If you had to guess the number of unintended pregnancies each year, what would you say? Ten thousand? One hundred thousand? Five hundred thousand? The number is actually more like 3 million unintended pregnancies per year in our country. That's a staggering number, and amounts to about 50 percent of all pregnancies in the U.S.

Wait. Wasn’t the discovery and development of "the pill" supposed to change all this? We have had FDA-approved hormonal contraception available since 1960. For over half a century we have been improving and promoting contraceptive products with greater efficacy, fewer side effects and more convenience. You would think this shouldn’t be a problem anymore; but it turns out the solution isn't quite that simple.

Yes, we have made great strides in creating contraceptives that are safe and effective, at upwards of a 99.9 percent rate when taken correctly. We have also taken steps to help ensure contraceptives are affordable (and often free) through generics, women’s health programs and medical insurance. However, since all oral, vaginal and transdermal contraceptives still require a prescription from a physician, easy access to birth control continues to be challenging.

But that is all about to change .Legislation in at least two states, California and Oregon, has been passed to allow pharmacists to prescribe birth control without any need for a physician visit. What has happened with immunizations soon may be happening with contraception, as pharmacists continue to stretch the borders of their professional involvement in patient care and community health.

But is this the right move for pharmacists and for our profession? Is it the best thing for women’s health? Are pharmacists prepared and poised to take this on?

In the opinion of this pharmacist, the answer couldn’t be clearer. Absolutely, yes.

For years, the medical profession has been aiming to make access to contraception easier. By removing the barrier required by the need for a physician visit, and annual follow-ups, we will be taking a large step forward in that goal. Access improves utilization. It worked with immunizations, substantially improving the number of patients getting important vaccines.

As far as safety goes, we almost couldn’t ask for a much safer category of medications to work with.In fact, the American College of Obstetricians and Gynecologists (ACOG) has stated that hormonal contraception is safe enough to be made available over the counter without any prescription at all.

However, while OTC status would appear to greatly improve access, it would undoubtedly be a step backwards in affordability, as many health plans would no longer cover the medication. Pharmacists prescribing and evaluating for potential contraindications is the right move at this time.

Pharmacists remain the most accessible healthcare profession in our country. Pharmacists have the clinical training and pharmacologic expertise to not only prescribe contraception, but to work directly with women to select the most appropriate birth control for their needs.This move by California and Oregon should be quickly followed by every other state.

Now, my enthusiasm for this important expansion of the role of the pharmacist in our healthcare system does not come without some reservations about how this will be implemented .Currently, the process will still apparently involve a collaborative practice agreement, or "standing order," from a physician to allow the pharmacist to perform this function. It would be my hope that as we press for provider status, this need will be eliminated.

Additionally, it is reasonable to be concerned about how this will be executed in some of our nation’s chain pharmacies that have steadily gravitated toward a high-volume, low-margin model. Will sufficient time be allotted for pharmacists to counsel patients about contraindications? And what about reimbursement? Will health plans provide any added reimbursement to pharmacies, since this approach theoretically saves them money on a physician office visit?

However, it is my firmly held opinion that we simply cannot hold up progress on this issue any longer. We have made contraception safe. We have made it effective. But we haven’t done enough to make contraception easily available, and 3 million annual unplanned pregnancies is evidence enough for me.

Women shouldn’t have to wait for an appointment to obtain hormonal birth control, and at least as far as women in California and Oregon are concerned, the wait is now over.