Birth control without the middle man

Thanks to new legislation, women in California and Oregon will be able to obtain hormonal birth control such as pills, patches and rings from pharmacists without a doctor’s prescription.

This is good news for residents of those states, but there’s a major potential drawback: It’s not clear whether insurance companies, which are obligated to cover prescription birth control under the Affordable Care Act, will cover the over-the-counter variety as well.

Democratic Sen. Patty Murray wants birth control to be available over the counter and covered by insurance whether or not it’s prescribed by a doctor. And Senate Republicans have proposed a bill that would give drug manufacturers more of an incentive to lobby the Food and Drug Administration to make birth control available over the counter.

If that sounds suspiciously generous and progressive for Senate Republicans, it’s because it is. They’re suddenly eager to get birth control approved for over-the-counter use because they want to protect their insurance company donor pals from having to pay for it. Sen. Kelly Ayotte, one of the Republican bill’s sponsors, has collected $470,066 from the insurance industry over five years in office; her co-sponsor, Sen. Cory Gardner, took $240,440 in just one year. Contrast this with Murray, who, in over 20 years in office, has accepted considerably less insurance industry money than Ayotte. Making birth control available over the counter without requiring insurers to cover it would certainly help insurance companies, but it won’t help women who can’t afford to pay for it out of pocket.

Another concern is that women may be less likely to make routine visits to their gynecologists if they can get birth control at their local drugstores. Many women do not need to be prodded into seeking routine medical care, but others are already resistant to it for a variety of reasons, including overwork, poverty, fear of deportation and an understandable reluctance to spend anywhere from two hours to two days traveling to the office of an overscheduled doctor who keeps you waiting forever only to hustle you out in 20 minutes. No woman I know looks forward to stirrups, speculums and sitting around in a paper gown that opens in the front. Even with insurance, doctor’s visits aren’t exactly fun. For most women, there are very few cheap, convenient alternatives other than Planned Parenthood, which, now that it’s under siege from Republicans and gun-wielding maniacs, is more crucial than ever. All of which explains why making access to birth control contingent on getting a Pap smear is nonsensical and unduly burdensome for women.

It makes sense to require a prescription for highly addictive substances and drugs that carry serious medical risks. But very little medical evidence suggests that modern birth control is dangerous. Thanks to lower doses of hormones, birth control is safer today than in the early days of the pill, and studies show that women are capable of properly evaluating the risks without a doctor’s help.

Because there is no serious medical case against it, the argument for restricting access to birth control boils down to religious conservatives’ disapproval of it. They object on grounds of religious freedom to employers’ and insurers’ having to pay for medications they don’t approve of. They argue that easing access to birth control promotes promiscuity and makes it easier for older men to prey on young girls.

With the exception of the debate over insurance coverage — which comes down to whether you want your boss or your insurance company rather than your doctor deciding what kinds of drugs you may take — there is no evidence of any of this. What really bothers those who seek to restrict access is that birth control empowers women to choose if and when to become mothers. Women’s gaining control of an aspect of life that used to be left up to God is a bitter pill for some to swallow.

It should now be clear to virtually everyone but conservative clerics and Republican lawmakers that women’s lives would improve if birth control were available over the counter and insurance companies required to pay for it. As Dr. Mark DeFrancesco, the president of the American Congress of Obstetricians and Gynecologists, recently told The New York Times, “My basic tenet is there should be nobody between the patient and the pill.”

Most countries allow women to buy hormonal birth control without a prescription. The American College of Obstetricians and Gynecologists has for years recommended that oral contraceptives be made available without a prescription. As early as 1993, The American Journal of Public Health published a paper contending that oral contraceptives should be available over the counter. Women around the world have been taking the birth control pill for decades, and there is a mountain of evidence that it is both safe and highly effective.

So why not cut out the middleman? In the United States, even having to ask a pharmacist for birth control can be a humiliating ordeal. As of 2012, six states (Arizona, Arkansas, Georgia, Idaho, Mississippi and South Dakota) had laws on the books allowing pharmacists to refuse to dispense contraception for moral or religious reasons. In 2012 an Illinois appellate court ruled in favor of two men who objected to filling prescriptions for emergency contraception. Colorado, Florida, Maine and Tennessee have broad so-called conscience clauses that do not specifically mention pharmacists but could be interpreted as applying to them.

In other words, women living in over one-fifth of this country’s states are subject to the whims of their local pharmacist. Even Jan Brewer, the right-wing Republican governor of Arizona at the time, admitted in 2012 that a bill she later signed into law might make things “a little bit uncomfortable” for women required by the bill to explain to their bosses why they needed birth control. (Arizona legislators ultimately had to revise the bill to specify that employers who opted out of covering birth control could not force employees to explain why they needed this coverage.)

The new laws in California and Oregon are a step in the right direction, but they don’t go far enough. Religious freedom means having the right to forgo birth control, not to restrict someone else’s access to it. Most women want and need unfettered access to birth control. In a free country, a small band of slut-shaming fundamentalists and free-market fetishists wouldn’t be able to stop them from getting it.