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Sell birth control pills over the counter to teens?

By Chanapa Tantibanchachai

Decades of research suggest it’s safe to sell birth control pills over the counter rather than by prescription, even for teenagers.

A team of experts reviewed the research and found evidence that teens are capable of safely and properly using oral contraceptives to prevent unwanted pregnancies.

“Our review strongly suggests that giving teens easier access to various contraceptives will not lead to more sex, but would result in fewer unwanted pregnancies.”

“Decades of research show that a majority of adolescents initiate sex before the age of 18 and that earlier use of contraception reduces the risk of teen pregnancy,” says team leader Krishna Upadhya, assistant professor of pediatrics at Johns Hopkins University.

“Our review strongly suggests that giving teens easier access to various contraceptives will not lead to more sex, but would result in fewer unwanted pregnancies.”

The study, published in the Journal of Adolescent Health, comes amid a continuing debate over switching oral contraceptives to over-the-counter (OTC) status, particularly for teenagers. A French drug company and US nonprofit recently applied to the Food and Drug Administration to sell an OTC birth control pill.

“Oral contraceptives are popular, safe, and effective methods of pregnancy prevention for women and teens,” Upadhya says. “Our review emphasizes that any future over-the-counter pill has the potential to benefit teens, and there is no scientific rationale to restrict access based on age.”

What critics say

The research team looked at teen-specific data on the safety and effectiveness of oral contraceptives, pregnancy risk, ability to use the pill correctly and consistently, and the impact of access on sexual behavior. They also considered concerns that OTC access might reduce doctors’ opportunities to counsel young patients.

The pill is already the most commonly used hormonal method of birth control by teens and other women in the United States. A 2011–2013 survey found that 54 percent of females age 15 to 19 have used it.

Advocates say easier, wider access to the pill will further reduce teen pregnancy and abortion.

The Centers for Disease Control and Prevention reports that births to US teens reached a historic low in 2015. A recent analysis found that the decline in teen pregnancy risk between 2007 and 2012 was entirely due to increased contraception. But critics of OTC status say they fear wider access would lead to more teen sex, sexually transmitted disease, and safety concerns over long-term use.

FDA says the pill is safe for teens

Under FDA laws and regulations, prescription drugs should become OTC only if they are safe for self-administration, are effective when self-administered, treat a condition or address a concern that is self-diagnosable, and can carry easily understood labels tailored for self-administration.

The FDA previously established the safety and effectiveness of oral contraceptive pills for all females. In the new review, the research team found that conditions that could increase the risk of serious side effects in pill users are rare among teens.

Studies show most teens can make informed decisions about oral contraceptives, Upadhya says. Because using the pill is a daily behavior not tied to imminent sex or emotional pressures—as with condom use—teens may actually be more likely to use it consistently.

Studies comparing contraceptive failure rate in teens versus young women showed no significant differences; one study about proper use of oral contraceptives found that 90 percent of teens answered questions correctly.

The team reviewed the impact of 2012 FDA action making the emergency contraceptive “Plan B” available OTC for teens. They did not find increased sexual behaviors and suggest the same would be true for oral OTC contraceptives.

Finally, the researchers considered the potential of OTC status to negatively impact clinicians’ opportunities to counsel teens and provide sexual and reproductive health care. The team found that the percentage of teens who get recommended annual preventive visits is already low.

That suggests that providing alternative access points outside of clinics, when possible, is critical to ensuring that all teens in need can use effective contraceptives, Upadhya says. Because not all contraceptive methods can be self-administered, however, Upadhya stresses the importance of continued efforts to ensure that teens see their clinicians.

Other authors of the study are from Columbia University, Kaiser Permanente Northern California, Emory University, and the University of California, San Francisco.

Source: Johns Hopkins University

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