Free the Pill! 

It's highly effective and "safer than aspirin." Selling it over the counter could prevent hundreds of thousands of abortions annually. So why on earth can't women get their birth control without a prescription?

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All of this is what Belle Taylor-McGhee, Pharmacy Access Partnership's executive director, calls a series of barriers for those at the greatest risk of unintended pregnancy: young teenagers, low-income women, the uninsured, and those who can't see a doctor during typical office hours. Last year, the nonprofit commissioned a national survey of 811 women to gauge their interest in getting birth-control pills direct from a pharmacist. The feedback was overwhelming: Two-thirds of the respondents, regardless of age, race, religion, or educational background, said yes, so long as pharmacists provided medical screening first. More strikingly, 40 percent indicated that they were not using any form of birth control, but would use a hormonal method if they could get it without seeing a doctor. This alone could have a profound effect on the unplanned-pregnancy rate.

Switching a drug from prescription-only to over-the-counter status is hardly a new concept. Scores of onetime prescription drugs have moved onto retail shelves after being proven safe without a doctor's okay -- hydrocortisone cream for skin rashes, Benadryl for allergies, Sudafed for congestion, and Zantac for acid reflux, to name a few.

In many ways, Taylor-McGhee says, the drugstore is the ideal place to reach out to women the health-care system overlooks. "There's one on every corner, there's one in your community, they have convenient hours, they're open on weekends and holidays," she says. You also don't need an appointment or insurance, and can remain relatively anonymous. Many people feel more at ease approaching a pharmacist for advice than a physician. Nobody is going to come at you with a speculum.

"I have no doubt that over-the-counter availability would mean better use of more effective contraception, particularly for teenagers," says Dr. Philip Darney, chief of obstetric gynecology at San Francisco General Hospital. "They are the ones most likely not to have regular contact with the health-care system, to be frightened of the pelvic exam, to run out of birth-control pills."

Taking the Pill out of doctors' hands is a big idea that raises a host of big questions: Is it safe? Who will pay? Will pharmacists want to get involved? There are plenty of details to nail down before this proposal gets to the legislative stage, but making "pharmacy access" work is no mystery. In fact, if you live in the East Bay, there may be a successful model just around the corner.

Around one East Bay corner, in Oakland's Fruitvale district, is Farmacia Remedios, a small drugstore less than a year old that specializes in selling Mexican products to a mostly Catholic, Spanish-speaking community. Pharmacist Gregory Tertes is boyish and eager to serve his growing clientele; if latecomers straggle in after he has closed the counter, he'll still pop back there to offer advice in his recently acquired Spanish.

Tertes participates in Pharmacy Access Partnership's emergency contraception program, which has been running since 2002, and now operates in about fifty East Bay pharmacies. He can't dispense the Pill, Patch, or Ring without a prescription -- only Plan B, the morning-after pill -- but the program shows how drugstores could be used to dole out conventional birth control. It trains pharmacists on the use of emergency contraception, and then allows them to dispense Plan B to drop-in clients without a doctor's input. Tertes is certain he is reaching women who don't interact with the traditional health-care system. "There are definitely people who come to me who would not go to a doctor for it," he says.

Plan B contains a high dose of the same hormones contained in the Pill, but is meant to be taken only in an "emergency," not on a continuing basis. It's recommended for women who have been raped, have experienced condom failure, or have otherwise had unprotected sex.

In most cases, according to recent research, Plan B prevents pregnancy by halting ovulation -- no egg, no embryo. But if a woman has already ovulated, the hormone speeds the movement of the ovum down the fallopian tube, allowing less time for fertilization to occur. As defined by modern medicine, pregnancy begins only when a five-day-old embryo, a microscopic cluster of cells called a blastocyst, successfully implants in the uterine lining, and if all else fails Plan B works to prevent this from happening. The drug cannot terminate a pregnancy -- if the egg has successfully implanted by the time the patient takes the Plan B tablets, she is already pregnant and the pills do nothing. Emergency contraception has to be taken within five days of unprotected sex, although it works best in the first three. Time is of the essence, and in lobbying the California legislature the Pharmacy Access Partnership hammered home this simple fact: A trip to the pharmacy is much faster than a wait for a doctor's appointment.

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