases.
Still, the doctors' group and other advocates say they are concerned about whether insurers will pay for non-prescription pills. The Affordable Care Act says insurers must pay for methods approved by the Food and Drug Administration (FDA), but it's not yet clear if nonprescription methods are covered, Moore says.
For now, the idea an over-the-counter birth control pill in the USA is just that: A change would require a drug company to ask for and receive FDA approval. Daniel Grossman, a San Francisco physician who is a leading advocate for over-the-counter birth control, says he knows of no pharmaceutical company even starting the studies that would be required for FDA review.
Grossman, vice president for research at Ibis Reproductive Health, does say the new support from doctors could encourage companies to try. He says it's likely that the first pills considered would be so-called "mini-pills" that use progestin but not estrogen and are safe for larger groups of women.
History suggests the road to approval could be rocky: Emergency contraceptive pills - Plan B "morning after" pills - are sold to women older than 17 without a prescription, but from behind pharmacy counters. An FDA decision to move those pills to shelves, where younger teens could buy them without prescriptions, was overruled by the Obama administration a year ago.
The FDA did recently hold a hearing to air opinions about moving a variety of prescription medications to non-prescription status. Proponents of over-the-counter birth control pills spoke at that hearing.
And so did the American Medical Association, which expressed concerns about the general idea of patients taking medications for chronic conditions such as high blood pressure, asthma and migraine without prescriptions or a doctor's oversight. The AMA had no comment Tuesday on the birth control pill opinion from the other physicians' group.