Last week, a team of health researchers published a paper reviewing the science behind oral contraceptives, concluding that there’s a strong case to be made for over-the-counter birth control — even for teenagers.
The strongest argument in favor of making the birth control pills more accessible comes from what the drug has already been able to accomplish. According to the Centers for Disease Control and Prevention, teen births in the United States reached a historic low in 2015, which can be explained in large part by an increased use of contraception among young people.
These gains took place despite efforts to restrict young people’s access to over-the-counter emergency contraception — better known as “Plan B” — which took years and multiple rounds of court cases to undo.
“The [emergency contraception] controversy was really unfortunate, and I hope there’s not a repeat of that,” said Krishna K. Upadhya, assistant professor of pediatrics at Johns Hopkins Children’s Center and a co-author of the paper published last week. “It perpetuates this unnecessary idea that we need to restrict access to products for young people that can help them have healthy reproductive outcomes. All it does it increase their risk of unplanned pregnancy.”
The Food and Drug Administration only allows drugs to be made over-the-counter if they’re shown to be safe and effective for self-administration, if they treat a condition that is self-diagnosable and if they can carry labels with directions that consumers easily understand. Right now, women need a prescription from their doctors to get oral contraceptives, but the movement to ease access has been supported by health experts including the American College of Obstetricians and Gynecologists. Pharmaceutical companies have likewise begun seeking FDA approval to make their products available over-the-counter late last year.
Birth control pills have always faced strong opposition, particularly from social conservatives uncomfortable with sexual promiscuity among young people. Critics often argue that greater access to oral contraception with encourage young people to have more sex, and that this puts them at greater risk of sexually transmitted diseases.
But as the Johns Hopkins paper explains, research doesn’t support those claims. Studies show that young people did not engage in more sexually risky behavior when given greater access to condoms or emergency contraception. Other studies on prescription birth control suggest that adolescents start off with condoms in the early stage of a relationship and then switch to the pill as time passes.
Others fear that women — especially teenagers — won’t adhere to the regimens of birth control effectively. For oral contraceptives, that means taking the pills at the same time everyday and using condoms whenever missing a dosage by more than three hours. But studies show that condoms have a higher failure rate than pills. Teenagers, in fact, are more likely use the pills consistently compared with condoms because taking the pills is not influenced by sexual or emotional pressures.
There are issues that put women at risk of complications if they use oral contraceptives, such as high blood pressure, heart disease and breast cancer. But these conditions are rare among teenagers, and women do a good job figuring out on their own when they shouldn’t be taking the drug, according to recent studies. Research has shown, however, that long-term use of oral contraceptives has a mixed impact on cancer risk, reducing the likelihood of endometrial and ovarian cancer and increasing the likelihood of of breast, cervical and liver cancer.
It’s certain that much time will pass before young women can go to the store and find birth control pills stacked alongside analgesics and skin creams, but given the science, such an outcome seems inevitable. The public-health benefits from oral contraceptives should by now justify giving women — particularly young women — more access to these drugs.