Over-the-Counter Access to Oral Contraceptives for Adolescents.
Oral contraceptives (OCs) are used by millions of women in the U.S. The requirement to obtain OCs by prescription from a clinician may serve as a barrier to contraceptive initiation and continuation for women, in particular adolescents. Over-the-counter (OTC) availability would reduce this barrier and could further reduce unintended pregnancy rates. This review explores the scientific issues and regulatory processes involved in switching OCs to OTC status for minor adolescents. We review: (1) the regulatory criteria for switching a drug to OTC status; (2) risk of pregnancy and safety during use of OCs including combined oral contraceptives and progestin-only pills for adolescents; (3) the ability of adolescents to use OCs consistently and correctly; (4) OTC access to OCs and potential effect on sexual risk behaviors; and (5) the potential for reduced opportunities for clinicians to counsel and provide recommended reproductive health care to adolescents. We find strong scientific rationale for including adolescents in any regulatory change to switch OCs to OTC status. OCs are safe and highly effective among adolescents; contraindications are rarer among adolescents compared to adult women. Ready access to OCs, condoms, and emergency contraception increases their use without increasing sexual risk behaviors.
Division of General Pediatrics & Adolescent Medicine, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland. Electronic address: kupadhy2@jhmi.edu.
Krishna K
KK
Upadhya
Heilbrunn Department of Population and Family Health, Mailman School of Public Health, Columbia University, New York, New York.
John S
JS
Santelli
Division of Research & Department of Obstetrics and Gynecology, Kaiser Permanente Northern California, Oakland, California.
Tina R
TR
Raine-Bennett
Jane Fonda Center, Department of Gynecology and Obstetrics, Emory University, Atlanta, Georgia.
Melissa J
MJ
Kottke
Department of Obstetrics, Gynecology and Reproductive Sciences, Advancing New Standards in Reproductive Health (ANSIRH), Bixby Center for Global Reproductive Health, University of California San Francisco, Oakland, California.
Daniel
D
Grossman
D000293:Adolescent; D003268:Contraception Behavior; D003276:Contraceptives, Oral / Q000627:therapeutic use*; D006297:Health Services Accessibility; D006801:Humans; D004366:Nonprescription Drugs / Q000600:supply & distribution*; D012725:Sexual Behavior
D003276:Contraceptives, Oral; D004366:Nonprescription Drugs
Adolescents; Contraception; Oral contraception