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Over The Counter Birth Control? The Percieved Fight For Contraception Equality

Bloomberg reports:

Anyone — a local teenager, a traveling businessman, a married mother of four, an illegal immigrant, even a student at a Jesuit university — can walk into my neighborhood CVS any time, day or night, and, for less than $30, buy a 36-count “value pack” of Trojan condoms.

That’s enough to last most Americans at least three months, according to Kinsey Institute surveys. If you want more, you can buy out the store’s entire stock. There’s no limit, and you don’t need to see a doctor for permission and a prescription.

Contrary to widespread belief, there’s no good reason that oral contraceptives — a far more effective form of birth control — can’t be equally convenient.

Whoa.  Back up.  There is “no good reason” why oral contraceptives cannot be equally more convenient?  I’m not sure I agree.  I’ll hold judgment until they make their case, though.

True, making the pill available over the counter could reduce the amount of outrage and invective available for entertaining radio audiences, spurring political fundraising and otherwise amusing the American public. But the medical risks are quite low.

Partly because birth-control pills are available only by prescription, people tend to think they’re more dangerous and less well understood than they actually are. In fact, “more is known about the safety of oral contraceptives than has been known about any other drug in the history of medicine,” declared an editorial in the American Journal of Public Health back in 1993. That editorial accompanied an article arguing for over-the-counter sales.

First of all, the statement that the medical risks of the birth control pill are “quite low” is a complete medical inaccuracy.  Moreover, the second point that more is known about the pill now, than ever before has nothing to do with the medical risks.  This is a terrible set up argument, faulty at best.

Unlike most medications, the article noted, birth-control pills require no medical diagnosis: “A woman herself determines her need for oral contraception; she assesses her own risk of pregnancy … and the costs and benefits of both pregnancy and alternative contraceptions.” Nearly two decades later, birth- control pills look even safer than they did then, and recent research indicates that women are both able and eager to manage their own purchase decisions.

Requiring a prescription “acts more as a barrier to access rather than providing medically necessary supervision,” argues Daniel Grossman of Ibis Reproductive Health, a research and advocacy group based in Massachusetts, in an article published in September in Expert Review of Obstetrics & Gynecology.

Shame on this writer for suggesting a woman NOT get examined before taking the pill.  I am flooded with all the reasons why this is harmful to women, and to men, as well as the pharmaceutical and medical industries.

Oh, this is cute, way down at the bottom of the article they acknowledge *some* of the risks.

Birth-control pills can have side effects, of course, but so can such over-the-counter drugs as antihistamines, ibuprofen or the Aleve that once turned me into a scary, hive-covered monster. That’s why even the most common over-the-counter drugs, including aspirin, carry warning labels. Most women aren’t at risk from oral contraceptives, however, just as most patients aren’t at risk from aspirin or Benadryl, and studies suggest that a patient checklist can catch most potential problems.

To further increase safety, over-the-counter sales could start with a progestin-only formulation, sometimes called the “minipill,” rather than the more-common combinations of progestin and estrogen. (Although we casually refer to “The Pill,” oral contraceptives actually come in about 100 formulations.)

Progestin-only pills, or POPs, have fewer contraindications. Unlike combination pills, they’re OK for women with hypertension, for instance, or smokers over the age of 35. The main dangers are fairly rare conditions such as breast cancer or current liver disease. “Not only are POP contraindications rare, but women appear to be able to accurately identify them using a simple checklist without the aid of a clinician,” declares an article forthcoming in the journal Contraception.

Here is the beginning of my anger filled rant: the pill can be very dangerous to a woman’s health.  Birth control pills can cause blood clots.  If you, or a family member have any history of blood clots, taking the pill CAN KILL YOU.  You absolutely MUST be examined before taking the pill to ensure that you are not subject to this risk.  My mother has a history of blood clots and because of that I went through testing before embarking on the pill journey to ensure I was not at risk.  Moreover, because of this, I am only allowed to take certain formulas of the pill.  How would I know this without a doctor’s exam?  The answer is I would not know and I could be dead.

And what about patients who do not know their or their family’s medical history – shouldn’t they also be similarly tested?  I had a friend who took the pill and her allergic reaction was so severe it made her pull her own hair out.  She lost chunks of hair.  Wouldn’t you have rather you paid $20 for a visit than lost your hair, or died?

I get it, the pool of high risk candidates is smaller than not, but the RISK is DEATH and in a simple risk/utility (read: Logical) balancing test it’s clear that the small amount of precaution (a simple Dr visit – which is either your $20 co-pay if you are insured or close to free at Planned Parenthood) far outweighs the inconvenience.

Aside from safety, the biggest argument for keeping birth- control pills prescription-only is, to put it bluntly, extortion. The current arrangement forces women to go to the doctor at least once a year, usually submitting to a pelvic exam, if they want this extremely reliable form of contraception. That demand may suit doctors’ paternalist instincts and financial interests, but it doesn’t serve patients’ needs. As the 1993 article’s authors noted, the exam requirement “assumes that it would be worse for a woman’s health to miss out on routine care than it would be to miss out on taking oral contraceptives.”

Going to the doctor is costly in time, money and sometimes in dignity. Not surprisingly, the prescription requirement deters use of oral contraceptives. In a 2004 phone survey, 68 percent of American women said they would start the pill or another form of hormonal birth control, such as the patch, if they could buy it in a pharmacy with screening by a pharmacist instead of getting a doctor’s prescription. Two-thirds of blacks and slightly more than half of whites and Latinas surveyed said they chose their current, less-effective method of birth control because it didn’t require a prescription.

“FORCES” women to go to the doctor?!  Are you kidding me?  Since when is that a BAD thing?  If a woman is sexually active she SHOULD be going to the doctor at least once a year if for no other reason to get an STD panel done to make sure she isn’t infecting the world with a new strain of goodness knows what. (To be fair, so should men).

“Going to the doctor is costly in time” they claim.  Pshaw.  It’s about an hour, including the drive.  For me, it’s about 30 minutes – TOPS.  The exam is literally 5-10 minutes, relatively painless, and again – if you are insured it si about $15-$30 and if you are uninsured you can get said exam and birth control at largely subsidized rates at Planned Parenthood or for free at a free clinic.

The article goes on to yet another slam dunk argument (sarcasm intended) about cross border prescriptions in Mexico.  So idiotic I cannot even go there.

I love the pill.  I think more women should take the pill (if that is their preferred method of contraception).  But I also think we, as a society, have done a very good job of making it easily accessible, without unnecessarily increasing the risk – which is exactly what making this an OTC purchase will do.

For more interesting insight into how the pill effects you read here.



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