Last week, two prominent health organizations issued bold policy statements. The American Academy of Pediatrics recommended providing prescriptions for and routinely counseling teens about emergency contraception,1 and the Association of Obstetricians and Gynecologists recommended making oral contraceptives (OCs) available over-the-counter.2

Both policies cite evidence that is supportive of the safety and efficacy of these health-care changes to reduce unintended pregnancies. Although teen and total birth rates have continued to decline in the United States during the last few years,3,4 unintended pregnancies still account for almost half of all births, a rate still higher than other developed countries.5 

Critics have expressed concerned that women will not be able to self-screen for medical contraindications to OC use. As a woman, I take this concern personally. Let me share a 30-year-old success story that demonstrates the safety and efficacy achieved by providing better access to birth control.

The 1970s in Thailand were marked by high birth rates and poverty levels that posed huge barriers to the country’s development. Recognizing that controlling the birth rate could solve some of the Thailand’s problems, political activist Mechai Viravaidya founded the Community Development Association (PDA). 

PDA established networks of female volunteers throughout the country to educate and distribute condoms and oral contraceptives to village women. No physicians or nurses lived in these remote areas, and the village women had very little formal education. Nevertheless, women began taking responsibility for their reproductive health. After the PDA program was established, Thailand’s birthrate was reduced more than half – from 3.2% to 1.2% — in its’ first 14 years.6

In the U.S., virtually all women have access to informational sources, including television, public libraries, billboards and the Internet.  The only thing a woman should need to self-screen for OC contraindications is a checklist. It could even be in the form of a smart phone app. 

As far as questions about cost and concerns over “who” is going to pay for this, it looks like health-care reform is going to stick around for the next few years. Under the Affordable Care Act women are guaranteed that health insurers must pay for all FDA approved contraceptive methods, unless their insurer is a religious organization that is exempted.

Women with Medicaid already have coverage for OCs. If a women does have to pay out of pocket, many retailers provide generic OCs for less than $25 for a 30 day supply. Wal-Mart and Sam’s Club charge $9.  Certainly, this expense is less than the daily expense of raising a child at a time when the mother is not ready.

Julee B. Waldrop, DNP, FNP, PNP, is the Director of the MSN-DNP Program and an associate professor at the University of Central Florida. She provides health care to children at a local community health center.

References

  1. Upadhya KK et al. Pediatrics 2012; doi: 10.1542/peds.2012-2962.
  2. American College of Obstetricians and Gynecologists. “Over-the-counter access to oral contraceptives.” Committee Opinion No. 544. Obstet Gynecol. 2012:120;1527-31.
  3. Centers for Disease Control. 2012. Fast Facts: Teen Births.
  4. Livingston G, Cohn D. U.S. Birth Rate Falls to a Record Low; Decline Is Greatest Among Immigrants. Washington, DC: Pew Research Center, 2012.
  5. The Alan Guttmacher Institute (AGI). 2011. Facts on unintended pregnancy in the U.S. New York: AGI, 2011.
  6. D’Agnes T. From Condoms to Cabbages: An Authorized Biography of Mechai Viravaidya.  Post Publishing Public Company Limited. Bangkok, Thailand. 2001.
  7. U.S. Department of Health and Human Services. Women’s Preventive Services: Required Health Plan Coverage Guidelines; 2012.