Two U.S. states, Oregon and California, have, in recent weeks, adopted laws that will make hormonal contraception available over-the-counter, without a doctor's prescription.
It's about time Canada did the same.
Sure, birth-control pills, patches and rings have risks, but so do all drugs. The Pill is among the safest medications you will find in the pharmacy. There is no risk of addiction or of toxic overdose; in short, it is as safe, if not safer, than Aspirin, Tylenol, Claritin and many other products that are sold freely.
There were 10.3 million prescriptions for hormonal contraceptives in Canada last year, and a handful of adverse events.
The principal reason the Pill is still a prescription drug is because it is used exclusively by women to prevent pregnancy – and when it comes to women's reproductive health and freedom, intrusive, paternalistic legislation, unnecessary bureaucratic hurdles, and unwarranted costs are the norm.
Last week, Health Canada finally got around to approving the so-called abortion pill, a mere 27 years after it was approved in France. It took 21/2 years to review the safety data that was already reviewed and accepted in 60 other countries.
There was similar dithering with making emergency contraception – commonly known by the brand name Plan B – more readily available. Now the morning-after pill can be obtained without a prescription, but it is still mostly a behind-the-counter product, meaning it has to be dispensed by a pharmacist.
Hormonal contraceptives have been available in Canada since 1961, but always with barriers. We should not forget that contraception was only officially decriminalized in Canada in 1969.
Since then, the impediments have been logistical. Going to the doctor takes time and can be costly (lost wages, transportation, etc.) especially for low-income women.
For a long time, physicians insisted on a full physical, or a pelvic exam, before prescribing hormonal contraceptives. While breast exams, Pap tests and screening for sexually transmitted infections are important in their own right, they should not be a prerequisite for access to birth control, and medical guidelines say so clearly.
Pre-prescription coercion, no matter how well-intentioned, is unethical. Women no more need a pelvic exam before getting the Pill than men need a prostate exam before buying condoms.
There has always been a lot of paternalism and moralizing when it comes to prescribing oral contraceptives, an unstated assumption that users are promiscuous or irresponsible. The reality is the Pill is the No. 1 birth control choice for women, regardless of their marital status or sexual proclivities, because unwanted pregnancy is their No. 1 concern.
What women need to know before getting the Pill are the risks and benefits. Hormonal contraceptives should be avoided if you smoke or if you have a family history of heart disease, or migraines, and they become slightly more risky with age.
New users could probably use some counselling on finding the right product for them but that's largely a trial-and-error process, even for physicians. (Hormonal contraceptives principally contain estrogen and progesterone, and side effects tend to vary based on the type of progesterone. There are also progestin-only pills, but they have a higher failure rate.)
The principal "danger" of the Pill is of blood clotting, which can lead to a heart attack or stroke. Somewhere between three and 10 per 10,000 women will have blood clots while taking the medication. To put that risk in perspective, consider that five to 20 women will suffer a blood clot while pregnant, and 40 to 65 post-partum. Again, the risk of gastric bleeding from taking Aspirin-like products and the risk of kidney damage from Tylenol-like products is more significant.
Taking the Pill also reduces the risk of ovarian and endometrial cancer. Many women also take birth control to treat painful or heavy menstrual periods. Most importantly of all, it prevents pregnancy, and unwanted pregnancy carries many risks, both physical and financial.
Research shows that making hormonal contraceptives available without prescription – as they are in most of the world – increases usage and reduces unwanted pregnancies, by 25 per cent.
Drug-safety rules should reflect the trade-off between potential benefits and harms. After half a century of safe use of oral contraceptives, we need to break down pointless barriers to access.
Giving women more control over their reproductive choices is of immeasurable benefit, while the risk of physical harm is negligible.
Lawmakers and regulators should be forging policies that are beneficial to the health of women. They have no business prescribing morality.
Editor's Note: Earlier versions of this digital article said the morning-after pill can be obtained without a prescription, but it is still a behind-the-counter product, meaning it has to be dispensed by a pharmacist. While that is correct in most parts of Canada, there are some exceptions. This digital version has been clarified to say that is mostly the case.