For millions of women, getting birth control is a laborious process. Would making the pill an over-the-counter drug be the best policy fix?
Beth Schwartzapfel | March 17, 2009 |
Last week, birth control for college students got cheaper. An "affordable birth control" provision in the 2009 appropriations bill, which President Barack Obama signed last Wednesday, restored an incentive for drug makers to offer college health clinics discounts on the pill (the longstanding incentive had been inadvertently eliminated in a 2005 deficit-reduction bill). Still, even when it's cheaper, birth control will continue to be two things: inconvenient and thoroughly tied up with the medical system.
A trip to the doctor. Time off from work. A waiting room. A pap smear. A co-pay (assuming you're insured, of course). A trip to the pharmacy. Another co-pay. Then, finally, your birth control: 28 little pills, packaged in foil and plastic, standing between you and a pregnancy you don't want.
If you are one of the 11.6 million women in this country who relies on the pill to prevent pregnancy, this scenario, or some variation on it, has played out in your life again and again. It may not have to be this way.
"A pap smear is important. The pill is important. There's not really a connection between the two," says San Francisco gynecologist Dan Grossman. "It's a very paternalistic attitude to say, as a physician, we have to hold women's pills hostage -- you can't get your contraception until you get your pap smear."
England's National Health Service recently announced that later this year it will launch a pilot program to allow young women in two London neighborhoods to buy birth control over the counter after a brief consultation with a pharmacist. The London program is modeled after a pilot program that was conducted in Washington state between 2003 and 2005, in which 26 pharmacists throughout Seattle safely provided hormonal contraception -- the pill, patch, or ring -- to almost 200 women without a prescription. A similar study is being planned for California.
Now, a group of doctors, pharmacists, researchers, and advocates have received a grant from the Hewlitt Foundation to fund a working group that studies the feasibility of making oral contraceptives available over the counter: as easy to purchase as aspirin. According to the reproductive-health think tank the Guttmacher Institute, nearly half of women will experience at least one unintended pregnancy by the time they're 45, and almost a third will have had an abortion. Part of the reason for this, those in the working group say, is that the barriers to birth control are simply too high.
"It's harder and harder to access contraception care if you want it, here in the U.S.," says Grossman, who is a senior associate at the nonprofit research organization Ibis Reproductive Health, which coordinates the Working Group. "Non-use of contraception is going up among people who don't want to be pregnant, especially among vulnerable populations, like poor women and women of color." The group's hypothesis is simple: If birth control were easier to access -- fewer medical gatekeepers, less inconvenience, and lower cost -- more women would use it. If more women used it, there would be fewer unintended pregnancies.
Fair enough. But is it safe? What effect would a switch to over-the-counter status have on poor women's access to the medication? And if women were no longer required to get birth control from their doctor, would they still go for their annual exams?
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http://www.prospect.org/cs/articles?article=inconvenient_contraception