Should Nurse Practitioners Support Over-the-Counter Contraception?

Article Outline

• Support for Selling Oral Contraceptives Over the Counter
• Rationale Against Selling Oral Contraceptives Over the Counter
• Copyright

Debra A. Gauthier graduated from LSU Baton Rouge in 1996 with a bachelor of science degree in psychology. After working as a psychologist, she decided to pursue a nursing career and entered the LSUHSC School of Nursing and obtained both BSN and MSN degrees. Her focus in the graduate program was the family nurse practitioner program of study. She has worked in many different roles, with specialty experience as a charge nurse and intensive care nurse before she became an NP. She is currently practicing as a family nurse practitioner in Louisiana.

Donna Cronk Duncan received her BSN from Southeastern University of Louisiana School of Nursing in 2000. She worked as an RN at a local Louisiana charity hospital, where she was a charge/staff nurse on a medical/surgical unit for 5 years prior to transferring to the ICU for 4 years. After careful searching, she decided to pursue her master of science degree, with a program focus as a family nurse practitioner. She graduated in May and is now practicing as a family nurse practitioner.

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Should oral contraceptives be sold over the counter or should they remain a prescribed medication? Birth control pills (BCPs) have historically made an impact on women's lives. They have astoundingly changed the way people look at birth control and they have helped provide women with the option of free choice in family planning. BCPs are also used to decrease menstrual pain, treat acne, reduce premenopausal symptoms, to help regulate menstrual cycles, or even skip cycles. Use of the BCP OTC gives women more control of their lifestyle so they can fully participate in social activities, or compete as an athlete without pain or menstrual discomfort.

While there are many benefits to taking BCPs, there are many health risks involved. They have the potential to cause life threatening events such as a venous or arterial thromboses, pulmonary embolism, myocardial infarction, cerebral hemorrhage, cerebral thromboses, hypertension, gallbladder disease, hepatic adenomas, and tumors. A nurse practitioner must be cognizant of the risks and benefits before encouraging women to use OTC BCP. But without accessibility to a health care provider, the question remains whether it is safe for BCPs to be OTC, and accessible to the public without counseling. To comment on this matter, e-mail section editor Jacqueline Rhoads at jrhoad@lsuhsc.edu.

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Support for Selling Oral Contraceptives Over the Counter 

Debra A. Gauthier

I believe that nurse practitioners should support allowing birth control pills (BCPs) to be sold over the counter. The University of Washington is conducting a pilot project whose aim is to find out if women and pharmacists are comfortable with drug store over the counter delivery of birth control pills, patches, and vaginal rings. This project is believed to be the first effort in the nation to offer hormonal contraceptives at drug stores without a doctor's prescription. Most medical organizations agree it is not necessary to have a pelvic exam to get birth control pills and the like and feel it is in the woman's best interest to have immediate access to birth control without barriers and difficulties. There would be many advantages for women if the prescription status was removed from acquisition of BCPs, and having BCPs over the counter (OTC) would provide women with a safe and effective birth control method that would be cost effective and not require the obligatory medical examination needed to obtain a prescription for birth control pills. It is assumed that easy excess to BCPs would contribute to family planning. Women's risks of certain diseases such as ovarian cysts, cancer of the ovaries, benign breast disease, endometrial cancer, and pelvic inflammatory disease (PID) are significantly reduced when women take BCPs. Practitioners should educate their patients on the benefits of using an oral contraceptive because they may not realize all of the health benefits involved.

If oral contraceptives were sold OTC, it is clear that women would have easier access to methods to support family planning without increased cost. This could be a significant cost-saving benefit by eliminating the office visits required for a prescription or for refills.

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Rationale Against Selling Oral Contraceptives Over the Counter 

Donna Cronk Duncan

Ibelieve that nurse practitioners should not endorse the selling of birth control pills over the counter (OTC). Birth control pills (BCPs) are legend drugs that the FDA requires by law to be issued with a prescription and labeled as: Caution: Federal Law Prohibits Dispensing Without a Prescription or Rx only. Therefore, to receive a prescription for BCPs would require seeing a practitioner and having a full gynecological exam with a UPT and Pap smear. BCPs have the potential to cause life-threatening events. Over 40 different BCPs have been invented to meet the needs of many different women while preventing pregnancy. BCPs have the potential to cause hypertension, thromboses, pulmonary embolism, ischemic heart disease, cerebral vascular attacks, hyperlipidemia, diabetes mellitus, complications of the liver and gall bladder, and may interfere with other medications.

Nurse practitioners have full knowledge of these drugs and, before prescribing, consider the finding of a woman's complete gynecological exam along with age, lifestyle, personal history, family history, allergies, current medications, as well as any existing disease that may cause medical harm. One must consider that most insurance companies do not cover the expense of medication bought OTC. With this in mind, how will women who are indigent and receive free health care and medication afford their BCPs?

Many women may not be aware they have hypertension and, as a result of taking the cheapest OTC BCP instead of the safest one, could be placing herself in medical danger. Also, if a prescription or a gynecological exam is not needed to purchase BCPs, then there is a great possibility that many women would forego their annual exams. This alone could wreak havoc among the female population. Without these regular exams, outbreaks of infections, sexually transmitted infections, and cancer could go undetected.