Nonsense NYT Op-Ed suggests the Pill should be available over-the-counter

Kelly Blanchard of Ibis Reproductive Health, a women's health research group, has published a ridiculous op-ed piece in the New York Times asserting that the Pill should be available over the counter, without a prescription, because it's safer than acetaminophen. Blanchard explains the problems with requiring a prescription for the Pill:

[The Pill's] usefulness has been limited because it’s available only by prescription. As every woman who has run out of pills on a Sunday or forgotten to take them along on vacation knows, refills are not always easy to come by.

This is not a problem most easily solved by eliminating the need for a prescription. This is a problem most easily solved by women watching their medication supply and double-checking their luggage before they leave the house. Blanchard's message here is not particularly empowering.

The pill meets F.D.A. criteria for over-the-counter medications. Women don’t need a doctor to tell them whether they need the pill — they know when they are sexually active and want to avoid pregnancy. Pill instructions are easy to follow: Take one each day.

Ease of use is not the sole, or maybe even the most important, criterion for whether a medication should be available without a prescription. After all, heavy-duty sleep aids are also once-a-day pills, and some anti-osteoporosis drugs are once-a-month pills. To suggest that their dosing schedule should control their over-the-counter availability is absurd.

It’s true that the pill could be dangerous for women with certain conditions. Women who are 35 or older and smoke, and those with high blood pressure, are at greater risk of a heart attack or stroke if they take oral contraceptives that combine estrogen and progestin. But these are not complicated conditions to identify[.]

Huh? The author checks her blood pressure at home? In fact, there is a lot of undiagnosed hypertension among adult Americans. It's inconceivable to me how Blanchard could advocate letting a drug be sold over the counter to literally millions of women who would then have an increased risk of death or permanent disability.

Blanchard analogizes the Pill to cold remedies and condoms. But drugs that affect sex hormones are way different than antihistamines or barrier contraception. A woman should absolutely see some kind of health practitioner before starting on the Pill, so that they can talk about the options as to dosages and as to which type of hormone or combination she'll use. The health practitioner should check her blood pressure, remind her that the Pill won't protect against STDs, and discuss the risks of blood clots, depression, and negative sexual side effects. There are way too many medical issues with the Pill for me to agree with the suggestion that it should be available over the counter like a cough suppressant or a contraceptive sponge.

[T]here are no special health risks for younger women on the pill[.]

Well, that depends how "special" you think your sex drive is, I guess. I spent a year on the Pill when I was in my mid-20s, and it killed my libido dead. It took me several years and a pregnancy to get it back, and I'm not alone . . . says The New York Times itself, in a 2006 article that notes the lack of a warning about that particular possible side-effect in birth-control paperwork.

The United States has one of the highest teenage pregnancy rates in the developed world, and better access to the pill is part of the solution to this problem.

I don't disagree. But Blanchard is not a medical doctor; she's a sociologist. Sociological and economic research is an important way to figure out how populations are barred from getting the healthcare they need. And sociological and economic strategies are important ways to try to remove or at least lower barriers to getting needed healthcare. But there are some important medical reasons for requiring a prescription for the Pill, and it's not helpful to the discussion to minimize those reasons by saying the Pill is safer than Tylenol, or to equate a doctor's prescription with "a doctor's permission," as Blanchard inexplicably does in the last paragraph of her op-ed.

A more important barrier to eliminate is that not all health insurance plans cover the Pill. Almost half the states do not require health insurance companies to do so (PDF). (This is one reason why your health insurance company should not be allowed to incorporate in whichever state it darn well pleases.) Let's focus on this real barrier to reproductive equality. It's a straw-man argument to characterize doctors as paternalistic, permission-granting gatekeepers standing between women and their birth control pills. If any entity stands between a woman and the Pill, it's a health insurance company that's choosing to not fully pay for women's healthcare.