Over-the-Counter Access for Birth Control Pills: What’s the Rush?

On April 17, 2017, a French group called « Libérez ma pilule” : (Free the Pill) published an open letter addressed to pharmaceutical labs, the French Health Products Safety Agency and the European Medical Agency (EMA), to request OTC (over-the counter) marketing of birth control pills.

This measure would affect progestin-only contraceptives which are reported to have fewer contraindications than “combined” pills (those with both estrogen and progestin), especially those from 3rd or 4th generation.

The side-effects associated with these latter pills led to a serious controversy with complaints being filed, whereby the French government finally refused the pills’ reimbursement in 2013, due to risks of phlebitis and vascular complications.

The group’s request, backed up by a petition, states « this step forward for women’s rights in Europe and in France to have free access to contraception is at a standstill”. In their opinion, without consulting a gynecologist or a general practitioner, “women should have access to birth control pills at the pharmacy (over-the-counter), whereby a pre-established questionnaire could determine whether or not a woman would be at risk”. This claim is supported by some countries’ example, where the practice is already authorized, and by statements issued by the American Congress of Obstetricians and Gynecologists that recommended the over-the-counter sale of birth control pills in 2012.

This so-called « Collective Group » purports to be composed of health professionals, members of Family Planning and feminists. Among the signatories, many figure among those who spoke out strongly against the conscience clause for pharmacists, discussed within the Order of Pharmacists as the “Joint Group of Pharmacists against the Conscience Clause”, and founded just for the event, without a spokesperson, and whose members are known as “twitter signers”, mostly anonymous or only known by their pseudonyms.

This activist petition was even passed on by French Minister for Women’s Rights, Laurence Rossignol. This rush for OTC pills raises several questions: especially since long-term oral contraception is not without risk. If women (especially young women) do not consult a gynecologist or a doctor, they are deprived from obtaining appropriate follow-up and prevention advice. In addition, if birth control pills are qualified as a medical treatment, it is because they have possible but non-negligible side-effects.

According to INED, (French National Institute for Demographic Studies) 72% of women carrying out abortions were using contraception when they discovered they were pregnant. Consequently, downplaying the risks of contraception by trivializing any need for regular medical check-ups does not appear as an appropriate answer

For Professor, Geneviève Plu-Bureau, a specialist from the French National Congress of Gynecologists and Obstetricians, “the reason the government increased the reimbursement rate for medical consultations for 15-18 year-old girls, is because it is not a simple evaluation.” She also emphasizes that “only long-term contraceptives such IUD’s or contraceptive implants have been shown to be effective in reducing the number of non-desired pregnancies.”

According to Professor Philippe Deruelle, French General Secretary for the National Congress of Gynecologists and Obstetricians, this is “only a good idea at first sight”, as he continues to point out drawbacks with progestin-only pills. Even if the pills themselves do not provoke adverse side-effects, taking the medication is inconvenient and is often associated with tolerance problems, especially that of having an effect on sexuality or provoking bleeding. “This is not an insignificant or innocuous matter. It can be worrisome for women to have unexpected bleeding throughout the month. This measure would implicate a simultaneous loss of choice and counseling.”

As for increasing the role of pharmacists, Philippe Deruelle sees a horrible lack of empathy. « It’s so contradictory. Lately, on one hand, we’ve seen that women need to be more listened to, as seen by all the criticisms voiced using “#paietonuterus”.) On the other hand, we only offer them over-the-counter advice, this is not credible… No one can offer an automatic prescription without having a minimum of interaction. A genuine consultation includes discussion during the consultation.



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