What If The Pill Were Over The Counter?

An op-ed in today's New York Times argues, "Women don't need a doctor to tell them if they need cold medicine or condoms, and they shouldn't need a doctor's permission to take the pill." Is that true?

Why not make the pill over the counter? Right now, its prescription is usually bundled with other women's health services like getting regular pap smears — which some see as paternalistic and adding an additional hassle to the process. Some doctors also argue that they need to assess women's particular health risks against potential side affects of the pill. But, argues Kelly Blanchard,

These are not complicated conditions to identify; women already have to tell their doctor about their health problems when they get a prescription, and research shows that women can screen themselves for contraindications almost as well as providers do.

Perhaps surprisingly, the pill is available over the counter in Kuwait and Mexico, and some American women have been known to cross the U.S.-Mexican border to obtain it without a prescription.

Even to women who actually already have a prescription for the pill, refilling it is a gigantic pain in the ass that can lessen its effective use. Blanchard puts this in terms that are familiar to this eight-year pill user who has had to scramble many a Sunday or en route:

As every woman who has run out of pills on a Sunday or forgotten to take them along on vacation knows, refills are not always easy to come by. What's more, the difficulties involved in obtaining a pill prescription, especially for women without access to a doctor, can cause gaps in contraceptive use.

If the pill were over the counter, would it help prevent unwanted pregnancies? According to an article by Blanchard's colleague Daniel Grossman, "A US national survey of women in 2004 reported that 41% of women not currently using contraception said they would start using the pill, patch, or vaginal ring if it were available directly in a pharmacy." The counterpoint to his article doesn't provide medical reasons for why the pill shouldn't be over the counter; it just doubts that it would make much of a difference either way.

If there are indeed compelling reasons for a doctor's involvement, surely some compromise can be worked out that refers at-risk women to a doctor or requires an on-site briefing of any information not included in the pill pack itself. If someone can come up with a convincing reason for a doctor to be involved after the first prescription, surely even they would agree that every six months is excessive and a hassle to obtain the contraceptive pill. Oh, and while we're at it, let's make them free.

Let The Pill Go Free [NYT]
Related: Should The Contraceptive Pill Be Available Without Prescription? Yes [BMJ]
Should The Contraceptive Pill Be Available Without Prescription? No [BMJ]

Earlier: Wouldn't It Be Nice If Birth Control Pills Were Free?

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