SEATTLE, Washington -- Step right up to the pharmacy counter, answer 23 questions and walk out with birth control pills.
That's all it takes for women enrolled in a study that is believed to be the first effort in the nation to offer hormonal contraceptives at drugstores without a doctor's prescription.
The University of Washington project aims to find out if women and pharmacists are comfortable with drugstore delivery of birth control pills, patches and vaginal rings.
That doesn't mean women should stop going to the doctor for annual checkups to guard against sexually transmitted diseases and other problems. But most medical organizations agree it is not necessary to have a pelvic exam to get birth control pills and the like.
The best situation is for every woman to have immediate access to medical care, "but there are women who don't have access, and there are some barriers and difficulties," said Dr. Robert Palmer Jr., an obstetrician-gynecologist on the study's advisory board. Palmer is also state chairman for the American College of Obstetricians and Gynecologists.
The study is also embraced by family planning and population control experts.
James Trussell, director of the Office of Population Research at Princeton University, is hoping the idea will spread.
"It's a terrific idea. Seeing a pharmacist is just fine for these methods," he said, noting that half the pregnancies in the United States each year are unintended.
"Anything that is expanding access to people where and when they need it is a positive thing," said Robert Harkins of Planned Parenthood of Western Washington.
A good-health checklist
More than 50 women have enrolled since the study was launched February 23 by the UW School of Pharmacy and Department of Obstetrics and Gynecology with funding from the National Institutes of Health. Researchers hope to enroll 300 women.
Women 18 to 45 years old can visit any of eight Fred Meyer or Bartell pharmacies in Seattle and its suburbs, complete a health questionnaire and have their weight and blood pressure checked.
If they pass a good-health checklist, they can obtain three months of birth-control pills or patches right away, and an additional nine months' worth at a follow-up visit. The price is $25 per visit plus the medicine. Insurance companies generally will not pay.
Washington state has a long history of bold moves regarding women's health. It became the first state to legalize abortion through a vote of the people when an initiative was approved in 1970.
And Washington was also the first to allow the morning-after pill to be given out without a doctor's prescription. A University of Washington study in 1997-99 pioneered the practice -- and it spread. Emergency contraception now is available at pharmacists' counters in California, Hawaii, Alaska and New Mexico.
Trussell predicted this latest idea will be copied elsewhere, too. The pharmacies involved report many callers asking about the project.
Lead researcher Jacqueline Gardner, a pharmacy professor at UW, said the birth-control study was an outgrowth of her team's earlier work on access to the morning-after pill.
"The pharmacists were feeling frustrated when a woman came in for emergency contraception and they gave it to her, they would say, `What do you plan to use?' and lots of times they didn't have a prescriber or a method in mind," Gardner said.
Pharmacists get eight hours of special training and operate under a set of rules approved by a doctor -- an arrangement already permitted by the state for other types of medicines.
They screen out women who are very obese, are heavy smokers or have high blood pressure, a history of breast cancer, blood clots or other risk factors.
Mixed reactions
Most of the 50 women already enrolled have previously seen doctors and used hormonal contraceptives but have not had easy access because of a recent move or some other problem, Gardner said.
Pharmacist Don Downing, another researcher, said he believes women who do not have doctors but need birth control are likely to be interested.
"Pharmacies don't have tables with stirrups on them and I think that's a bonus, and we're available after hours and weekends when most clinics are not open," Downing said.
Two women shopping near Bartell's 24-hour pharmacy in Seattle told The Associated Press they have mixed feelings about the program.
"We don't want women being jeopardized in any way taking medicine that is not monitored in some way," said Kim Daley, 27.
Danielle Levine, 23, said annual checkups are important.
Common side effects of hormonal birth control are irregular bleeding, nausea, vomiting, breast tenderness and swelling.
Dr. Elisabeth Evans, an obstetrician-gynecologist at Overlake Hospital Medical Center in Bellevue, said birth control pills are very safe.
However, she said one advantage of seeing a doctor is that a woman gets checked for sexually transmitted diseases, including human papilloma virus, which is a precursor to cervical cancer.
"I think personally the positives probably outweigh the negatives for women," she said. "I think it's hard for women to always go to the doctor to get a prescription for something that's probably safer than aspirin."
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