In all the fussing over the sale of emergency contraception over-the-counter (OTC), it’s easy to forget that there’s another contraception drug out there that should be available OTC but isn’t: the ordinary, everyday birth control pill. The American College of Obstetricians and Gynecologists (ACOG) thinks birth control pills should be sold OTC. Most other countries sell birth control pills OTC. And now, as ThinkProgress reports, nearly two-thirds of American women say they want the pill sold OTC, and about 30 percent who aren’t currently on the pill would consider going on it if this option was available.
So why can’t we have this, when the public and the medical establishment both think it’s a great idea? Part of it is no doubt the politics of it. As the furor over emergency contraception—which you only take in emergencies (and don’t need if you’re consistent with your birth control pills)—demonstrates, the idea of women being able to prevent pregnancy easily sets off all sorts of irrational reactions in this country. You should have to struggle for it to prove you deserve to be not-pregnant, because … mmmph that’s why. The religious right already believes that contraception is too easy to get, which is why they’ve been attacking it with so much vigor lately. Trying to make birth control pills available OTC would set off a political firestorm that would make the emergency contraception wars look like mere skirmishes.
Still, for women’s health, I believe that’s a fight that pro-choicers would be happy to have (though maybe not the folks in the Obama administration trying to maintain the ruse that they better understand medical risk than researchers and doctors). The problem here, however, is that there’s still a widespread belief that birth control pills need to be prescription-only in order to make sure women go to their doctors. Unlike many of the other countries that have the pill available OTC, the United States doesn’t have universal health care (yet, though in 2014, we may see this shift dramatically due to Obamacare), which means that doctors have a uniquely difficult time in this country encouraging women to go to the doctor regularly. The argument is that we need to use the pill as bait to make sure women are going to their doctor—or to a local Planned Parenthood—to get their check-ups.
It’s a tempting argument, but something that needs to be tossed out for a number of reasons. First and foremost, as pro-choicers we need to adhere closely to the principle of supporting a woman’s right to the ultimate authority over her own health care. If birth control pills are safe enough to be sold OTC, then it’s up to a woman to decide if she wants a doctor’s supervision to take them, just as we allow individuals to make that determination with other drugs, like allergy medications or pain killers.
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Second of all, the science doesn’t support the claim that using the pills as bait supports women’s health better than decoupling the pill from regular exams. Increasingly, research supports the conclusion that American doctors overuse the pelvic exam and the Pap test. Forcing women to take a major health risk with unintended pregnancy in order to get them to submit to a bunch of medical tests they may not even need is not good medical practice, especially when you consider that pregnancy requires massive medical intervention whether a woman chooses abortion or to bring the pregnancy to term.
Most importantly, there’s no reason to believe that women will stop getting regular medical care just because they can buy the pills OTC. Prescription pills will be available without a co-pay for insured women under the Department of Health and Human Services (HHS) regulations, which will be plenty of encouragement for women to keep in regular contact with their doctors without taking away their right to choose. In addition, making pills available OTC could be met with creative responses to use the pill-buying experience as an opportunity to encourage women to get checked up by a gynecologist, albeit by the more relaxed new standards instead of the old, overly invasive routine.
Planned Parenthood could play a major role in all this. Planned Parenthood clinics could continue to offer pills with a deep discount by tweaking their already-existing practices slightly, but when women come to pick up their prescription-free pills, the staff could use that time to highlight other important services they offer. Knowing that they don’t actually have to come in for invasive tests every year could encourage a lot of women who are currently hesitant to come in. Perhaps some of those 30 percent of women who aren’t on the pill but would consider it if they could get it OTC would be reached. They aren’t being reached now, if they avoid family planning clinics completely out of an overblown fear of being subject to too many tests. College health centers could play a similar role, offering the pills OTC but also including information on getting inexpensive and non-invasive check-ups.
Right now, birth control pills being prescription-only means that they’re decoupled from condom use. You can go pick up pills at the pharmacy counter without even walking by the condoms in most drugstores, creating this sense that there are “pill users” and “condom users,” and that they don’t even share an aisle. But if pills were sold OTC next to condoms, as emergency contraception soon will be, that creates an association. They could even be advertised as things to be used in conjunction with each other. If you’re with a partner in a non-monogamous or non-tested relationship, it would make it much easier to think of yourself as someone who uses condoms first and the pill as back-up.
We should charge ahead on this unafraid. Standing up for OTC birth control pills would absolutely be a hard, long fight, but it would be one that demonstrates that the pro-choice community really means it when we say we trust women with their own health-care decisions. Putting more time and resources towards this also means picking another fight with the right over contraception, and history shows that’s a fight that tends to favor our side in public opinion.