The XX Factor

Put the Pill on Drugstore Shelves. Pregnancy Is More Dangerous Than Birth Control.

Why aren’t oral contraceptives available over the counter?

Photo by Philippe Huguen/AFP/Getty Images

This month, a federal judge ruled that emergency contraception should be made available without a prescription to women of all ages. This week, the New York Times takes on the next phase of the birth control debate: What’s stopping us from making all oral contraceptives available without a doctor’s note?

When a friend posted the link to his Facebook page, armchair physicians aired some common concerns about that possibility. They said that without a doctor’s advice, women would be ill-equipped to choose the right hormone dose for them; that without clear instructions from a doctor, women could “misuse” the pill; that potential side effects make oral contraception too risky for drugstore shelves; and that without the threat of an expired prescription, women would no longer head to their gynecologist for other types of preventive care.

Real doctors disagree. In a paper published last year, the American College of Obstetricians and Gynecologists recommended that oral contraceptives be made available without a doctor’s prescription, pointing to studies showing that, despite widespread fear to the contrary, “women are able to self-screen with checklists to determine their health risks” and that they “will continue seeing their doctor for screening and preventive services even when allowed to purchase [oral contraceptives] without a prescription.” The reality is that oral contraceptives help prevent a much more serious condition: pregnancy, which brings with it huge medical, emotional, financial, and legal risk. More specifically, the main health concern with oral contraceptives is an increased risk of blood clots, but as the ACOG points out, that risk is “extremely low.” It’s also “significantly lower than the risk of blood clots during pregnancy and the postpartum period.” What if a woman fails to maintain her prescription because she’s working, traveling, or loses a pack of pills? That is when she’s really at risk.

Unfortunately, Facebook naysayers aren’t the only ones with unfounded fears about freeing up the pill. According to the New York Times, a recent poll out of the University of Missouri “found that a majority of gynecologists and family doctors in training opposed the practice, worried mainly about safety.” The researchers “concluded that the fear was irrational, revealing ‘a knowledge deficit’ about ‘the safety of oral contraceptives,’ ” even among doctors. If contraception hit the shelf, the health industry would have much to lose. The NYT notes that “gynecologists might resist for financial reasons”—while birth control requires an annual visit to the doctor to get a new prescription, Pap smears are now recommended only once every three years for women 21 and up.

The prescription-only system for oral contraceptives is totally out of step with the realities of American health care and life. When I moved across the country to Los Angeles, I spent weeks calling down a list of gynecologists approved by my health insurance and found dozens who would accept patients only who were already pregnant or trying to conceive (an event I was hoping to avoid). When I finally found an available doctor, my existing prescription ran out before I got in to see him. Then he wrote me just a three-month prescription, insisting that I come to see him four times a year to check in on the drug I’ve been taking without incident for a decade. Oh, and he was super creepy about my sexual history and relationship status, too. I had to start my gynecological hunt all over again and just got in to see my current doctor before the three months were up. Thankfully, she was great—and she spoke to me for less than one minute about the medication before ripping the prescription from the pad. If I hadn’t had the benefit of an understanding boss and a flexible work schedule, I may have never gotten my hands on the pill.

Many American women don’t benefit from my circumstances. All women should have access to a good gynecologist who is available to counsel her through all her reproductive health options. But making comprehensive care truly accessible would require not just an overhaul of the health care system, but a radical rethinking of the American workplace. Forty million Americans work without the benefit of paid sick leave. Reliable childcare is unaffordable for even middle-class families. Meanwhile, 43 million American women are currently at risk of unintended pregnancy. For a lot of people, making enough money to feed children—and getting into the doctor to prevent having more—is a serious challenge. Putting birth control on the shelves won’t solve these problems, but it would help prevent unwanted pregnancies, which only compound them.