Number 788 ( Replaces Committee Opinion Number 544 , December 2012 ) Committee on Gynecologic Practice

Barriers to access are one reason for inconsistent or nonuse of contraception. The requirement for a prescription can be an obstacle for some contraceptive users. Several studies have demonstrated that women are capable of using self-screening tools to determine their eligibility for hormonal contraceptive use. Pelvic and breast examinations, cervical cancer screening, and sexually transmitted infection screening are not required before initiating hormonal contraception and should not be used as reasons to deny access to hormonal contraception. Also, a plan to improve access to hormonal contraception should address cost issues. Pharmacistprovided contraception may be a necessary intermediate step to increase access to contraception, but over-thecounter access to hormonal contraception should be the ultimate goal. The American College of Obstetricians and Gynecologists supports over-the-counter access to hormonal contraception without age restrictions. This Committee Opinion has been updated to expand the focus of over-the-counter contraception to include oral contraceptive pills, vaginal rings, the contraceptive patch, and depot medroxyprogesterone acetate, to address the role of pharmacist-provided contraception, and to provide recommendations for individuals younger than 18 years. Recommendations and Conclusions Over-the-counter access to hormonal contraception (oral contraceptive pills [OCPs], the contraceptive patch, contraceptive vaginal rings, and depot medroxyprogesterone acetate [DMPA] injections) eliminates the need for prescriptions and relies on a woman to self-screen for eligibility. Based on the current evidence, the American College of Obstetricians and Gynecologists (ACOG) supports the following recommendations and conclusions: c The American College of Obstetricians and Gynecologists supports over-the-counter access to hormonal contraception without age restrictions. c Over-the-counter access has continuation rates of hormonal contraception comparable to prescriptiononly access and has the potential to decrease unintended pregnancy. c Evidence demonstrates that women want over-thecounter access to hormonal contraception because it is easier to obtain. c Data support that progestin-only hormonal methods are generally safe and carry no or minimal risk of venous thromboembolism (VTE). c The VTE risk with combined oral contraceptive use is small compared with the increased risk of VTE during pregnancy and the postpartum period. c Pelvic and breast examinations, cervical cancer screening, and sexually transmitted infection screening are not required before initiating hormonal contraception and should not be used as reasons to deny access to hormonal contraception. c Several studies have demonstrated that women are capable of using self-screening tools to determine their eligibility for hormonal contraceptive use. c The goal of over-the-counter access is to improve availability of hormonal contraception, but not at the expense of affordability. Also, a plan to improve access to hormonal contraception should address cost issues. c Pharmacist-provided contraception may be a necessary intermediate step to increase access to contraception, but over-the-counter access to hormonal contraception should be the ultimate goal.