The Pill: Still Safe, Effective, and Threatening after All These Years

With the passing of the pill’s fiftieth birthday, much ink has been spilled over the effect oral contraception has had since its initial release in 1960. Women’s rights have certainly progressed in leaps and bounds as women took control of their reproductive systems and took advantage of the opportunities this allowed them, flooding universities and business. The pill’s level of involvement in the women’s movement depends on who you ask—some say it created the movement, others believe its effect is exaggerated due to coincidental timing. Its exceptional performance or efficacy, however, cannot be overstated.

Oral contraceptives are among the most widely prescribed, consistently used, safe, and effective drugs available. Approximately 12 million U.S. women and over 100 million women worldwide use them. The birth control pill is 99 percent effective when used as directed, which, when accounting for missed pills or irregular dosing, translates to about 95 percent in practice. And unlike other birth control methods, oral contraceptives have yet to lose popularity in lieu of an alternate method. Beyond safe prevention of pregnancy, the pill, when taken consistently over a long period of time, has been linked to a decreased risk of ovarian cancer. In addition, oral contraceptives regulate a woman’s menstrual cycle and often give her lighter periods with alleviated pre-menstrual symptoms. They can even clear up skin for women who suffer from persistent acne.

After half a century of such success, there is the possibility of another revolutionary advancement in the pill’s future: over-the-counter (OTC) availability.

With a world of options open to her, today’s woman is often balancing an education or a career, perhaps a family and more, which means getting to the doctor for a prescription can be a hassle. Even worse, it can be an impossibility for women without health insurance and for teens who can’t go through a family doctor or access a clinic. Providing an OTC oral contraceptive would increase access, lower the cost, and again change the way women view birth control.

While the idea has sparked controversy, the truth is that we’re already part of the way there. Pharmacies in the United States distribute emergency contraception (“the morning-after pill”) without a prescription and traditional oral contraceptives are available over the counter in numerous countries around the world. Recent studies conducted in the Southwest have found that an increasing number of U.S. women choose to buy their birth control pills in Mexico because it’s easier to cross the border than go to the doctor for a prescription.

The pill even got some rare, albeit vague, support in May from the National Association of Evangelicals when they released a statement saying they wanted to partner with groups providing contraception in order to reduce the number of abortions. But a month later conservative groups, including the Heritage Foundation, the National Abstinence Education Association, and U.S. Conference of Catholic Bishops, voiced their opposition to the section of the new federal healthcare law that would require employers and insurance companies in all fifty states to fully cover the cost of prescription contraceptives (currently twenty-seven states do). “We don’t want to see the sexual health of our young people compromised,” said Valerie Huber, executive director of the abstinence education group. “We are concerned that if there isn’t a policy correction, that will be the result.” Deirdre McQuade of the Catholic bishops concluded: “Married women can practice periodic abstinence. Other women can abstain altogether. Not having sex doesn’t make you sick.” These recycled arguments continue to beg the question, who are we really trying to protect?

A recent study conducted by the Guttmacher Institute determined that at least 40 percent of American girls are already on the pill, which is actually fewer than in most developed nations, and that the figure should, if anything, be higher. Approximately 757,000 teenage girls in the United States became pregnant in 2006 alone and 316,000 of those pregnancies resulted in abortions or miscarriages. Restrictive birth control policies don’t shield teens from sex and they don’t protect young bodies from the trauma of pregnancy or abortion. They simply make it more difficult for healthy, responsible youth to take precautions.

One argument against OTC oral contraceptives notes that most doctors require a woman to come in for a yearly gynecological examination in order to renew her birth control prescription. While the intention is benevolent—symptoms of cervical cancer often go undiagnosed without an exam—this forces women who don’t immediately have the time or money for an exam to put themselves at further risk by going without birth control until they can see a gynecologist. It also makes women who don’t wish to be examined, which is perfectly within their rights, feel bullied or violated by their doctor.

One could argue all day about the validity of the demand for an OTC oral contraceptive but when it comes down to it, this is a drug—not a lifestyle—that’s been approved and it needs to be treated as such. This shouldn’t be an issue of religion and morals but one of safety and legality. Like it or not, this is a secular state in which citizens—not the government—choose to live their lives according to their own beliefs. A woman’s reproductive rights include the right to have sex without reproducing, and with the existence of safe options she shouldn’t have to abstain from sex or be forced into a medical exam to exercise that right.

As wonderful as oral contraceptives can be for the majority of women, there are, as with all drugs, some legitimate concerns for outlying groups, and many challengers worry that if the drug can be bought over the counter it’ll be flying off the shelves in the hands of every unsuspecting victim. Women over thirty-five who smoke, for example, do have an increased risk for developing blood clots if taking the pill (2 in 10,000 will experience a clot as opposed to 1 in 10,000 women who don’t use the pill) and are often advised against taking oral contraceptives. They would not be the first group advised against taking an OTC medication, though, and all that’s needed are some simple precautions and freely available information. All medications come with labels outlining instructions as well as warnings and red flag symptoms.

The unfortunate reality is that prescription drugs are being bought and sold illegally every day and there’s nothing stopping a woman from giving her monthly packet of pills to an uninsured friend or timid niece who might not be informed about the risks. Furthermore, people who want to have sex rarely abstain just because they can’t get oral contraceptives; they do it anyway and at a higher risk. With OTC availability, the issues surrounding birth control would be addressed more completely so that every woman could get the pill for herself and speak with a pharmacist if she so chooses.

To borrow Carol Hanisch’s well-worn phrase, the personal truly is political and women’s opportunities can only extend as far as current policy allows. Over the counter access to oral contraceptives would allow many more women to experience the liberation of safe, noninvasive, and—for the overwhelming majority—morally acceptable reproductive freedom. Fifty years after the pill’s birth, perhaps it is time we give it to them.

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