The Pill over the Counter and Birth Control Accessibility

I am absolutely thrilled by the American College of OBGYNs’ recent recommendation that the birth control pill be available over the counter. From the press release:

Oral contraceptives (OCs) should be sold over the counter (OTC) in drugstores without a doctor’s prescription, according to The American College of Obstetricians and Gynecologists (The College). Easier access to OCs should help lower the nation’s high unintended pregnancy rate, a rate that has not changed over the past 20 years and costs taxpayers an estimated $11.1 billion annually.

Cost, access, and convenience issues are common reasons why women do not use contraception or use it inconsistently. There are no OCs currently approved for OTC access, but The College believes OTC availability will improve women’s access to and usage of contraception. The benefits of making OCs easily accessible OTC outweigh the risks, says The College.

Even though no drug is risk-free, the overall consensus is that OCs are safe. There is a risk of blood clots with OC use, but it is extremely low and significantly lower than the risk of blood clots during pregnancy and the postpartum period. The College points out that aspirin and acetaminophen are both available OTC even though they have well-known health risks.

Studies show women support OTC access to OCs and are able to self-screen with checklists to determine their health risks. Evidence also shows that women will continue seeing their doctor for screening and preventive services even when allowed to purchase OCs without a prescription or doctor’s appointment. Women who receive more than one month’s supply of OCs at a time have higher contraceptive continuation rates than those who receive fewer pill packs.

Last year in the wake of all the hullabaloo over the birth control mandate, which requires insurance companies to cover birth control without a copay, one constant meme on the Right was that birth control is already ridiculously easy to get, and that nothing more is needed. They basically reduced the issue to “sluts” wanting the government to pay for their birth control.

Of course, the conservative narrative missed the issue on several levels – one being that we’re talking about insurance companies covering birth control as part of an insurance package purchased by an employer or an individual, not about the government doing it or about it being free - but one key issue was just how easy, or difficult, obtaining birth control was before the mandate, and on this topic conservatives displayed a dismaying level of ignorance about women’s health care and birth control in general.

At the time, I read an article in the National Review - a publication I respected in my conservative days – arguing that birth control is so widely available that the idea that it needs to be made more widely available is laughable.

Were one to have listened uncritically to the more hysterical elements in America’s news media over the past month, one would have concluded that contraception is intractably hard to come by in the United States; but a cursory glance at the New York City Department of Health and Mental Hygiene’s well-appointed website gives quite the opposite impression. There, contrarily, visitors are informed that anyone in need of contraception is somewhat spoiled for choice.

If the website’s extensive online search facility does not meet with their approval, habitués can instead call 311 and ask for advice directly. And the more tech savvy — or, perhaps, desperately mobile — can download the free “NYC Condom” app to their Windows, iPhone, BlackBerry, or Android smartphones and have its GPS service direct them to the nearest provider of free contraception with devastating accuracy. Never has a society been so precisely and easily led to safe sex. (One might well ask whether someone who can afford a smartphone and its attendant bills is genuinely in need of an app that locates “free” — i.e., paid for by taxpayers — condoms, but then this is 21st-century America, and New York’s mayor is Michael Bloomberg, so such petite questions are unavoidably consumed by bigger ones.)

The NYC Condom program’s not-so-subtle slogan is “Grab a handful and go,” which, having set out yesterday to source some myself, I found to be rather a solid description of the process. And the Department of Health’s offerings are not just generous but also various: “NYC”-branded condoms are available for both men and women, and in addition to the curiously titled “Lifestyles Alternative Condom,” complimentary “Personal Lubricant” is also available at select locations.

The author does eventually acknowledge that there is birth control out there besides condoms.

The Children’s Aid Society was a little more comprehensive in its offerings. It has three centers — in midtown Manhattan, Harlem, and the Bronx — all of which receive New York State Title X grants. Women can visit centers in Harlem and the Bronx to arrange for their contraception — including more permanent methods such as the ring, the patch, and the Pill. If their insurance covers contraception, the insurance must pay for it. If it does not and the woman in question is living below the federal poverty line, she will be given the contraception without charge. (The HHS mandate, remember, is not designed to help the poor; the overlap between them and those who are employed is, by definition, minuscule.) Condoms, meanwhile, are just given out gratis, although the representative I spoke to told me that relatively few people take advantage of this provision.

This, I think, gets to the absolute lack of understanding going on here. Birth control that requires male involvement – i.e. condoms – is available for free in many places (note: the author seems to think that just because he can find free condoms in NYC they must be also available everywhere; I he underestimates the resistance to things like free birth control, which might – horrors! – encourage promiscuity, in smaller and more rural areas). Birth control that is completely controlled by the female, i.e. the birth control that is most effective, is generally not.

More than that, birth control like the pill, the implant, or the IUD all require a visit to the doctor. Every time I heard someone say “you can get the pill for $9 at Walmart” or some such similar phrase, I wondered whether those saying that were aware that you have to have a prescription to do this. I can simply walk into Walmart and buy tylenol or aspirin. I cannot simply walk into Walmart and buy the pill.

Now, for some forms of contraception this makes sense. A woman has to have the implant, well, implanted, and an IUD has to be carefully inserted by a doctor. Having things like this covered by insurance without a copay or having to run through a deductible will be extremely helpful in allowing women to gain access to the most effective methods of birth control – and allowing them to freely choose which method is best for them. But the pill?

I understand that there are concerns with allowing any drug to be available over the counter, but if medical organizations like the American College of OBGYNS, made up of the people currently doing the prescribing of the pill, think that it’s safe to allow the pill to be purchased over the counter, I’m all for it. In fact, I think it’s awesome. This way a woman who wants more reliable birth control than condoms, and birth control she can control, can obtain it without having to schedule a doctor visit or pay any fees. All she has to do is pay for a packet of pills, and she’s good to go.

To bring this back around to the National Review article, I think that article and others like it, including Rush Limbaugh’s complete ignorance about how contraception works (when you’re on the pill, it’s not pay per sex act, it’s a flat rate regardless of how much sex you have, and it turns out Rush had no idea it worked this way – and I’m not sure he’s figured it out since, either), displays a lack of understanding of birth control, women’s concerns, and women’s health care. Birth control does not equal condoms. In fact, at the moment, you can’t get the pill without seeing a doctor first, which means scheduling an appointment and taking time off of work and, before the mandate, also meant a fee in the form of a copay or deductible. But maybe, just maybe, that is all about to change.

About Libby Anne

Libby Anne grew up in a large evangelical homeschool family highly involved in the Christian Right. College turned her world upside down, and she is today an atheist, a feminist, and a progressive. She blogs about leaving religion, her experience with the Christian Patriarchy and Quiverfull movements, the detrimental effects of the "purity culture," the contradictions of conservative politics, and the importance of feminism.

  • jose

    But Obamacare doesn’t cover over-the-counter medicines. Wouldn’t this make the pill expensive?

    • Makoto

      Technically, it’s still covered as a preventive service, so it’s still free-ish, depending on the insurance plan, as it would have been before.

      • Amanda Price

        My thoughts exactly.. just saw something about otc pills not being covered by health insurance anymore on eQuibbly and even if that costs just $9 a sheet; that still amounts to $108 a year – maybe more for high-end brands. Then, pills don’t exactly protect you from HIV and other sexually-transmitted disease so how’s that a better option?

    • Carys Birch

      When my allergy medication went OTC, I could no longer afford it. I’m desperately worried this will happen with hormonal birth control.

      • kenneth

        OTC always lowers prices in the end. I too take an a daily allergy pill, loratidine, and I’ve taken it since it came out in the early 90s. At the time, I was paying $3 a pill! Now, 10 years after it went OTC, I pay about 3 cents each! OTC status brings real competition, unlike the price fixing and captive markets of Rx drugs. Before long, the brand name OTC is competing with every huge discount chain that decides to market their own store brand. It also pays to buy multi-packs of store brands online. You will find they are much cheaper than the small boxes sold in walk-in stores.

        The insurance price gap you speak of only holds true for the diminishing slice of the population which still has insurance with real prescription benefits. If you have it, it’s great. If you don’t, you pay the highest prices on the planet for prescription drugs. Pharmacies charge a much higher price to people who pay all out of pocket.

      • http://dukesofearl.blogspot.com Joy

        It isn’t OTC status but competition with low-priced generics that brings down cost. There are already low-priced generic birth control pills on the market so I would not necessarily expect OTC status alone to bring prices down much further.

      • Carys Birch

        I actually don’t have insurance at all, but I qualify for a prescription assistance program due to my income. But it has to be a prescription.

        I also know that the difference affects a small number of people and it’s dwindling, and I’m definitely in favor of measures that improve things for more people than just myself… I hope it will be a positive step collectively. But I still can’t help but feel grim thinking about what will happen to me if that does follow a similar path. Probably what will happen to me is condoms, and it’s not the end of the world, but it will be a step backward for some of us, and I think I’m entitled to feel concerned about it. When it happened with my allergy medication, we tried to convince my doctor to prescribe for me something that was still coverable. They refused to do so, because the OTC was available. The result was, I suffered with allergies for years with no relief (except if I was in a situation where the drowsiness of diphenhydramine wasn’t a problem).

        If something similar happened with my birth control I could get condoms, but I wouldn’t get any of the side-benefits of the pill either (easier periods, clearer complexion, protection in the event of something non-consensual happening to me).

        That said, I’ve had great experiences with Plan B since it went OTC, so I’m hopeful it might turn out great… just Plan B isn’t something you have to budget for monthly, I’ve picked it up exactly twice.

    • http://salami-orchids.blogspot.com PlumJo

      Is there any insurance that covers OTC meds?

      • http://salami-orchids.blogspot.com PlumJo

        In the US, I mean.

      • http://www.facebook.com/lucrezaborgia lucrezaborgia

        No. The closest thing you can get to coverage for OTC meds is a pre-tax medical expense plan that you contribute to out of your own paycheck. The money must be spent entirely each year. It’s a huge savings to people with chronic issues, but it’s still not cheap

  • machintelligence

    The whole rationale for having some drugs available only by prescription needs to be examined. Certainly there are some classes of drugs which must be limited in distribution, but in other cases it is done for economic reasons. My favorite example is Prilosec and quoting myself

    Generally OTC drugs are cheaper than prescription drugs. Prilosec, for example, once only available by prescription for treating ulcers, is now available OTC for treating gastric reflux (heartburn). The cost for a 20 mg. tablet is about $1.40 by prescription and $.55 OTC. Of course, almost no one has stomach ulcers anymore, since they have identified the bacterium that causes them and treat the infection rather than the symptoms. Almost like magic, they found a new (or at least popular) use for this “powerful prescription only” drug and now sell it OTC.

    IMHO one of the reasons for the popularity of herbal remedies (and even worse, the quackery of homeopathic treatments) is that they are available OTC.

    • http://dukesofearl.blogspot.com Joy

      While ulcers caused by H. Pylori are declining rapidly, ulcers from other causes are still found and treated. NSAIDs are a larger cause now.

  • http://dukesofearl.blogspot.com Joy

    “think that it’s safe to allow the pill to be purchased over the counter” — I think it’s more accurate to say that ACOG thinks that the benefits of allowing the pill OTC outweighs the risks. No drug, OTC or not, is completely safe. My understanding is that for the pill to be available free at point of service, though, will still require a prescription and perhaps the ACOG is relying on mechanisms like that to make sure that women on the pill still receive the appropriate screenings. Of course, no manufacturer has yet applied to make the Pill OTC, and there are a lot of formulations–I wonder if it will be one of the older generics that goes OTC first.

  • http://www.facebook.com/lucrezaborgia lucrezaborgia

    I think a good step in that direction is allowing women to get more than a 3 month supply of pills at a time. It would cut down on administration costs as well as the overall cost of the pill in general. This could also apply to the nuvaring.

    • plunderb

      My insurance only allows one month at a time, and I can only purchase it within a specific 7-day window. I have to plan travel and research trips around my birth control (they won’t send it in the mail because I haven’t lived at my current address for 3 years). Thank goodness for Planned Parenthood — they fill the gaps in my coverage.

      • http://www.facebook.com/lucrezaborgia lucrezaborgia

        You’d think people were snorting it with those restrictions.

  • Karen

    Cue the Catholic church to have their usual fit in 3…2…1…

  • http://mymusingcorner.wordpress.com Lana

    Sex is not an illness. You shouldn’t have to go to the doctor to get a BC pill.

  • Noelle

    Here ya go, if you’re interested. How an Rx med gets reclassified OTC: http://www.aafp.org/afp/1998/0501/p2209.html

    It usually takes a name-brand company willing to jump through hoops to extend its patent.

  • Meyli

    Oh this would make things easier. I can’t stand only being allowed to get mine one month at a time, because my insurance won’t allow more than one months’ supply :-/

    • http://dukesofearl.blogspot.com Joy

      One pack of pills, though, is not a month’s supply. It is 28 days supply. That’s why my old plan always gave me 2 packs per refill. This becomes most important near the end of the year–you need 13 packs for a year. Well, 13 + 1 pill which would really be 14 if you want to keep up with the medication.

  • Little Magpie

    I hope this happens.

  • Rae

    I’d support it being available OTC but needing to request it from a pharmacist, like some sorts of OTC medicines are right now. Because the accessibility needs to be balanced out by the fact that, at the current point, there’s very poor education regarding birth control – I know many young women who didn’t or don’t understand that it must be taken daily, and I’ve known even more who think that they can just safely go on it without a doctor’s appointment if the reason they’re going on it is reproductive related problems and not just contraception.

    • Christine

      That was exactly my worry when I heard about this. I forgot that there are OTC things that you have to ask the pharmacist for (which is funny, because I take ferrous gluconate regularly). I’m worried by the fact that even with the mandatory two points of contact with health professionals now so many women don’t know how to take it.

      • Sarah-Sophia

        I definitely think they need to improve sex-ed first. A lot of people buy baby oil or vaseline because it’s cheaper than KY or other lubricants but you are not suppose to use oil-based lubricants with condoms. Not to mention at work I’ve had to explain to more than one person why I can’t put their condoms in the same bag as their frozen dinners/cold drinks. One woman even thought it was okay to put condoms next to a bag of ice. (Don’t get me started on douches and diet pills).

      • Christine

        You know what’s really sad? I have a degree in mechanical engineering, my husband works in polymers. I can tell you very technically why it’s a bad idea to put condoms next to cold stuff. Would it occur to me to watch where I packed them? Nope. (I’ve bought condoms all of twice now…) I only would have caught heat.

  • Katherine

    I remember hearing that at one time the pill was only available to married women only. Women had to lie to their doctors to get it. Giving BC to unmarried people would lead to “non-procreative sex” and outside of a marriage too- oh the horror! Today they obviously haven’t changed. They are still afraid of people having premarital, not-for-babies sex. That’s what the opposition to birth control availability comes down to.

  • Ursula L

    Right now women who could get birth control pills over the counter will still get routine screenings and preventative services. But can we count on this continuing in the future?

    Before the pill was available, women didn’t seek out routine gynecological care, only obstetric care and a source for the birth control methods available at the time, such as diaphragms.

    When the pill became available, it was prescription. This made complete sense at the time, because it was a new medicine, with only limited testing.

    But it also created an opportunity, and getting your birth control was tied to getting your annual exam and screenings. This, in turn, made a huge difference in the amount of screening done – almost every woman would, at some point, want birth control, and would, in the process, be screened for things like cervical cancer, and also develop a relationship with a doctor who was a source of health education.

    Death rates from things like cervical cancer plummeted, simply from early detection, even before all the treatments we use now were developed.

    Right now, a woman who has developed the habit of annual exams (because that’s what you do to get the pill) is likely to keep up the habit, out of, well, habit.

    But what about a young woman who is using the pill for a first time? Who is perhaps, buying it in secret from her parents, and who can’t seek out a gynecological exam without either having it show up on her parents’ health insurance or paying cash? If she develops the habit of just buying birth control pills, in the way that her mother developed the habit of getting an annual exam in order to get birth control pills, what will help develop a positive habit of having an annual exam because it gets you something really, really important and good (birth control pills.)

    ***

    My point is not, in any way, that birth control pills should not be easily available, even over the counter.

    ***

    My point is that if we separate the annual exam from the benefit of the annual birth control prescription, we probably want to have something just as wonderful as the birth control pill as an incentive for that annual exam.

    Detection of disease is not a suitable incentive. People aren’t willing to deal with invasive screening as frequently as once a year just for the sake of detecting disease for early treatment. Who has an annual colonoscopy? Detection of disease is a negative incentive – you’re enduring the screening to avoid something bad, not to get something good.

    ***

    Everyone involved in this discussion takes it for granted that women need an annual exam. And that is an idea that has grown from the fact that a woman goes to her annual exam to get her annual birth control prescription, and access to effective birth control is utterly wonderful and in most cases worth any inconvenience associated with an annual exam.

    ***

    If we change the connection between birth control and annual exams, then we’re going to be changing the way in which future generations of women weigh the cost/benefit analysis of getting that annual exam.

    It may well be a worthwhile trade-off.

    But it isn’t a trade-off we should make assuming that a generation of women who routinely buy birth control pills at the grocery store drug aisle, from the very first day they want them, will make the same decisions about annual exams as women who have, for their entire reproductive lives, had to get the annual exam to get birth control pills.

    Different circumstances, different costs, different benefits.

    ***

    We have a good counter example.

    The most effective, non-permanent, available birth control method that men can control is condoms. And men can buy condoms over the counter. Always have been able to. See no risk that they might need a doctor to sign-off on condom purchases in the future. Men also are not anywhere nearly as likely to get annual exams and screenings as women.

    • machintelligence

      With the increasing immunization of women (and men) against HPV, the need for annual cancer screening should decrease. I have also heard that annual health checkups do not result in better health. http://www.bmj.com/content/345/bmj.e7001 That is just the abstract, I am not a subscriber to BMJ.

    • plutosdad

      We don’t put hoops in front of men to jump through, assuming men are too dumb to go get checkups that they need. Why do we assume women won’t take care of themselves if they don’t have barriers in the way?

      And secondly, why are birth control and cervical cancer linked? I doubt it truly has to do with making sure women get checked. If that were the case, we’d have mandated HPV vaccines already.

      • Noelle

        Everyone, regardless of age or gender, should have a primary care physician to call his or her own. Anyone on prescription meds finds themselves at the very least in need of an annual med review. If annually, you also happen to get the other recommended things checked (wt, bp, go over that family history, are you smoking, are you due for any labs, and other screening like paps and mammograms and colonoscopies) then your health care professional is doing what he or she is trained for to keep you healthy. Cervical cancer still kills women. If coming to the end of the year of a prescription reminds them they’re due for a pap, then that a good thing. Most offices will Rx a few more months worth if needed to tide someone over to get in. It’d be nice if men had the same reminder to go in for regular preventative care. Often, by the time they do wander in, it’s because a disease process has already set in and is causing organ damage that would’ve been preventable if caught earlier.

        This is hardly just for the ladies, or just for contraception. For those with HTN, a doc would like to make sure the med’s working and not giving you side effects a couple times a year. Same for diabetes, coronary heart disease, acne, etc. Last I checked, these were equal-opportunity conditions regarding gender. And while one is there to go over a med, all the other healthy living and preventative care can be addressed at the same time.

        Contraception and cervical cancer are not linked. But neither is sinusitis and diabetes. But of you see your PCP for one, he or she can use that visit to treat the other too.

      • plutosdad

        that does not answer the question:

        Why are women singled out to not get drugs they need unless they see a doctor and get certain tests (that have nothing to do with those drugs) but men DO NOT have similar hoops to jump through to get drugs they need?

        The only arguments to make a drug OTC or not are whether it is safe and easy enough for people to use. NEVER do we say “but men are too dumb and lazy to go to a doctor first” , that is not a reason. But suddenly when it comes to pills for women, we can’t trust women to care for themselves, so we decide to take it upon ourselves to do it for them.

        Do you see the double standard, and how this “looking out” for women is actually inftantalizing them?

      • Noelle

        Men have to go to the doctor too for Rx drugs.

    • EEB (Aust)

      Using that reasoning we should force men to see a doctor when they want condoms…compulsory prostate check or no condoms. It would be considered unacceptable, yet that’s what has been happening to women for decades, medical coercion and to think some women actually agree with the practice.
      Of course, these exams have nothing to do with the Pill, are completely unrelated and were only linked to the Pill to force women into annual exams and screening. This put many women off the Pill, I’ve never used it.
      The routine pelvic and breast exam… take a look at the evidence…the pelvic exam is of poor clinical value and exposes women to risk, even unnecessary surgery. Dr Carolyn Westhoff, ob-gyn, partly blames this exam for America’s high hysterectomy rates and for the removal of healthy ovaries. The routine breast exam, no evidence it helps, but it leads to excess biopsies. These exams are not recommended at any age in asymptomatic women of any age in many countries, including Australia. Pap testing is an elective cancer screening test that legally and ethically requires our informed consent, it is no different to colonoscopies or mammograms. Also, women have been horribly over-screened which does nothing more than greatly increase the risk of a false positive and potentially harmful over-treatment. The Finns have had a 7 pap test program, 5 yearly from 30 to 60, since the 1960s and have the lowest rates of cc in the world and refer far fewer women for colposcopy and biopsy. The Dutch have the same program, but will shortly move to a new program, following the evidence, women will be offered 5 hrHPV primary triage tests offered at ages 30,35,40,50 and 60 and only the roughly 5% who are HPV positive and at risk will be offered a 5 yearly pap test. There is already a self test HPV device in use, something long overdue. This program will save more lives and finally protect the vast majority of women from a lifetime of unnecessary pap testing and the high risk of over-treatment. As a low risk woman my risk of cc is near zero, while the lifetime risk of referral thanks to false positives is a whopping 77%… the risks were too high for me and I have always declined to test.
      The Pill has been proven safe over decades and should have been freely available a long time ago, the risks with an unplanned pregnancy, abortion, ectopic pregnancy or miscarriage are much higher. It is shameful that unnecessary medical barriers have prevented access to the Pill and our need for reliable contraception has been used to coerce women into elective screening, over-screening and unnecessary and potentially harmful gyn and breast exams. Over-screening has created a vastly profitable industry in the over-treatment of CIN, so many women have been harmed unnecessarily, mentally and physically. Cervical cancer was always rare and was in natural decline before testing started, the lifetime risk is less than 1%…0.65%…there was no need to harm so many with testing following the evidence, doing what’s best for women and with some respect for informed consent as Finland and the Dutch have shown the world.

  • Marta L.

    I was a bit confuzzled by some things Libby Anne said about non-condom birth control – that it was the only form of contraception that was completely under a woman’s control and that it was the most effective kind of contraception. It’s clearly the only kind women take themselves, but wouldn’t a woman also have control over a condom use? Women can carry them, and women can insist a man wear them after all. Or am I missing something? And on the efficiency point, I thought condoms were effective, if used properly – I always thought the problem was in the condoms being misused, not the condoms per se.

    I’ll admit to a rather embarrassing lack of information in this area. As it happens I’m a virgin, so contraception in any variety simply isn’t an issue that really affects me. I certainly support the free access for anyone else that wants it and think this would be a really good thing if we made female BC available without a prescription.

    On the comments upthread that asked about whether this move would make BC more expensive: it’s true that OTC meds are more expensive than an insurance co-pay in most cases, particularly at first. But I think in most cases the pill is still available as prescription if you want it that way. I remember that when Plan B became available OTC, a lot of articles encouraged people to continue using their prescriptions if they had them or could get them, as it would be cheaper than buying the OTC variety. So if the pill and other BC methods follow that pattern you should still be able to use your prescription if you want. But then again, I obviously don’t know how this would play out.

    • http://Patheos.com/blogs/lovejoyfeminism Libby Anne

      Male cooperation is necessary for condom use, but NOT necessary to use the pill. Also, the typical use failure rate of the pill is much lower than the typical use failure rate for condoms. Yes, that is largely because condoms are often not used consistently, but the fact remains that for the average person being on the pill has a better chance of being reliable than using condoms. And more than that, when I made the statement about effectiveness I was including IUDs and implants as well as the pill, because I was talking about ALL the methods a woman needs a doctor visit for.

      • Christine

        Technically it’s necessary for any condom use, but it’s really not as much of an issue with female condoms, only with traditional ones.

  • Christine

    I personally would have had a hard time having to pay for the pill out-of-pocket. But I’m actually less worried about the financial burden this would represent, and more worried about removing it from the doctors. Sure, having sex isn’t an illness, but what’s the best known cure for menstural cramps? The problem is, a lot of dysmenorrhea has an underlying cause. Rather than teenagers just going to the pharmacy to fix the problem, they should see a doctor. Sometimes there’s a better way to manage the problems (dietary treatment may be preferable, but how many people know about it?), and even if there isn’t, it’s a good idea to be aware of your body.

    And yes, my concerns there are connected to fertility problems later in life. It can be stressful to find out about those as a teenager (even when you think you don’t care), but once you reach your twenties and get married it’s better to know than to not know, if you want to have biological children. Getting the word out that the second magic age for women is 35 only works if individual women know if they are likely to be sub-fertile.

  • E

    Not directly on topic, but did you notice the part of the quote where he says that the overlap between employed and poor is “by definition, minuscule”? That alone is enough to mark him as out of touch.

    • http://ripeningreason.com/ Bix

      Yeah, that was flabbergasting.

  • Angie Y

    Regarding the comments about annual exams being necessary to prevent cervical cancer, the ACOG also had this press release recently:
    http://www.acog.org/About_ACOG/News_Room/News_Releases/2012/Ob-Gyns_Recommend_Women_Wait_3_to_5_Years_Between_Pap_Tests
    It states that the exams should occur only once every 3-5 years and not in women under 21. Granted, they still encourage women to have an annual wellness exam for the concerns outside of the Pap test.

  • Anonymous

    Until this group supported OTC birth contol, I did not even know it wasn’t OTC. I hate how ignorant the right-wing arguments have left me in order to sound less unreasonable. I have so much catching up to do on reality. Thanks for the help LA.

  • plutosdad

    As for the safety: we could easily help by limiting the number of pills you can buy without prescription, just like we do for decongestants. Limit it so you can only buy one per day (maybe a little more so it overlaps near the end and is easier to buy). But if you want more, such as when you want to change formulations, you need a doctor’s script to get those extra pills. That would stop people from trying to take multiple pills etc that might be dangerous, thinking “more is better”. Since there is a danger, but there are ways to help people avoid danger while still making it easier to get.

    • smrnda

      This could cause problems in the case of someone who is purchasing medications not just for themselves, but for other family members where you might exceed the limit. Also, now and then they have these things called “sales” on over the counter medicine, and sometimes (if it won’t expire) it can be a good idea to stock up, particularly if you are low income or have limited mobility and a trip is costly in terms of time, effort or money.

      The other issue, that people need to be hit with regulations that will force them to go to doctors because, if they don’t absolutely have to they just will forgo beneficial preventative screening, is a little patronizing. Yes, people sometimes decide to try over the counter medications where a doctor’s visit would be more enlightening, but part of this can be cost, and people are going to do this for all sorts of conditions no matter what, no reason to single out women as in need of a special incentive to get to doctors.

    • Noelle

      The pill won’t work unless you have the full 4 weeks to take on schedule, with follow-up packs to continue that schedule. You can’t miss a beat with it if you want the synthetic hormones to trick the hypothalamus into not triggering the feedback loop necessary for ovulation.

  • Kaboobie

    My only concern with the Pill being available OTC is that there are so many different doses and formulations. It took me almost two years under a doctor’s supervision to find the correct Pill for me. At the time, it was more important to get my cycle under control than to prevent pregnancy. I went from being regular like clockwork, every four weeks, to having very irregular periods that sometimes lasted two weeks and gave me debilitating cramps that caused me to miss work. I would try a new formulation every 2-3 months, and it might work for a month or two, but eventually, as my doctor put it, my hormones would find a loophole. Some formulations even made my cramps worse.

    Maybe I am the rare exception, and there is one Pill that works for the majority of women. Maybe there could be 3-4 formulations available on the shelf, with instructions to try another formulation if the first one doesn’t work for you. But if the risk of “not working” means you might get pregnant, that’s a big risk. I’m concerned, especially given the state of sex education in the US, that young women won’t have the information necessary to take the Pill correctly and use a backup method until they’re sure it works.

    • Christine

      When I had to switch formulations a bunch of times, my doctor seemed to think that it was fairly normal. I’m fairly sure that even the ones that didn’t work for me would have prevented pregnancy. (And not just because I was too nauseated to be interested in sex).

    • Reisel

      My experience with doctors and insurance has been that going it alone is just as well. My first doctor insisted I just tough it out on what she prescribed me. I had to strongly request a formulation change from my second doctor. After things got better, the insurance decided they weren’t going to carry that pill in their formulary any more and switched pill formulations on me without an explanation. I toughed it out as suggested again and it took yet another strong request to get an exemption and be put back on the formulation that worked best for me. If I’d gone it alone I might not have spent a couple years finding the best formulation for me and I certainly wouldn’t have had to fight anyone over it.

      • Kaboobie

        I’m fortunate that I didn’t have to fight with my physician or insurance company over anything. It just wasn’t until I had tried at least 7 or 8 different formulations that one succeeded in regulating my cycle (and, thankfully, with a much lighter flow and milder cramps than I had ever had before, on or off the Pill). It’s the highest dose of estrogen I think you can get. I’m glad my doctor kept trying with me, because I might have given up on my own.

    • http://ripeningreason.com/ Bix

      I was concerned about that as well, which is why I hope oral contraceptives still remain available by prescription (and also for insurance coverage reasons). I imagine they will, since many women do take them for therapeutic purposes, and because there are different formulations and it’s not one-size-fits-all.

      I think it needs to be accompanied by a thorough public education campaign making sure people know they have different options for both oral contraceptives and other forms of contraception, because I think oral contraceptives have fairly high rates of discontinuance, especially among women who experience undesirable side effects, and they don’t always replace it with a different method.


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