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Can I Buy Birth Control Pills Over the Counter?

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Updated June 22, 2011

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Can I Buy Birth Control Pills Over the Counter?

Birth Control Over the Counter?

Photo © 2011 Dawn Stacey
Question: Can I Buy Birth Control Pills Over the Counter?

One of the most common questions that people ask me is whether or not they can buy birth control pills over the counter. There are several over-the-counter birth control methods that are available; however, birth control pills are not one of them.

Answer:

Buying birth control over the counter is a gray area. If you are 17 years of age or older, you can buy emergency birth control over the counter. Plan B One-Step (or its generic version, Next Choice) –- also known as the morning after pill -- is a type of birth control pill that is sold at pharmacy counters without the need for a doctor’s prescription. You just need to verify your age. Plan B One-Step may help prevent a pregnancy after unprotected intercourse or contraceptive failure has occurred, but it cannot be used as a regular, consistent birth control method.

In order to buy regular birth control pills, you do need a doctor’s prescription (so, you can't get any birth control pills over the counter). Most doctors will require a clinical breast and pelvic exam in order to write you this prescription. There is a lot of debate over this practice. Given that menstruation and wanting to prevent pregnancy are not diseases, and since the birth control pill is not a dangerous medicine, many wonder why women really need to obtain a prescription to purchase the pill.

Basically, there is no real risk of drug abuse, an overdose is more likely to result in vomiting than any kind of high, and most of the side effects are not serious. This leads many to argue whether or not the government has a legitimate role in imposing on women the added cost associated by maintaining the pill's prescription status, not to mention creating a significant barrier to its access.

Studies done by the Institute For Women’s Policy Research reveal that making birth control pills available over the counter would dramatically increase its usage. It could also potentially result in 2.08 billion dollars in medical savings from preventing unplanned pregnancies. However, would this be putting women’s lives at risk?

Right now, general medical guidelines and research suggest that hormonal contraception (like the pill) can be safely prescribed on the basis of careful medical history and blood pressure measurement. Breast and pelvic examinations, and pap smear screening for cervical cancer and sexually transmitted diseases, are important in their own right, but they are not necessary for identifying women who should avoid hormonal methods or need further evaluation before a decision about hormone use is reached.

Women still need to talk to their doctors because there are some who are not good candidates for the pill. This is why it is important that your doctor does a thorough medical history with you (and that you are honest about your history). It is still an important part of family planning and reproductive health care that women undergo screenings for cervical and breast cancer. Additionally, routine screenings for sexually transmitted infections are recommended because women who use birth control pills may be less likely than other women to also use condoms that protect against these infections.

The pill is an effective, discreet and convenient birth control method. It allows you to have control over your fetility, to manage your period, to prevent pregnancy, and its use probably results in fewer abortions.

Many women may want to use the pill, but don’t because they are afraid of having a pelvic exam and a pap smear. Though these are important diagnostic procedures for maintaining your gynecological health, the medical consensus that has developed over the last decade supports a change in practice: Birth control pills can be prescribed safely based on careful review of your medical history and blood pressure measurement. For most women, no further evaluation is necessary.

If your doctor insists that you must undergo a breast and pelvic exam in order to obtain your pill prescription, talk to him or her, explain your concerns, and request not have these procedures done. Another option is to find a different doctor who follows the guidelines put forth by the World Health Organization and the American College of Obstetricians and Gynecologists suggesting that hormonal oral contraception can be safely prescribed without a pelvic exam.

I would like to stress, however, that even though they can be uncomfortable and not something most women look forward to doing, routine pelvic and breast exams, pap smears, and STD testing should be part of your overall health care. Though they may not be effective for screening whether or not you are a good candidate for the pill, they are essential for early detection of life-threatening diseases.

Sources:

Stewart FH, Harper CC, Ellertson CE, et al. "Clinical breast and pelvic examination requirements for hormonal contraception: Current practice vs. evidence." JAMA 2001; 285:2232-2239. Accessed via private subscription.

World Health Organization. "Selected Practice Recommendations for Contraceptive Use." Second ed. Geneva: WHO; 2004. Accessed 4/11/11.

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