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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Pharmacy Access Partnership hopes to organize a similar pilot program for California as early as next year. But despite Washington's success, there's no guarantee of smooth sailing. Not all pharmacists embrace the idea of pharmacy access for the Pill, even though they may have collaborated with the nonprofit on other initiatives.

Jim Cohen has owned the Medicine Chest in Hayward for twenty years, and for the last several has been dispensing emergency contraception and refill Depo-Provera shots. His shop is about as different from Farmacia Remedios as two drugstores can be -- instead of banda tunes blaring from ceiling speakers, '50s hits pump from a jukebox. Instead of tightly packed shelves of perfumes and Mexican candies, the Medicine Chest has a classic soda fountain with vintage red-vinyl booths. Cohen sinks back in his office chair, puts up his cowboy-boot-clad feet, and closes his eyes while he mulls the question of pharmacy access to hormonal birth control. "I have some fears about that," he finally concludes.

Like Tertes, Cohen believes repeat users of Plan B should be encouraged to try routine birth-control methods, but he has reservations about taking responsibility for starting a hormonal method then and there. He isn't reassured by the recently adjusted FDA guidelines regarding pelvic exams and Pap smears -- he'd still rather that women had them. And, he wonders, shouldn't he also be administering a pregnancy test? "If I were in a clinic setting where I had access to all that stuff that would be another issue, but just in a retail pharmacy like this I don't think it's appropriate," he says. "It would be really complicated, I think, to work out the protocols of how things are going to work. It's not as simple as someone coming in for emergency contraception."

Cohen is correct in noting that, while there is only one Plan B, there are dozens of brands of birth-control pills on the market. Although most are equally effective, work the same way, and are based on similar chemicals, there are differences. They come in varying dosage levels and may have different side effects. Some contain progestin (synthetic progesterone), while others use combinations of the female sex hormones estrogen and progesterone. Some pills give the woman consistent doses for 21 days, followed by 7 days of placebo pills; others alter the daily dosage each week for three weeks, then revert to placebos for the fourth week. Cohen wonders whether pharmacists will be able to select the right type for each patient.

Darney and other supporters of greater access to the Pill are convinced pharmacists can be trained to do it right. So long as the pharmacist is taught how to select among the broader categories of pills, Darney says, choosing between brands differs little from selecting between bottles of ibuprofen: It's mainly packaging, and the consequences of picking the wrong brand are not severe. "If you were unhappy with your choice, the unhappiness won't be due to some horrible consequence," he says. "It will be due to the bothersome things about taking birth-control pills -- irregular bleeding, sometimes nausea."

Indeed, modern birth-control pills -- which employ doses ten times smaller than those first approved by the FDA -- have a superior medical track record. "Very frankly, hormonal contraception is safer than aspirin," says Judith DeSarno of the National Family Planning and Reproductive Health Association. However, oral contraceptives have been linked to a few serious conditions, most notably increased risk of blood clots. For this reason, the Pill isn't recommended for women with a personal or family history of blood clots -- or hypertension, since the hormones also can elevate blood pressure.

There's conflicting evidence on breast cancer risk. The National Cancer Institute cites three studies: A 1996 epidemiological study involving more than 153,000 women found that current or recent users of oral contraceptives had a slightly higher risk of developing a tumor, while a later study of 4,411 women reported a "significantly" elevated risk for women aged 20 to 34. A third study, involving 9,257 women, found no significant increase in risk for women 35 to 64. In the comprehensive 1996 analysis, the researchers found that a woman's breast cancer risk returned to normal within ten years of quitting the Pill. There's also some evidence linking oral contraceptives to the development of glandular cervical cancer and a very rare form of liver tumor.

For people who oppose birth control for ethical or religious reasons, these potential risks are another reason to avoid it. Tim Wohlers directs client services for the Pregnancy Care Clinic, a faith-based counseling program based in Antioch and Concord. The group is pro-life and promotes abstinence; for pregnant women, it offers help with parenting and information about adoption, abortion, and parenting options. Clinic staffers will provide information about birth control, but won't prescribe it, and they are careful to spell out its risks -- something Wohlers thinks many birth-control advocates don't do thoroughly enough. "If the risk there is even very, very small, a one-in-a-million chance you're going to get breast cancer, we need to inform people of that and have really good information on failure rates," he says, adding that people should also be made aware of the risks to those with a family history of blood clots, stroke, or heart problems.

Wohlers worries that making the Pill more easily available will multiply the dangers. "What about the thirteen-year-old girl who is going to be picking up the box, bringing it home, throwing the box and any information that was written in medical jargon on a little strip away?" he asks. "Who is going to inform her about the risk and potential side effects and life issues that are going to come out of a decision like that?"

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