Over-the-Counter Birth Control Would Increase, Not Limit, Choice
A colleague of mine at Care2 recently wrote over-the-counter birth control is “doomed to fail” because of what happened with emergency contraception. Even after the FDA made emergency contraception OTC, she writes, there were barriers to its implementation and availability, and OTC birth control would befall the same fate:
Like Plan B, [birth control] would be locked behind the pharmacist counter, not on the actual shelves, adding another gatekeeper into the mix. It would allow protesters to picket and pressure stores to get the stores to not stock the product, and it especially would limit birth control options to be primarily pill based, since long acting reversible contraception like IUDs wouldn’t be available in this venue, and without a no-copay policy will remain financially out of reach for a vast number of people.
This view has lots of flaws. Let’s break them down bit by bit.
“Access to EC continued to be at the discretion of the pharmacist or pharmacy, despite the drug being officially over the counter…[Birth control] would be locked behind the pharmacist counter, not on the actual shelves, adding another gatekeeper into the mix.”
Here, Marty has identified the wrong agent. It is not the pharmacists’ choice to keep contraceptives locked behind the counter per se, but rather, the state. Behind-the-counter (BTC) status allows the FDA to require consumers to go through a pharmacist (who often checks age, etc.) before obtaining a product. This has been controversial since the 1970s, and for now is limited to select drugs. Proponents of BTC cite safety reasons, while opponents assert it enacts unnecessary barriers for consumers (which it has, for women seeking emergency contraception).
So yes, emergency contraceptives are legally classified as OTC drugs, but are often stored behind the counter and sold only in stores that are registered with their state. But the FDA is the culprit here, not pharmacists themselves. If you want to fight gatekeepers, your fight is with the FDA, which is really what forces pharmacies to keep the product locked away.
“It would allow protesters to picket and pressure stores to get the stores to not stock the product.”
Everyone has the right to protest. Freedom of speech asserts that we can protest when a company does something we don’t like, and freedom of assembly allows us to express those views, by picketing if we so choose.
For the time being, it appears birth control will remain a sharply divided issue, with advocates/users on one side and conservative opponents on the other. This is unfortunate, but opponents have a right to their opinion — even opinions many of us don’t like. It’s unfortunate we live in a world where many try to impose their morals on others, because in reality there is a simple solution facing social conservatives: they don’t have to use birth control or buy it at all, particularly if the product is OTC. No one would be forcing it upon them.
The good news is, the demand for birth control isn’t waning any time soon, as more than 99 percent of women have used birth control at some point in their lives. Yes, even if protestors “picket and pressure,” there will always be companies willing to supply birth control to interested consumers, because there is demand for the product.
Squashing or avoiding pesky protestors is not a compelling argument against making birth control available without invasive (and medically unnecessary) exams, insurance battles, and a monthly trip to the pharmacy counter. (Let’s be real, we’ll never get back those precious hours we spend waiting in that damn line at Walgreens.)
“It especially would limit birth control options to be primarily pill based, since long acting reversible contraception like IUDs wouldn’t be available in this venue.”
Just as the availability of KitKats at your local drugstore does not limit the availability of say, Hershey’s chocolate, OTC birth control would not make it more difficult to get an IUD or contraceptive device that requires medical knowledge to implant.
An IUD is a lot different from ingesting a pill because it actually has to be inserted into the uterus. Mess that up and you’ve got some problems, so it could make sense to leave this to a physician.
OTC birth control pills would have no effect on the availability of IUDs — but it would give millions of women freedom of choice to purchase a product that can control their reproduction.
“Without a no-copay policy [birth control] will remain financially out of reach for a vast number of people.”
This is where the beauty of the marketplace comes in! A brief history of how emergency contraception came to be OTC shows us all the barriers it faced coming to market: Plan B was introduced by Teva Pharmaceuticals in 1999. It became available BTC in 2006 only to women over 18, as per government regulation. In 2009, the FDA approved a generic form of Plan B, “Next Choice,” which also had an age requirement of 17 (a prescription was required for anyone younger). In 2011, the FDA recommended the Department of Health and Human Services approve Teva’s request to make Plan B available OTC without age restrictions, but Secretary Kathleen Sebelius rejected the application.
Finally in 2013, Plan B was made available OTC for people of all ages. However! This decision included an FDA deal with Teva in which the FDA agreed to limit competition from products like Next Choice by enforcing age restrictions on generic drugs. Finally, on March 2, 2013, the FDA lifted these age restrictions.
At every step along the way the state enacted barriers in the form of age restrictions that favored one manufacturer (Teva) and stifled competition, effectively playing politics with women’s bodily autonomy. Instead of wasting millions of dollars on lobbying, government lawsuits, etc., Teva could have spent money and time ensuring Plan B beat out competitors — and the resulting low-cost pill would be a win for women. Remember, competition drives down price. Disentangled from insurance plans/co-pays, birth control would be kept affordable by market forces.
OTC status is not a barrier to choice, but the state has been. Allowing over-the-counter birth control would get the state and employers’ chosen insurance plans (remember Hobby Lobby, anyone?) out of millions of women’s reproductive choices. If we really want freedom of choice, we have to provide the conditions for it — and keeping birth control tied up in state regulations and insurance plans is not the answer.
Update 12:03 p.m.: I’ve been asked why exactly making birth control OTC would increase competition — is it easier for companies to bring OTC products to market? The answer is yes — the FDA has less restrictions on OTC drugs — see here.
I also want to include my friend Kat’s important argument below — OTC status would increase access for sex workers, undocumented immigrants, and women without jobs: