As medical organizations and other groups push to ease the prescription requirements for the Pill in the U.S. and elsewhere, "we can start to use this information to... get a sense of the safety of women having access to this method where no prescription is required," said Kari White, who studies birth control at the University of Alabama in Birmingham.

The Pill is generally considered safe, said White, who was not involved in the new work, and some studies have shown that, without a doctor's input, women can accurately screen themselves for risk factors to steer away from using the Pill if it's not appropriate for them.

Earlier this year, the American College of Obstetricians and Gynecologists, a leading group of women's doctors, endorsed the idea of making the birth control pill available without a prescription (see Reuters Health report of November 20, 2012 here: reut.rs/UH0Zz9).

In a survey of government health officials, pharmaceutical companies, family planning groups, medical providers and other experts in 147 countries Dr. Daniel Grossman, of Ibis Reproductive Health in Oakland, California, and his colleagues found that women in the U.S. and 44 other countries need a prescription to get birth control pills.

The group reported in the medical journal Contraception that while another 56 countries had laws requiring prescriptions, in practice women could access the contraception over-the-counter.

Thirty-five countries legally allowed access to oral contraceptives over-the-counter, and 11 countries allowed over-the-counter access as long as the woman is screened to ensure that she is a good candidate.

"The patterns we saw were interesting," said Grossman. "Higher income countries - western Europe, Australia, Japan and North America - generally require a prescription."

Grossman told Reuters Health he couldn't explain why these patterns have emerged.

"Perhaps in places like China and India that have pills available over-the-counter formally without a prescription might be consistent with strong national family planning programs," he speculated.

Dr. Ward Cates, of FHI 360, a research organization in Durham, North Carolina, said the lack of a prescription requirement might also reflect a general approach to making health care more accessible in countries where it is less available.

In some countries, "healthcare tends to be more fragmented and healthcare oversight tends to be more fragmented. Therefore the availability of products tends to percolate to outlets that tend to be more accessible to the public," said Cates, who was not part of the study.

Grossman said it will be useful for countries looking to ease restrictions on birth control access to look to the experiences of these countries.

"Will this information about the availability of pills being over-the-counter in other countries influence policy here? Probably not," Grossman told Reuters Health.

"But I do think it helps to put it in perspective that this is not something revolutionary."

SOURCE: bit.ly/S51BnH Contraception, online December 10, 2012.

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