The New York Times published an op-ed piece a few days ago about making the birth control pill available without a prescription. Kelly Blanchard, president of Ibis Reproductive Health, offers the following rationale:
Women don’t need a doctor to tell them whether they need the pill — they know when they are sexually active and want to avoid pregnancy. Pill instructions are easy to follow: Take one each day. There’s no chance of becoming addicted. Taking too many will make you nauseated, but won’t endanger your life, in contrast to some over-the-counter drugs, like analgesics.
I have mixed feelings, myself. I’m in favor of just about anything that makes contraceptives more accessible to the people who need them, but I fear that the likely increase in cost of OTC pills means the availability won’t benefit those who most the need them – the young and the poor. Also, there are some contraindications for pill use, such as high blood pressure, history of migraine, and use of certain anti-seizure drugs for epilepsy. And despite the happy, shiny images of Yaz and Seasonique commercials, some women just can’t tolerate the side effects, for any number of reasons.
What do you think, re:Cycling readers?
I am all for making birth control options as accessible as possible for women and with as much information as possible. If hormonal birth control was made available OTC I suspect there is even less likelihood than now that women would be informed about 1) how the “periods” they have on hormonal contraceptives have nothing to do with normal ovulation and menstruation, 2) that hormonal contraceptives include synthesized molecules that are not normally produced by a woman’s body and are therefore alien to her body and as such may cause profoundly disturbing side effects, 3) the decades long controversy about the safety of hormonal contraceptives, and 4) that hormonal contraceptives are designed to profoundly disrupt normal female endocrine function, which in turn affects her psychoneuroimmunology? Hormonal contraceptives OTC cannot be considered the same as condoms or a diaphragm OTC — in fact we would think it silly to suggest a woman fit herself for a diaphragm.
The only good reason for doing this, in my warped opinion, is that if women were making the choice to start using OC’s without a doctor’s persuasion, support or guidance, they would also start making the choice NOT to take them, without being dissuaded by a doctor. When women present with side effect issues, they are often sent on a wild goose chase from pill to pill to ring to patch to yet another formulation to try and find the “right” pill or delivery method. I doubt most women would bother with this exploration on their own, let alone undertand how to choose one pill from another. One bad experience and the pills would end up in the garbage. And then we better have those “diaphragms and how to use them” clinics and workshops ready to go.
But truthfully, I doubt very much docs would be willing to give up the power of prescribing these drugs. They must realize that compliance would plummet like a 10 ton block of cement in the ocean if choosing and using hormonal contraception were left up to women. Typical effective rates would also drop. In addition, I believe we would start to see many more “negative events” in women for whom these drugs, or variations of these drugs, would be contraindicated.
Since I’m a historian who works on the history of contraceptive technology I find this article very interesting (along with your earlier post on the diaphragm). I’m working on the history of this discussion, which came up in the early 1990s. A lot of the supporters then
and now are physicians and public health professionals. On the other hand, some
women’s health activists have questioned this switch for some of the same reasons
you mention above — e.g. safety, the influence of pharmaceutical companies and direct-
consumer advertising. It’s a complex story that overlaps with the battle to get
emergency contraception OTC (which I’m also writing about).
Anyway, those are just some preliminary thoughts.
Clio, I first heard about this about ten years ago, in the context of service on the board of directors of my local Planned Parenthood affiliate. The physicians on the board were generally in favor – “it’s safer than aspirin”, I recall one doc telling me. If I recall correctly, the PP admin folks were concerned about costs – at that time, PP was able to purchase pills for CONSIDERABLY less than retail. (While they still usually get a better price than the rest of us, they’re paying a lot more for pills these days.)
I agree that it’s a complex issue, with many threads to untangle.
Elizabeth — I’ve heard the phrase “safer than aspirin” before too. In a literal sense, it’s true — aspirin has so many risks associated with it (especially for children) that today it would be unlikely to be approved even as a prescription drug.