Something unexpected happened a few years ago when drugmaker Ortho-McNeil introduced Ortho Evra, a contraceptive patch women can wear for a week at a time. To let women test how the adhesive feels on the skin, the company ran magazine ads with a chemical-free peel-off sample patch. A week later, to the drugmaker's surprise, women who hadn't realized the patch contained no medication began asking how they could get more magazines for refills. That's the sort of thing that smacks health-care policy experts between the eyes. "Women thought it was safe to just slap it on from a magazine!" exclaims Sharon Cohen, associate director of the Pharmacy Access Partnership.
The more these women's-health advocates thought about it, the more they felt the consumers were onto something: on-demand, hassle-free access to birth control. Why wait for a doctor's appointment? Why not just get it when you need it? "There's an intuitive sense that it should be that simple," Cohen says.
Few people are saying we should dispense hormonal contraceptives like perfume samples, but there's a growing wave of medical and political opinion that these methods are so safe, effective, and common that they should be a heck of a lot easier to get. Making the Pill and its modern descendants, the Patch and the NuvaRing, available directly from pharmacists is the goal of Cohen's employer, an Oakland-based public health nonprofit that over the last six years has been quietly revolutionizing the way women obtain birth control. In 2001, Pharmacy Access Partnership convinced state legislators to back the nation's first law to let pharmacists dispense emergency contraception -- aka Plan B, or "the morning-after pill" -- without a prescription. The next year, it launched the Health Step program, which lets women who got Depo-Provera injections from their doctor return to a pharmacist for follow-up shots. Now the group is paving the way for what would be the most sweeping change of all: taking the prescription out of the Pill.
It's about time.
America has a serious problem: Nearly half of its pregnancies are unplanned, about three million a year, and 43 percent of them -- roughly 1.3 million -- end in abortion. You could build the world's biggest calculator and still not be able to compute how much this extraordinary unplanned-pregnancy rate costs our society in medical and social support expenses, lowered educational and career attainment, and emotional distress. But as a tool to deal with the problem, hormonal birth control is unrivaled. It's unobtrusive, reversible, affordable, simple to use, and 99-plus-percent effective if taken properly. Even factoring in misuse, the Pill has a 3 to 6 percent failure rate, better than condoms, diaphragms, sponges, or spermicides.
It's also famously safe. As the nation's leading birth-control method, the Pill has been used by 44.5 million women over four decades. When women are properly screened for preexisting conditions, most negative side effects are minor and temporary, while other side effects are actually beneficial. Pharmacy Access Partnership estimates that if even a quarter of the women "at risk" for unintended pregnancy, and who don't currently use contraception, were to go on the Pill, half a million accidental pregnancies -- and hundreds of thousands of abortions -- could be avoided each year.
"I think contraception should be handed out on street corners," says Judith DeSarno, president of the National Family Planning and Reproductive Health Association, a lobbying powerhouse that has embraced the concept of birth control on demand. "It helps women's health. Financially, it helps the country to lower unplanned pregnancies. It would lower the abortion rate. I think it should be as easy as possible."
Why then, after forty years of mainstream use, is birth control still such a pain to get?
It's true that some pro-life factions still equate birth-control pills with abortion, and have lobbied to keep them less available. Some hospitals and insurance companies with religious affiliations have refused to prescribe or cover birth control, while Republican politicians are rallying to let pharmacists refuse to dispense certain drugs on personal moral grounds. But the bigger issue in the East Bay is one of convenience, and the primary culprit isn't any pro-life group, but an entrenched medical establishment.
Generally, women seeking birth control have to visit a clinic or wait for a doctor's appointment to get a prescription that is typically good for only a year's supply. Renewing it usually requires a pelvic exam, in which the woman is screened for cancer and STDs. Even if the woman's insurer covers both the doctor's visit and the pills -- and insurers sometimes don't -- most plans dole out the prescriptions one pack at a time: another month, another trip to the pharmacy, another copay. Perhaps most aggravating is that many plans cover only refills purchased just as the previous month's supply runs out. Women who show up a few days early are told to come back later. If a woman arrives a few days late, that's a bigger problem -- she has probably delayed her next month of birth control, and that can wreak havoc with the effectiveness of hormonal methods.
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