Should birth control be available over the counter? | The Tylt

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Making birth control sounds like a good idea until you get into the details of it. Insurers typically only cover drug costs when a doctor prescribes it. By removing the doctor from the picture, birth control could become much more expensive for many Americans. Of course, this issue can be addressed if the law were to be changed, but it highlights the many potential unintended consequences.

Zack Cooper, a health policy and economics professor at Princeton University, said it’s possible that if the pill was reclassified as over-the-counter, consumers would have more options, sales volume would go up and competition would increase between drug companies. These factors can all lead to prices going down.But he said it’s also possible that it has a negative effect, since suddenly consumers are paying for birth control at the point-of-purchase instead of getting it at no cost."
When you make something even a little more expensive, use goes down," Cooper said. "That means more women get pregnant, and babies cost a lot more than birth control. You can argue it would actually increase the cost of insurance and the government will be on the hook for more federal subsidies."
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Others argue birth control should not be taken without medical supervision. Some forms of birth control could have serious side effects—if someone chooses to take birth control, it should be done with the guidance of a trained professional.

The absolute risk for serious side effects among large populations, Daniels says, is low—she and ACOG agree on that point. But only talking about the absolute risk “makes it seem like [complications] rarely happen,” she says, which couldn’t be further from the truth. When complications arise, says Daniels, they can be catastrophic, necessitating hospital stays or months of anticoagulants. “To put [hormonal contraception] on the same aisle as Tylenol and Zantac is absurd.”⠀⠀⠀⠀⠀⠀⠀
Proponents of over-the-counter birth control have said that putting prescriptions over the counter could improve contraceptive access as well as drive down costs, which Daniels thinks is important. But with so much emphasis on access and convenience, Daniels feels that women are losing something more important in the process. “We’re losing the doctor-patient relationship,” she says. “We’re losing the opportunity for risk-factor assessment. We also lose the ability to know if a woman is having side effects from the birth control.”
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Supporters argue the risk is low and with proper implementation and guidelines, making birth control available over the counter can be risk-free. 

In many ways having the Pill available over the counter would make it more effective, not less. While the Pill has an impressively low failure rate on paper—0.3 percent in the first year; in practice, the actual failure rate is about 8 percent. One important—and fixable—reason: missed pills and gaps in prescriptions. Some physicians won’t provide a refill prescription unless a woman comes in for an appointment (with some doctors insisting on an often unnecessary pelvic and Pap in many cases). And so for women who can’t get an appointment when they need one, or lack health insurance and can’t afford to see a doctor, or can’t get time off of work to get to an appointment, the story is sadly familiar: missed pills, less effective backup methods, and unintended pregnancies.
Risk can be further reduced by starting with forms of birth control that have the fewest known contraindications. 
Making the Pill available over the counter could solve this problem, according to some groups and columns in the New York Times, Los Angeles Times, and Bloomberg News. The easiest way to do this, according to Dr. Daniel Grossman, an OB-GYN on faculty at UCSF and a senior associate at Ibis Reproductive Health, would be to start with the progestin-only minipill. With a new study confirming a low prevalence of contraindications, he told me that “it’s a no-brainer that the minipill should be available over the counter right away.”

Here are a few interesting points. A lot of people think it's a good idea on the surface, but worry about potential unintended consequences if birth control shifts to over-the-counter.

Within reach of women, beyond the reach of misogynists. There's an idea. http://slate.me/FWeFhV

Posted by Carolyn Hax on Monday, March 19, 2012
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Here are some more perspectives on the issue.

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Post by Nina Kate Kennedy.
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Post by Gail Haler.
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Post by Wanda Mayer.
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Should birth control be available over the counter?
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