Post-Roe v. Wade, broaden access to birth control pills

Opinion editor's note: Editorials represent the opinions of the Star Tribune Editorial Board, which operates independently from the newsroom.

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Preventing unplanned pregnancies ought to be common ground among anti-abortion and pro-abortion rights forces. That's why a pragmatic new proposal from the nation's doctors — making birth control pills available over the counter instead of prescription-only — should inspire broad support.

The commendable call for this shift came during the American Medical Association's annual meeting earlier this month. The AMA's membership includes over 250,000 U.S. physicians.

The organization's over-the-counter (OTC) push is timely. The nation has been expecting, and on Friday received, a contentious U.S. Supreme Court ruling overturning the constitutional right to the medical procedure of abortion. A leaked draft had suggested the court would do so, limiting access in many states.

Making oral contraceptives easier to obtain, with effectiveness ranging from 91% to 99%, is a logical step.

A doctor's visit to obtain a prescription can be a hurdle to using birth control pills. Getting to clinic locations may be inconvenient, especially for those without transportation or too young to drive. Appointments may not be readily available.

"Providing patients with OTC access to the birth control pill is an easy call from a public health perspective as the health risks of pregnancy vastly outweigh those of oral contraceptive use," Dr. David H. Aizuss, an AMA board member, said in a statement.

The American College of Obstetricians and Gynecologists also supports OTC status and has backed it for many years, according to a spokeswoman. It said the AMA's support "makes a clear statement that physicians are united in their strong support for improved access to safe, effective birth control without requiring physician or pharmacist prescribing, which may present a barrier for individuals — especially when time is of the essence."

The AMA's call to action is aimed at the Food and Drug Administration (FDA), where it says a "regulatory pathway" exists for switching oral contraceptives to OTC. A manufacturer application for such a switch is required but "is expected to be submitted before the end of 2022," an AMA spokesman said.

The FDA declined to comment on whether an application has been submitted or is expected.

Birth control pills are sold over-the-counter in many countries, including Mexico, most Asian countries and most of South America. At least one study suggests that women able to buy the pill OTC had higher "continuation" rates than those who obtained the drugs through a clinic. Continuation is a way to gauge proper use vs. inconsistent use, with the latter undermining this contraceptive method's effectiveness.

It's not clear how many pharmacists completed training. The Minnesota Board of Pharmacy doesn't track it. In other states that have taken a similar step, a limited number of pharmacists have exercised this new capability. "Only 11% of community pharmacies in California are prescribing [oral contraceptives] due to barriers such as reimbursement, liability, time available and lack of knowledge," according to a University of Minnesota report.

Clearly, broader steps are needed to ease access.

OTC availability would shift the responsibility of evaluating the risks of birth control pills from medical providers to individuals. Like any medication, there can be rare complications. For a complete list, go to tinyurl.com/w4k6tan4.