Elec­tion man­date? OB-GYNS en­dorse wider ac­cess to Pill

The Washington Times Weekly - - Politics - BY KEELY BRAZIL

The na­tion’s largest or­ga­ni­za­tion of women’s health pro­fes­sion­als said Nov. 20 that it now sup­ports al­low­ing over-the-counter sales of all oral con­tra­cep­tives.

The Amer­i­can Col­lege of Ob­ste­tri­cians and Gyne­col­o­gists (ACOG) said in a pol­icy state­ment that mak­ing birth con­trol avail­able for women with­out a doc­tor’s pre­scrip­tion would help de­crease the rate of un­planned preg­nan­cies in the United States, which has re­mained stub­bornly high in re­cent decades.

Given the group’s pres­tige and in­flu­ence, the state­ment — a step be­yond ACOG’s rec­om­men­da­tion last month to make emer­gency con­tra­cep­tives read­ily avail­able — is con­sid­ered a sig­nif­i­cant boost for re­pro­duc­tive rights ad­vo­cates in eas­ing rules that re­quire women to ob­tain doc­tor’s pre­scrip­tions to pur­chase oral con­tra­cep­tives.

Crit­ics warn that the ACOG shift raises health and safety is­sues and could un­der­mine parental over­sight and author­ity.

With an es­ti­mated 50 per­cent of all U.S. preg­nan­cies un­planned, doc­tors who backed the move said the cur­rent more re­stric­tive ac­cess rules are fu­el­ing a larger health care prob­lem for the coun­try.

“It’s sup­ported by a great deal of med­i­cal ev­i­dence that the pill is safe enough for over-the-counter sale,” said Dr. Daniel Gross­man, an OB-GYN and vice pres­i­dent of re­search at Cam­bridge, Mass.based Ibis Re­pro­duc­tive Health. “Women are able to use sim­ple check­lists to de­ter­mine if they might have con­di­tions that are dan­ger­ous, and some stud­ies show women stay on the pill longer when they have ac­cess to over­the-counter avail­abil­ity. It’s a great move.”

“It’s un­for­tu­nate that in this coun­try where we have all th­ese con­tra­cep­tive meth­ods avail­able, un­in­tended preg­nancy is still a ma­jor pub­lic health prob­lem,” North Carolina OB-GYN Dr. Kavita Nanda, a co-au­thor of the report, told The As­so­ci­ated Press in an in­ter­view.

But ACOG mem­ber Donna Har­ri­son, an OB-GYN, called the de­ci­sion a “step back for women’s health.”

“Birth con­trol pills are pow­er­ful hor­mones and those pow­er­ful hor­mones can cause prob­lems like blood clots and strokes and, in some cases, in­creased risk of heart at­tack,” said Dr. Har­ri­son, a lead­ing mem­ber of a group of physi­cians within ACOG who are pro-life. “This is not a con­tra­cep­tive is­sue as much as it is a women’s health and safety is­sue.”

Hur­dles ahead

Although ACOG’s find­ings carry weight with government groups such as the Food and Drug Ad­min­is­tra­tion and the De­part­ment of Health and Hu­man Ser­vices, there are still hur­dles to over­come be­fore birth con­trol pills can be stocked next to con­doms in Amer­i­can phar­ma­cies.

Un­der cur­rent law, all forms of oral con­tra­cep­tion re­quire pre­scrip­tions ex­cept for the Plan B One-Step or the “morn­ing-af­ter” pill — and even that calls for a doc­tor’s sig­na­ture for pur­chasers younger than 17.

An­a­lysts pre­dicted that the move by the physi­cians group would not change the avail­abil­ity of oral con­tra­cep­tives overnight.

FDA rules re­quire drug com­pa­nies to con­duct stud­ies prov­ing that their of­fer­ings are safe for over-the-counter use, and must pro­vide clear guide­lines for women on po­ten­tial side ef­fects and the cir­cum­stances un­der which they should not take the Pill.

Even so, Jan­ice Shaw Crouse of Con­cerned Women for Amer­ica called the ACOG rec­om­men­da­tion “reck­less,” say­ing the use of birth con­trol by girls with­out a doc­tor’s su­per­vi­sion could prove dan­ger­ous.

“Any guy who is older and tak­ing ad­van­tage of a younger girl could put her on a pill,” Ms. Crouse said. Be­cause birth con­trol doesn’t pre­vent sex­u­ally trans­mit­ted dis­eases, she added, a girl not un­der a doc­tor’s care might con­tract a disease with­out know­ing it.

“We are in an era where peo­ple are sup­posed to care about women, yet we’re be­ing very cava­lier about women’s health,” she said.

But ACOG of­fi­cials said women can ef­fec­tively pro­tect them­selves from side ef­fects of oral con­tra­cep­tives by “self­screen­ing” us­ing check­lists.

“I think there is a lot of value in prevent­ing un­planned preg­nancy in the first in­stance,” said Jon O’Brien, pres­i­dent of Catholics for Choice. “And I think mak­ing emer­gency con­tra­cep­tion avail­able to women is a pos­i­tive step for­ward for all of us.”

Pro-life push­back

Ac­cord­ing to the report, 50 per­cent of preg­nan­cies in the United States are un­planned. Af­ter weigh­ing the risks and ben­e­fits, ACOG said, mem­bers found that mak­ing oral con­tra­cep­tives avail­able over the counter would be the best move for women’s health.

But since abor­ti­fa­cients — which are de­signed to cause a newly im­preg­nated egg to mis­carry — are among the med­i­ca­tions in ques­tion, Dr. Har­ri­son said, ACOG is do­ing its mem­ber doc­tors a dis­ser­vice by fail­ing to de­ter­mine whether or not most are pro-choice or pro-life.

She serves as re­search di­rec­tor for one of the or­ga­ni­za­tion’s largest in­ter­est groups — the Amer­i­can As­so­ci­a­tion of Pro-Life Ob­ste­tri­cians and Gyne­col­o­gists.

“ACOG has never polled its mem­ber­ship on [their] po­si­tion on abor­tion, and yet they throw the whole weight of the mem­ber­ship into pro-abor­tion ac­tivism.”

But Mr. O’Brien called the move “a very com­mon-sense, prac­ti­cal rec­om­men­da­tion by doc­tors.”

“It makes no dif­fer­ence if you’re a Demo­crat or Repub­li­can — we should see it from a woman’s point of view and de­politi­cize con­tra­cep­tion,” he said.

The ACOG rec­om­men­da­tion didn’t ad­dress teen use of con­tra­cep­tion. De­spite protests from re­pro­duc­tive health spe­cial­ists, cur­rent U.S. pol­icy re­quires a girl younger than 17 to pro­duce a pre­scrip­tion for the morn­ing-af­ter pill, mean­ing phar­ma­cists must check cus­tomers’ ages. Reg­u­lar birth con­trol pills pre­sum­ably would be treated the same way.

Pre­scrip­tion-only oral con­tra­cep­tives have long been the rule in the U.S., Canada, West­ern Europe, Aus­tralia and a few other places, but many coun­tries don’t re­quire pre­scrip­tions.

This ar­ti­cle is based in part on wire ser­vice re­ports.

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