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Why a Prescription for Birth Control Pills?

The president of Ibis Reproductive Health, Kelly Blanchard, argues in the New York Times for over-the-counter access to the pill. I’ve long thought that the pill should be nonprescription. What’s the argument for requiring a consultation with a doctor? The doctor will tell you not to smoke while on the pill, and perhaps remind you to continue to use condoms to prevent STI transmission. These are things many women know already, and they can, and should, be clearly indicated on the pill’s packaging. If a smoker has decided she’s going to risk it and smoke while on the pill, a doctor’s warning may not deter her, anyway.

The pill’s prescription status seems like a holdover from the days when contraception was forbidden: when women who wanted it were reprimanded and those who provided it were jailed. (Not that the days of contraception stigma are over—far from it.) As Blanchard points out, there are far more hazardous drugs on drugstore shelves: Tylenol, which can be deadly, and potentially addictive drugs like Benadryl or sleep aids. So why does a woman have to go through her doctor to get hormonal contraception? So that her doctor can remind her how STIs are contracted? With many women in this country unable to afford regular checkups, we don’t rely on the doctor-patient relationship to educate people about sexual health; this happens (hopefully) in school, in our families, if we’re lucky, and through public health campaigns.

The one downside to sending the pill over the counter is cost:

We also need to address the problem of pricing. Plan B became more expensive when it went over the counter. If that happened to the pill, it could be unaffordable for many women on Medicaid whose prescriptions are now covered. In some states Medicaid already covers over-the-counter contraception like condoms; Medicaid coverage in all states should be extended to all over-the-counter methods, including the pill.

If you’re fortunate enough to have insurance, but not fortunate enough to have infinite funds to spend on monthly medications, getting the pill over the counter could be a burden. I wonder, though, if the great number of pill brands would help keep the cost low. There are only two brands of EC currently available in the United States—Plan B and Next Choice—and over forty brands of the pill. In any event, it would be great if such an essential piece of women’s health care a) was not treated like a dangerous drug and b) was as affordable as ibuprofen. After fifty years, it might be time.


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