The Food and Drug Administration announced this week that women and girls aged 15 and up will henceforth be able to buy emergency contraception (Plan B, the “morning-after pill”) over the counter, without a prescription. And there will be no need to ask a pharmacist for it: Plan B will be found in the regular drugstore aisles. This is a good first step, but Republicans should push to improve women’s access to birth control even further.
In much of the world, women can buy oral contraceptives over the counter. But in the U.S. they have to see a doctor and get a prescription, even though the American College of Obstetricians and Gynecologists has found that “access and cost issues are common reasons why women either do not use contraception or have gaps between use.”
The results are predictable: A 2011 study (using data from 2006) found that 49 percent of all pregnancies in America weren’t planned or wanted. Among poor, uneducated, or minority women, the percentage is even higher. So it’s little wonder that by age 45, three in ten women have had an abortion, according to the Guttmacher Institute, which studies sexual and reproductive health.
While Plan B’s over-the-counter availability may help reduce the number of unwanted pregnancies while providing an alternative to abortion, making prophylactic oral contraceptives easier to get would probably be more effective. Numerous surveys have suggested that making contraceptives nonprescription would significantly increase usage.
As it is, contraceptives have fewer side effects than many medications that have long been sold over the counter — acetaminophen (e.g., Tylenol) being the most notable example — and certainly fewer than pregnancy. Opponents are quick to point out that, for example, oral contraceptives increase a woman’s risk of venous thromboembolism, but women are much more likely to experience that condition while pregnant than while on birth control.
And the pill carries health benefits beyond preventing pregnancy. One long-term study showed substantial reductions in ovarian, uterine, and bowel cancer among birth-control users; less dramatically, it can help with everything from acne to menstrual cramps.
So why require a prescription? The federal government’s existing requirement isn’t about safety; it’s about controlling women’s health-care choices, forcing them to make annual visits to the gynecologist. And these visits are seldom confined to the business of writing or renewing a birth-control prescription. In most cases, before a woman can get her prescription, she is pressured or outright required to submit to a pelvic examination, a Pap test, a breast exam, an STD screening, and sometimes even a cervical-cancer vaccination. These tests are important, to be sure, but they tell doctors little about whether a woman is a good candidate for birth control. In fact, pelvic exams don’t reveal any of the factors that would preclude a woman from safely taking the pill. It’s the equivalent of linking condom purchases to prostate exams. But the government wants you to see your doctor every year, and it holds contraceptives hostage to make sure you do.
Making the doctor’s visit a prerequisite drives up the user’s costs, of course. So does putting the pill behind the pharmacy counter. Shifting the pill to the drugstore aisles would decrease the costs of labor and increase competition, potentially driving down price. But even if the pill still cost as much as it does now — around $16 a month — removing the need for a doctor visit and a trip to the pharmacy counter would make buying contraceptives much simpler and less time-consuming, thus removing two major deterrents to their wider use.
If Republicans backed this effort, as Louisiana governor Bobby Jindal has, it would carry not only social benefits but also political ones. During the 2012 election campaign, Republicans were portrayed as anti-woman, especially regarding sex and reproduction. As the Republican National Committee acknowledged earlier this year, “40 percent of female voters are single . . . and Obama won single women by a whopping 36 percent.” By championing birth-control reform, Republicans could help women while emphasizing a critical point: Health care should be a matter of personal responsibility, not government control.
— Jillian Kay Melchior is a Thomas L. Rhodes Fellow for the Franklin Center for Government and Public Integrity.