There has been much discussion about birth control pills being made available over-the-counter (OTC), primarily by Republicans as an “answer” to the concerns about the inclusion of contraception in the Affordable Healthcare Act (AHA) and the contention that government should not be paying for birth control. Oh, yeah…and maybe a way to score points with women voters.
OTC birth control pills have been discussed in nonpartisan forums, including by professional medical organizations that have supported conditional OTC initiatives. Democrats now respond that it is not a good idea, leading to notions that their opposition is due to Republican support. There are also claims that women’s healthcare providers, such as Planned Parenthood, have a financial interest in preventing OTC access. I always hate to see such worthy debates become so mired in political posturing. What were once valid views that could be tweaked and put into public policy are now referred to as political party or ideological positions.
At first blush, it seems reasonable. After all, Plan B emergency contraception – the morning after pill – is now available OTC without age restrictions. Recall that there was Republican opposition to Plan B, particularly whether women under age 17 should have access. President Obama and then-Secretary of Health Sebelius favored an age requirement while most Democrats wanted it available to all sexually active women who experienced failed birth control or something horrible like rape. Eventually, science won. Nonetheless, political gamesmanship governed the debate over Plan B and it now appears to be governing the debate over OTC birth control pills, but with Republicans promoting it and Democrats rejecting it. As our individual positions evolve, there are certain questions we should ask and facts we should know regardless of our political preferences.
Why did Republicans oppose OTC access for Plan B? Some believed that by making it OTC, it would affect or encourage sexuality activity among young teens. In 2004, the FDA considered the OTC application “unapprovable” for that reason. Safety did not matter, nor did the recommendations of professional medical organizations. Sexual behavior was a concern but financial behavior was not – although the high cost of a single pill, as much as $50, for emergency contraception would substantially reduce the likelihood that young teen women would even be able to“abuse” or misuse Plan B was not considered; only immoral sexual behavior was worthy of deliberation in some political circles.
Since Republicans opposed OTC Plan B based on moral and not scientific reasoning, how can they support OTC birth control pills now given that it might indicate women are, yikes, having sex? The answer here is: fill in the blank. There are some who genuinely, however foolishly, hold the belief that the government should not pay for any birth control except maybe sterilization. Many others, like Louisiana Governor Bobby Jindall, claim that it is “hogwash” that Republicans do not believe in contraception… that anyone over 18 should be able to get contraception OTC so that those individuals and businesses with a “religious objection” will not have to pay. What is noteworthy is that the intent of OTC birth control is not to help women – it is to “help” those with specific religious views.
How can Republicans who support personhood amendments and stringent anti-abortion legislation support OTC birth control? Politics, plain and simple. It is probably unwise to even remotely consider that they have a change of heart or that they have scientific awareness about how the pill functions.
Why are we not hearing from National Right to Life and morality-policing organizations, such as Focus on the Family, that adamantly opposed Plan B and frequently lied that it was an abortifacient? Another interesting question. It is arguable that as much as some Republicans claim that putting birth control pills OTC would take the politics out of contraception, such organizations are simply biding time to get through the midterm elections and get their candidates in office. Later, if birth control pills were OTC approved, then they would come out, well-organized to mislead the public ala Hobby Lobby style seeking to ban some pills because they are abortifacients, imposing age restrictions, pushing for legislation for parental and spousal consent, or prohibiting birth control from being a reimbursable expense under flexible medical spending plans offered through many employers. I am pessimistic that approving birth control pills for OTC access would ever happen without the intervention of the morality policing groups.
Why did Democrats support OTC Plan B? Unplanned pregnancy is a public health and social issue – it is a significant factor in predicting poverty for women and children. Taking birth control pills regularly was and is not an option for all women due to contraindications in health, lack of insurance coverage, affordability, and side effects. Other effective contraceptive choices, like the IUD or hormonal implants, were/are cost-prohibitive for many women while other methods are more likely to fail. Plan B offered a safe way for women to address failed contraception or unprotected intercourse and, consequently, prevent an unplanned pregnancy and birth into negative social and economic circumstances. To date, there is only evidence of Plan B helping women and no evidence of it being misused or used in place of regular contraception.
Why are Democrats opposed to OTC birth control pills? It would be disingenuous to say that Democrats are opposed only for legitimate concerns about women’s health. Of course they do not appreciate Republican support for OTC birth control! Framed correctly and without Tea Party-ish nuances, by gosh, women voters might just buy into the idea that Republicans are not out to get women! I do not expect Democrat candidates to agree, so, now that I have said it, let me identify legitimate concerns.
Requiring a prescription ensures that women receive wellness checks for health issues that can arise or become pronounced due to the pill. For younger women in particular, it also ensures screening for sexually transmitted infections and pregnancy prevention counseling. The most significant reason to oppose OTC birth control pills is economic for women. Once a drug is OTC approved, insurance will end coverage. Thus, women of means will continue to have access and even appreciate the convenience of OTC. Poor and young women will be hurt the most. The Republican argument that it will increase competition and decrease price is misleading and could prove wrong. Additionally, OTC birth control pills would not help women who benefit most from other contraceptive methods like the IUD. What about women who need the pill for medical reasons unrelated to preventing pregnancy? They may not be able to afford the up to $120 monthly tab either.
We should all favor improving and increasing access to birth control pills and other methods for women. It must be done the right way for the right reasons. Abortion is legal but not accessible to the most vulnerable women. If birth control pills are OTC approved, it does not mean they will be accessible and it could even lead to other forms of birth control no longer receiving insurance coverage. Voters concerned about women’s health and reproductive justice should think hard about Republican support for OTC birth control. Then they should contact their elected representatives about a bill to make Viagra and Cialis OTC – just to see if male legislators think men are intelligent and strong enough to assess usage and that they can safely assume the risk of, say, a four-hour erection. Only then might we learn the authenticity of Republican concern for women’s health and that their support for OTC birth control pills is not judging the sexual behavior of women in some way.