Few of the laws regarding birth control in the United States have ever passed simply; from contraception's "official" introduction in 1923 (when Margaret Sanger opened her second birth control clinic — the first had been shut down) until the present day, it has been a contentious issue for men and women who want to control their own fertility (or choose not to have children at all). The latest kerfuffle is two-pronged since twin issues have come to the fore simultaneously; the first is that hormonal birth control — "the Pill" in most of its formulations — was recommended last year by the American College of Obstetricians and Gynecologists to become available over the counter (currently, it requires a doctor's visit and prescription to obtain). The second is that emergency birth control, also called Plan B, which used to be only available to women who are 17 or older, would now be available to any woman aged 15 and older with proper ID.
That both of these changes are happening around the same time is not coincidental; the recommendations that they both be approved were suggested over the last year by health and governmental agencies and both are considered low-risk (some have pointed out that other over-the-counter drugs have far more potentially problematic side effects, and pregnancy is more risky to women's health than birth control use); but making changes during an election year is something the Obama administration chose not to do.
When it comes to the Plan B (emergency contraception) age restriction, the FDA Center for Drug Evaluation and Research, with input from pediatricians and gynecologists, recommended that the age restriction be lifted. But Health and Human Services head Kathleen Sebelius objected to the change with a memorandum that questioned the ability of younger girls to use the product properly. Interestingly, this is the first time the HHS secretary has issued such a memorandum to override an FDA decision. Since the window for effective pregnancy prevention for Plan B — which prevents implantation of an egg, but is not abortive of an already fertilized egg — is 72 hours, any delays (like getting a parent or older friend to buy the pills) can result in an unintended pregnancy. It looks now as if this recommendation and rule change will go through.
Turning to the question of whether non-emergency contraception (ie. the Pill) should be available without a prescription: according to a survey, women who currently use birth control support the rule change, and 30 percent of women using no birth control or a less effective method, like condoms, say they would switch to hormonal contraception if it were available without a prescription (which implies quite bluntly that many uninsured and poor women are not taking the Pill currently because of access or financial issues). Dr. Daniel Grossman, at the University of California, San Francisco, told Reuters that the finding, "gives us some indication that making the Pill over the counter could help improve use of more effective contraception and help women use the method they'd like to use." Even women who have health insurance face a number of hurdles in getting their birth control pills early if they are traveling, or on time if they miss a doctor's appointment due to illness (I know at least one woman who faced an unintended pregnancy due to missing a doctor's appointment to get her birth control prescription refilled).
The Centers for Disease Control and Prevention report that about half of all pregnancies in the U.S. are unintended; of those unintended pregnancies, about half end in abortion and the other half are brought to term. Studies show that the more easily available birth control is, the lower the rate of abortion in a given population.
While there has been some debate on the safety of both of these issues on the side of doctors (who stand, especially in the case of over-the-counter birth control, to lose plenty of yearly OB/GYN visits—which is why many women visit a doctor at all in a given year), most health providers think they are safe and women are able to understand contraindications. In many countries, birth control is given out by pharmacists, not doctors, who do the basic screening for possible negative health effects. Most of the other protests against increased access to contraceptives have come from groups associated with conservative religious movements, most of which would like to severely restrict or eliminate the availability of birth control for all women.
So, is this debate about health or about personal beliefs about contraception? It's hard to tell these days in America.
What do you think? Should birth control be available over the counter? Should Plan B be available to girls 15 and up?
Related on MNN: Emergency contraception: This is how Plan B works