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.