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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This makes some people very unhappy. Some of the religious groups that originally condemned hormonal birth control still do. And some pro-lifers view it as causing abortions, although this view is not universal in right-to-life circles. To understand their objections, it helps to understand that, much like emergency contraception, the Pill prevents pregnancy in three ways, each providing a backup for the others. It suppresses ovulation; it thickens the woman's cervical mucus, making it more difficult for sperm to reach the egg; finally, should sperm manage to fertilize the egg, the Pill prevents the resulting blastocyst from implanting in the uterus. Failure to implant is also a natural phenomenon -- it happens in about one in five cases.

Although science views pregnancy as beginning at implantation, many religious faiths teach that life starts when sperm meets egg. In this light, some abortion-rights opponents view the third mechanism as "chemical abortion." It's a serious concern for them; there are even Web sites that attempt to tally how many potential lives have been aborted via birth control pills. Consequently, some pro-lifers think increased access to hormonal birth control means increased access to abortion. "Since they are all abortifacient in one mechanism of action, no doubt the rates of all abortion will go up," e-mails Kuhar of Pharmacists for Life International, who claims that the rate of chemical abortions from oral contraceptives and other hormonal birth-control products is four to five times that of surgical abortion. "It stands to reason," he writes, "those staggering rates can only go up when the products are unsupervised." It's impossible to check Kuhar's math, but you see his reasoning.

A more moderate pro-life critique of expanding access to the Pill is that by making it easier to get, you make it -- and therefore extramarital sex -- more socially acceptable. "If something is there and easily accessible, people are going to try it more," says Wohlers of the Pregnancy Care Clinic. A Presbyterian pastor as well as a clinic staffer, he says he often counsels young girls who were smooth-talked into sex before they were ready, or others who made relationship choices thinking they couldn't get pregnant -- and then did, or ended up with an STD or a broken heart. "I see so many people that thought that the consequences were going to be all taken away and they made choices they might not have made otherwise and are really hurting because of it," he says.

Pharmacy access also eliminates what Wohlers views as a de facto "cooling-off" period. "The whole waiting period of having to make an appointment to see a doctor, I think that sometimes that can be really helpful," he says. "You have to talk with a doctor and make sure you have a really good understanding that these aren't foolproof, and what the failure rates are, and how to properly understand the method of what you're using."

The truly mind-blowing thing is that activists on both side of this debate profess the same goal: reducing the abortion rate. Couldn't improved access to reliable birth control be a bridge between moderate factions on both sides? After all, more than four out of five American woman have used the Pill, which means countless pro-life women and their partners also have used it. Pharmacy Access Partnership's Taylor-McGhee throws down the gauntlet: "If you say that you really are opposed to abortion and you want to stop abortion, then you ought to be doing everything you possibly can to prevent unintended pregnancy," she says. "So why are we standing in the way of women having access to something that's going to prevent an unintended pregnancy and possibly an abortion?"

But the divide may already be too vast. Asked whether the two sides might be able to join hands on the matter of birth control, Wohlers doesn't hesitate. "Never," he replies wistfully.


If anything, there's reason to believe the poles are growing farther apart. Particularly alarming to the pro-choice camp is a subtle campaign by abortion-rights opponents to change the legal definition of when life begins. Last year's Unborn Victims of Violence Act, which grew out of the Laci Peterson murder, mandates that two crimes have been committed if the victim is pregnant and loses the baby. Although federal policy has long held that pregnancy begins at implantation, this recent law defines pregnancy as a fertilized egg. It's a seemingly trivial and unenforceable detail, and yet it lays the groundwork for the argument that unimplanted embryos have human rights, and that birth control is a crime against them. "You can't even really touch that one in court, because how would you be able to prove a woman was carrying a fertilized egg?" DeSarno asks. "But it's very clever of them to change the definition in this way, because at some point it's going to [put] the easy access to contraception that Americans take for granted at risk."

For birth-control advocates, such ominous moves have created a sense of urgency, a need to rapidly make hormonal contraceptives a more accessible, and therefore accepted, part of American life. The pharmacy is a logical place to do it. Far less controversial than schools, available at odder hours than clinics, more approachable than doctors' offices, they offer health-care technicians who are usually happy to do more than count and pour. As it stands, retail pharmacists perform an increasing number of clinical services that were once the sole province of doctors: for example, flu shots and other immunizations, diabetes management, blood-pressure testing and, recently, emergency contraception. There's every reason to believe that most of the concerns raised by doctors and pharmacists could be addressed with a well-designed protocol -- making sure women return for check-ups, as the Washington pilot study did; and making sure they leave the store armed with information about using condoms and the need for an annual Pap smear. It may not be simple, but it's far from impossible.

The science, the demand, and the Washington test model are in place -- all that's needed now is the political will, and that's on the rise in California. There's a burgeoning sense among women's-health advocates that the fight for the Pill didn't end in the '60s with the demise of the Comstock Law; that the policies keeping such a tight line on birth control are driven less by medical necessity than by a centuries-old subliminal fear that if sex doesn't lead to permanent consequences -- like kids -- women will keep on having it. And liking it. And that they'll spend less of their time bearing and raising children, and more doing whatever else it is they'd like to do.

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