Virginia Postrel, the American political and cultural writer, has an idea for de-escalating the birth-control controversy that's sweeping the United States: Sell the Pill over the counter.
After all, that's the way it works with condoms. Anyone can walk into a drugstore and buy a three-month supply of Trojans for under $30, no questions asked. Nobody argues about who should pay, who's morally entitled to them or whether they should be covered by health insurance or the government. Make the Pill as convenient and cheap as condoms and the fight would be over. Besides, the Pill is far more effective.
I confess, I'd never thought of this. Like most people, I've always thought the Pill is a semi-risky drug, and you need a doctor's supervision to be on it.
Not so.
Tim Rowe is one of Canada's leading experts in reproductive health. He's been arguing for years that selling the Pill by prescription is outmoded and paternalistic. There's no reason you shouldn't be able to buy the Pill as easily as you buy Aspirin – or condoms. "There are much more dangerous things available without prescription," he says. Antihistamines and alcohol are two examples.
If the Pill were easier to get, far more women would be using it. But going to the doctor in order to get a prescription is a nuisance. Getting it renewed is a nuisance. And getting your annual pelvic exam is a major nuisance. This exam has nothing to do with the Pill anyway. It's just a convenience for the doctor. In fact, there's no more reason to have a pelvic exam before you get the Pill than there is for a man to have his testicles inspected before he uses condoms. (And how many men would put up with that?)
Dr. Rowe, who heads the Division of Reproductive Endocrinology and Infertility at the University of British Columbia, argues that the benefits of greater access to the Pill would be huge. Apart from preventing unwanted pregnancies, it also reduces the risk of uterine and ovarian cancer by 50 per cent or more. Some experts say it should be available over the counter for its cancer-reducing effects alone.
Not everyone agrees, of course. Some doctors worry that if women didn't have to come in to get the Pill, they'd skip their Pap smears. Some fret about the risk of blood clots and stroke.
Yet after decades on the market, the Pill has been declared so safe that you can get it over the counter in Mexico and other countries. So why not in the United States and Canada? "Extortion," says Ms. Postrel. For pharmaceutical companies, over-the-counter approval would be costly. Doctors would lose patients. Pharmacists would lose dispensing fees.
But I suspect the main barrier is that women simply aren't demanding it. Maybe we still feel a little guilty about the Pill. After all, it wasn't so long ago when oral contraception was not considered suitable for single women. When I got my first prescription, I picked a strange doctor out of the phone book and wore a fake engagement ring from Kresge's.
A lot of women also still believe the Pill is risky. For decades, we were fed scare stories (from feminists, ironically) about the terrible dangers of oral contraceptives and the reckless abuse of women's health by Big Pharma. The result was to scare far too many women away from the safest and most reliable form of birth control yet devised.
"It's time to liberate the Pill," says Dr. Rowe. "This should be a feminist issue."