It might surprise American women to learn the process most of them have to undergo to access hormonal birth control — which requires an annual screening and a prescription from an obstetrician-gynecologist — is fairly unusual in most countries around the globe.
A 2012 survey conducted by researchers at Ibis Reproductive Health and published in the journal Contraception looked at rules in 147 countries and found that only 31 percent of them required a doctor’s prescription to obtain oral contraceptives. For the rest — in countries like Brazil, Russia, India, China and South Africa, not to mention Greece, Turkey, Portugal, Mexico, New Zealand and South Korea — oral contraceptives can be obtained either over the counter or following a minor screening by a health professional.
If it seems strange that a communist country like China has a more open market in this area than the United States, at least there are efforts afoot to change U.S. practice in ways that would bring it more in line with global norms. Some states, for instance, now allow women to skip their doctor’s visit and access birth control with a prescription from a pharmacist. California and Oregon last year became the first states to pass these “pharmacy access laws,” but six more have since joined them, with Maryland set to become the ninth state in 2018.
These regimes are not fully “over the counter,” since they require a consultation with a pharmacist, who has authority to prescribe and dispense birth control. During these consultations, pharmacists check patients’ blood pressure and screen for common side effects and potential drug interactions. Some states also require these results to be sent to primary care physicians. While not a perfect solution, the gradual proliferation of these rules marks a major step in the right direction.
But why has it taken this long for the issue to catch on? Usually, when libertarians see paternalistic regulations—and especially, protectionist licensing regimes—they are quick to suspect some lobbying group of rent-seeking. But that may not be the case here. The American College of Obstetricians and Gynecologists, which represents 58,000 ob-gyns across the country, has been on record as supporting over-the-counter birth control since 2012. In fact, the group’s criticism of the California and Oregon laws are that they don’t go far enough, noting in a January 2016 statement that “we know from evidence and experience that oral contraceptives are safe enough for over-the-counter access, and do not require any prescription at all.”
Indeed, the American Academy of Pediatrics also supports over-the-counter birth control, as do 76 percent of physicians, according to a 2015 survey conducted by the University of California San Diego and University of California San Francisco.
While not completely risk-free, birth control is extremely safe, effective and easy to use. By making hormonal birth control available over the counter, we could give women greater control over their reproductive health while also experimenting with new, consumer-driven ways to deliver better health care to Americans. This would be a win for reproductive rights advocates and for deregulation advocates alike.
The issue is starting to gain attention, even among conservatives in Congress. Rep. Mia Love, R-Utah, and Sen. Joni Ernst, R-Iowa, have introduced federal legislation that seeks to enact a regime similar to the “pharmacy access” states nationwide. This is smart policy for a number of reasons. First, it has potential to increase access to contraception greatly and reduce the public health burden of unplanned pregnancies. Even with free coverage of birth control, the added step of having to make a doctor’s appointment can serve as a high barrier to access—especially for disenfranchised women who have difficulty taking time off work. Women should be able to determine for themselves which form of birth control is best for them, and they shouldn’t be forced to pay what Cato Institute scholar Jeffrey Singer has called a paternalistic “toll” — a doctor’s office visit — for contraception.
For conservative champions like Rep. Love and Sen. Ernst, OTC birth control is seen as a free-market solution that could drive down health-care costs and increase consumer choice. It’s also a politically advantageous counteroffensive to the claim that Republicans want to control women’s bodies and restrict their reproductive freedom. And, many conservatives hope, it may be a useful tool for absolving insurance companies of the contraceptive mandate.
While Republicans and Democrats tend to favor OTC birth control for different reasons and are likely to continue to disagree on whether or not insurance should be required to cover the cost, that’s a separate issue from the impact it could have on licensing reform. There’s no reason why pharmacists — who complete eight years of education and are trained experts in administering drugs — shouldn’t have the authority to prescribe all forms of self-administered birth control that do not require insertion from a doctor, including hormonal pills as well as the birth control injection, patch and vaginal ring.
But more importantly, if the experiment with allowing pharmacists to prescribe birth control and provide clinical advice proves successful, it’s easy to imagine pharmacists doing so for a host of other low-risk, commonly prescribed drugs. By allowing pharmacists to act as health-care providers, pharmacist-prescribed birth control could pave the way for much broader licensing reform across the medical profession.
Conservatives should embrace over-the-counter birth control—not only as a market-friendly, consumer-driven solution or as political ammo against the left’s “war on women” rhetoric—but also as a useful experiment in finding innovative ways to deliver convenient and affordable health care to all Americans.
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