With unintended pregnancies accounting for about half of all pregnancies in the United States, the American College of Obstetricians and Gynecologists recommended last year(www.acog.org) that women be allowed to skip obtaining a doctor's prescription and instead purchase oral contraceptives OTC in drugstores.
Angela Sparks, M.D., a women's constituency delegate from Olympia, Wash., speaks in favor of a resolution asking the AAFP to support oral contraceptives being sold OTC. The resolution was referred to the Academy's Board of Directors during the National Conference of Special Constituencies in Kansas City, Mo.
Family physician delegates to the AAFP's National Conference of Special Constituencies were divided on whether the Academy should adopt a similar position and, ultimately, referred a resolution on the topic to the Board of Directors during their April 27 business session here.
Cathleen London, M.D., a women's constituency delegate from New York and co-author of the resolution, testified April 26 during the Reference Committee on Advocacy hearing that many other countries already allow oral contraceptives to be sold OTC.
"Women are very capable of screening themselves for risk factors," London said, echoing a conclusion from the ACOG recommendation. "Our unplanned pregnancy rate is the highest of any industrialized nation. It's ridiculous."
London also pointed out that a woman's risk of developing venous thromboembolism (VTE) from using oral contraceptives -- one of the primary risks posed by birth control pills -- is lower than her risk for VTE during pregnancy and in the postpartum period.
- After lengthy debate, delegates to the National Conference of Special Constituencies referred to the AAFP Board of Directors a resolution asking the Academy to support oral contraceptives being sold OTC in drugstores.
- Delegates also adopted substitute resolutions calling for the Academy to support research into the health implications of gun violence and marijuana legalization.
However, several delegates testified against the resolution based on safety concerns.
Lillian Wu, M.D., a minority delegate from Renton, Wash., testified during the reference committee hearing that OTC availability would solve an access issue for patients at her federally qualified health center.
"In my population, patients get pregnant because they don't see me," she said. "They would be better able to prevent pregnancies if they could get (birth control) over the counter.
"Yes, we would love to have them see us and get counseling from us, but there are access issues."
The question of age was an issue for several delegates who spoke against the resolution. For example, Ilona Farr, M.D., a women's constituency delegate from Anchorage, Alaska, testified during the reference committee hearing that the OTC concept made sense for stable adult patients, who should not need to see a physician to renew their prescription every year. But she did not think the same held true for teens.
"Sixteen-year-olds need counseling," she said. "They need a health care professional to go over the risk and benefits. Teens don't always follow directions and do the things they need to."
During the business session, an attempt to amend the resolution to include an age restriction failed. Delegates ultimately referred the issue to the AAFP Board of Directors.
"The current system is broken," Angela Sparks, M.D., a women's delegate from Olympia, Wash., and co-author of the resolution, said during the business session. "And this is the best idea I have to address it."
In other action, delegates adopted substitute resolutions supporting research on two potentially controversial topics: marijuana and gun violence.
Responding to votes in the Colorado and Washington legislatures to legalize recreational marijuana use, as well as to the legal use of medicinal marijuana in 18 states, Heather Toney, D.O., co-author of the resolution and a new physicians delegate from Kansas City, Mo., testified during the reference committee hearing that physicians need more research on the health implications of marijuana use for appropriate counseling of patients.
Delegates adopted a substitute resolution calling on the AAFP to investigate the feasibility of disseminating such information and for the Academy to encourage public funding to review existing data and support future study regarding the health implications of marijuana legalization.
Delegates also cited a need for evidence to support counseling patients about guns. They adopted a resolution that calls on the AAFP to support increased research into how gun violence affects public health and to support the use of federal funds for such research.
"This is such a polarizing issue," said Adnan Ahmed, M.D., a GLBT delegate from Lexington, Ky. "We need unbiased research that says how this affects the health of our people."
In addition, in response to a recommendation from the Council on Graduate Medical Education to increase the percentage of primary care physicians from 32 percent to 40 percent of the total physician workforce, delegates adopted a substitute resolution that asks the Academy to advocate that the majority of new graduate medical education residency slots be allocated to family medicine. The original resolution met no opposition in the reference committee hearing.
"This is a no-brainer," said resolution co-author F. George Leon, M.D., an IMG delegate from Waldorf, Md., during the reference committee hearing.
Delegates also adopted a substitute resolution that calls on the AAFP to support interoperability of state-based tracking systems for controlled substances that all prescribers can access. "It puts the physician in a bind when a neighboring state is only a few miles away," said Joylin Dsa, M.D., a minority delegate from Lewiston, Pa. "If (patients) go there, there's no way for us to track it."