ORAL CONTRACEPTION (OC) - ORAL CONTRACEPTION (OC) - OVER THE COUNTER (OTC)? OVER THE COUNTER (OTC)? Arie Yeshaya, M.D. Arie Yeshaya, M.D. Pediatric Adolescent Clinic Pediatric Adolescent Clinic Schneider Children’s Hospital Schneider Children’s Hospital and and Department of Obstetrics and Gynecology Department of Obstetrics and Gynecology Rabin Medical Center, Petah Tikva, Israel Rabin Medical Center, Petah Tikva, Israel
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ORAL CONTRACEPTION (OC) - OVER THE COUNTER (OTC)? Arie Yeshaya, M.D. Pediatric Adolescent Clinic Schneider Children’s Hospital and Department of Obstetrics.
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ORAL CONTRACEPTION (OC) - ORAL CONTRACEPTION (OC) - OVER THE COUNTER (OTC)?OVER THE COUNTER (OTC)?
A prescription drug should be switched toover the counter Status if:
The drug is safe for self medicationThe drug is effective when self administeredThe condition to be treated is self diagnosableThe drug’s labeling is tailored to self administration
Should Oral Contraceptives Be Sold Over the-Counter?
OC - OTCOC - OTCPROSPROS
OC - OTCOC - OTC
Easier to achieveEasier to achieve
More usersMore users
Less unwanted pregnanciesLess unwanted pregnancies Less abortionsLess abortions
Lower maternal morbidity and mortalityLower maternal morbidity and mortality
WORLDWIDE STATISTICSWORLDWIDE STATISTICS
>1 of 2 pregnancies >1 of 2 pregnancies are unwantedare unwanted
Over 35 years of ageOver 35 years of age SmokersSmokers HypertensionHypertension DiabetesDiabetes HyperlipidemiaHyperlipidemia
ATTITUDE OF FEMALE COLLEGE ATTITUDE OF FEMALE COLLEGE STUDENTS TOWARDS AVAILABILITY OF OC STUDENTS TOWARDS AVAILABILITY OF OC
OTC OTC
Forman et al. (1997)Forman et al. (1997)
No. - 290No. - 290
Age - 20 ± 3Age - 20 ± 3
84% - previous sexual 84% - previous sexual intercourseintercourse
Age at first sexual encounter - Age at first sexual encounter - 16.6 ± 216.6 ± 2
52% used OC at first encounter52% used OC at first encounter
65% - against OC-OTC65% - against OC-OTC Side effects could be preventedSide effects could be prevented Users would not go for regular checkupsUsers would not go for regular checkups
35% - pro OC-OTC35% - pro OC-OTC Fewer unwanted pregnanciesFewer unwanted pregnancies
OC - OTC : PROS and CONSOC - OTC : PROS and CONS
Not significant:Not significant:
–RaceRace
–Previous OC usePrevious OC use
–Previous sexual activityPrevious sexual activity Significant:Significant:
Should Oral Contraceptives Be Should Oral Contraceptives Be Sold Over the-CounterSold Over the-Counter??
Potential AdvantagesPotential Advantages Increased access to affective Increased access to affective
birth control for all womenbirth control for all women Increased access for younger Increased access for younger
women, the prime users of women, the prime users of OCs OCs
Reduced rate of unintended Reduced rate of unintended pregnanciespregnancies
Cost savings from reduction of Cost savings from reduction of physician and family planning physician and family planning clinic visitsclinic visits
Encouragement of the national Encouragement of the national trend toward self-caretrend toward self-care
Potential DisadvantagesPotential Disadvantages Increased rate of unintended Increased rate of unintended
pregnancies due to unproper pregnancies due to unproper use of OCsuse of OCs
Reduced OC compliance Reduced OC compliance because of lack of counseling because of lack of counseling and management of nuisance and management of nuisance side effectsside effects
Increase in liability due to errors Increase in liability due to errors in self-prescribingin self-prescribing
Possible cost increases for Possible cost increases for Medicaid and family planning Medicaid and family planning clinic patientsclinic patients
Possible price increases due to Possible price increases due to the costs of marketing to the costs of marketing to consumersconsumers
Reduced opportunities for Reduced opportunities for preventive medical carepreventive medical care
OC - OTCOC - OTC
Population, social and Population, social and religious attitudereligious attitude Availability of local family Availability of local family planning service planning service Availability of providersAvailability of providers
Conclusion
In order to expand OCs use:Reinforce the activity of family planning ClinicsFacilitate public access to professionalsInstituting charge free visitsOrganizing visits to schools
Conclusion
Better access to physicians might be the best way toEstablish the OC as the main and most efficaciousContraceptive method
So….should it be prescribed, So….should it be prescribed, or OTC?or OTC?