An over-the-counter birth control fight

A birth control pill container. Image copyright Thinkstock

Some Republican congressional candidates this year think a proposal to allow the sale of birth control pills without a doctor's prescription will bring greater support from women voters.

So far, four GOP Senate candidates in competitive races against incumbent Democrats have voiced their support for over-the-counter access to birth control.

Although most of Western Europe, including the UK, requires physician approval for the pill, much of the rest of the world allows the sale either with an in-store pharmacy consultation or no approval whatsoever.

In November 2012 the American College of Obstetricians and Gynecologists endorsed making the pill available without a prescription. Only this year, however, has the proposal become a hot political issue.

In June, Colorado GOP candidate Cory Gardner unveiled his proposal in the Denver Post explaining that oral contraception's record of safety makes it an excellent candidate for deregulation.

"It is safe, reliable, effective, and presents very few risks or complications for the more than 10 million women who use it," he wrote. "When other drugs have that kind of track record, we approve them for purchase without a prescription; the Food and Drug Administration has already reclassified over 100 different treatments."

He adds:

"When treatments go over-the-counter, two things happen: they get dramatically cheaper and consumers save time and hassle by avoiding unnecessary doctors' appointments just to get the pharmaceuticals they already know they need."

Reason's Elizabeth Nolan Brown notes that "Plan B", an emergency contraceptive using similar hormones to traditional birth control pills, is already available without a prescription.

"There's no good medical justification for the differentiation," she writes. "Yet in America, regular birth control pills remain stubbornly behind the pharmacy counter and behind the times."

While the idea's backers hail this as a way to widen access to birth control, liberal opponents think conservatives are backing the measure for cynical reasons.

"Don't be fooled," writes Lisa Wirthman for the Denver Post. "It's a disingenuous move that could actually make the pill more expensive for women, and ignores the growing popularity and effectiveness of long-acting contraceptives that are reducing unintended pregnancies here in Colorado."

She claims that Mr Gardner is only trying to get around the coverage already available under the Affordable Care Act. If women began using over-the-counter birth control pills, she says, their insurance companies would stop covering the drugs, costing women who take them as much as $600 (£367) out of pocket a year.

The Daily Beast's Sally Kohn calls this strategy deceitful and insulting.

"These Republicans candidates have taken such unpopular and extreme anti-abortion position, like supporting fetal 'personhood' measures and mandatory trans-vaginal ultrasounds, their only hope of winning over women voters is deception," she writes. "I would tell you what a pathetic political strategy that is, but I wouldn't want to be condescending too."

Image copyright AP
Image caption Colorado Republican Senate candidate Cory Gardner says birth control pills are safe enough to be available without a prescription

By stripping insurance coverage for birth control and contraception, the plan would disproportionally affect low- and middle-income women, she writes.

Instead of really changing course, she says, these Republicans are simply maneuvring for a temporary electoral advantage.

The editors of the Baltimore Sun agree, and urge people to put this shift in opinion in context with the Supreme Court's Hobby Lobby decision, which allows closely held corporations to refuse to include coverage for contraception in their employee benefits because of religious reasons.

They contend that because that decision is generally unpopular with women, a key demographic in these tight congressional races, but popular with social conservatives, these Republicans are in a difficult situation.

"This latest political ploy offers a clever way out: The Affordable Care Act's mandate refers specifically to prescription forms of birth control, so making the pill available over the counter, these candidate presumably figure, makes the issue go away," they write.

Beyond the obvious political gamesmanship at play, they write, the side effects some women experience because of birth control medication is an important reason that it has only been available through a prescription.

"If that standard is to change, let it be because the medical community has concluded that the risks posed by birth control pills are of a magnitude similar to other medications that are sold over-the-counter, not because some political candidates see it as an easy way around the issues posed by the Hobby Lobby decision," they write.

"Offering over-the-counter birth control instead of insurance coverage for birth control amounts to a $483m tax on women," argues Cecile Richards, the president of the reproductive and maternal health organisation Planned Parenthood.

Writing for CNN, she says the argument is not between more or less access to birth control, but between insurance coverage or out-of-pocket costs.

"We don't have time or energy to waste on political games, not when roughly half of all pregnancies in the United States are unintended and too many women still struggle to get the health care they need," she says.

The Federalist's Ben Domenech sees an ulterior motive in Planned Parenthood's objection to the Republican proposal, however. He says the organisation's annual report shows that 34% of its services are related to contraception counselling and prescribing.

"Planned Parenthood's hypocrisy here is borne out of their interest in survival as an institution, an impetus for rent-seeking over access," he writes. "The existing and arbitrary government barrier to over-the-counter oral contraception is a major path to how they get customers in the door, and they know it."

Sex, money and politics. Is it any wonder why birth control has become such a contentious topic in this election cycle?

(by Kierran Petersen)

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