The Pill: Can We Expand Access While Respecting Diverse Experiences?


I’m writing in reply to Amanda Marcotte’s article, “The Pill: A Counter to ‘Over-the-Counter.’” As I observed on my own blog, this is not the first time that the Pill has been considered for a switch from prescription only (Rx) to over-the-counter (OTC). The first time this issue was raised was in the early 1990s.  Historically, the arguments in favor of OTC status for oral contraceptives have tended to come from public health experts who, like Marcotte, see the prescription as paternalistic and an unnecessary barrier to timely access. While I think this is a legitimate point, I also think it’s unfair to characterize the work of Laura Eldrige as simply “freaking out about the pill.” I also think that Marcotte’s claim that complaints of side effects and criticisms of the Pill itself are due to our culture’s “sex panic” is a simplistic analysis of the situation and overlooks a long history of feminist activism on behalf of women consumers.  

For example, the work of Barbara Seaman and the National Women’s Health Network in the 1970s and 1980s exposed serious ethical lapses in human subjects research involving women, especially women of color, and that the possible health risks of various forms of contraception — including the Pill, the Dalkon shield IUD, Depo Provera, and Norplant, were underplayed at the expense of women’s health.

In my opinion, Marcotte’s claim that women’s symptoms while on oral contraceptives are merely the result of “sex panic-driven fears” is just as paternalistic as saying women need a prescription for the Pill.   This same argument was made in the 1960s when the first serious side effects from the Pill were reported, i.e. that women who reported problems were just “hysterical” and subconsciously felt guilty about taking the Pill.

I think Laura Eldridge follows in the same tradition as her mentor Barbara Seaman and other founding members of the feminist health movement such as the authors of Our Bodies, Ourselves.  In my opinion, providing women with accurate information about the benefits AND risks of various contraceptive methods is an important way to empower women to make their own reproductive health choices.  We can have a balanced discussion about this without feeding into “right-wing misinformation.” Indeed, I think a nuanced evaluation of the historical and scientific arguments in favor and against various methods of contraception can help combat conservative opposition.  I also think we should respect women’s choices about contraceptive methods, even if they aren’t what we would choose for ourselves.

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  • amanda-marcotte

    Someone’s right to have “diverse experiences”, and certainly anyone can go off the pill if she likes.

    But Eldridge goes way beyond that. She hides behind “just asking questions” to spread paranoia about the pill, and then when called on it, denies that’s what she’s doing. It’s really irresponsible, and not based in science.

    For instance, this all came up in the context of a discussion about means to expand access by making the pill over the counter, which you were against. It’s really bad faith to suggest that you’re on the “it’s all good team” when you pop up only to argue against any measure that would make it easier for women to use the pill if they choose.

  • squirrely-girl

    So if we present a “balanced discussion,” who gets to write the “other” side detailing the “possible health risks?”

     

    If this issue is treated at all like abortion, which its hard to imagine it wouldn’t, then misinformation is a legitimate concern. Sadly, I envision a scenario with legislators arguing about what to include in the government sanctioned propaganda… errrr… “informed consent document.” I take sincere issue when NON MEDICAL PERSONNEL involve themselves with legislating medical issues. If they wanted to be doctors, they should have gone to med school. Allowing politicians to write medical policy is like letting a mentally retarded person teach you physics.

     

    While no medication is without side effects, I take issue when those side effects are exaggerated or hailed with a single or handful of cases as the supporting evidence. Hell, Tylenol has a considerable number of potential side effects and a much higher potential for overdose and accidental poisonings but I don’t see the “pro-life” crowd complaining about it

     

    So what does the medical profession think about OTC status?

  • crowepps

    If the societal goal is to make everyone’s life 100% risk free, we’ll have to ban peanuts and fish and strawberries and everything else to which anybody’s ever had a serious allergic reaction.  Sometimes the rhetoric makes it really, REALLY obvious which side believes people have actual brains capable of thought and which side believes the average person is too stupid to be allowed to cross a street.

  • arekushieru

    Except that I really don’t think anyone was talking about banning anything.  And why can’t prescriptive powers fall under a medical body’s legislation?

  • hmprescott

    Arekushieru is right — I’m not suggesting banning anything.  I also think that the argument in favor of an OTC switch has merit (which I said in my first comment on Amanda’s original article).  My point — which may have been lost in the harsh language of my post above — is that there are multiple issues at work here, not just a battle between science and conservative politics.  For example, how will the OTC switch affect the cost of oral contraceptives?  Using the case of the OTC switch for emergency contraception (which I strongly support), the cost went up considerably and because it was an OTC product, was not included in prescription drug coverage.  Although I agree that some people (conservatives especially) exaggerate the dangers of oral contraceptives, there are also some serious risks for some women that should not be ignored. 

     

     

  • craftingchange

    While I think this is a conversation we should be having, I think that the ‘offer it as an OTC’ is a solution that doesn’t necessarily add up. Poor women will still have inadaquate access, women will still run into problems at their pharmacy, and w/o medical guidance choice between hormonal variations will be much like brand choice instead of the actual medcial differences.

    I touched on the subject in my most recent podcast, but I’m really glad I’m not the only one having this conversation.

  • crowepps

    Weekly Pulse: The Religious Right vs. Birth Control

     

    by Lindsay Beyerstein, Media Consortium blogger

     

    Does health care reform’s promise of preventive care extend to free birth control? Officials at the Department of Health and Human Services have 18 months to decide whether to require insurers to provide oral contraceptives, IUDs, and other prescription birth control with no co-pay. With pro-choice Secretary Kathleen Sebelius at the helm, HHS is expected to say yes. …

     

    Predictably, the U.S. Conference of Catholic Bishops (USCCB), the National Abstinence Education Association, and the Heritage Foundation are up in arms. They’ve picked a deeply unpopular battle. Abortion remains controversial in some circles, but birth control is as American as baseball. The vast majority of sexually active women in the U.S. tell pollsters that they are not trying to become pregnant, and 89% of them are using some form of birth control.

     

    “Seriously,” writes Monica Potts of TAPPED, “a battle over contraceptives?” Over 15 million Americans currently use hormonal contraception. Studies show that the vast majority of Americans are morally comfortable with birth control.

     

    Expanding access to birth control is smart policy because it reduces health care costs, as Suzi Khimm notes in Mother Jones. Birth control is a lot cheaper for insurers than pregnancy and childbirth. Free birth control could change women’s lives for the better. In this economy, $30-$50 a month for hormonal birth control can be a major obstacle for many. As Michelle Chen notes in ColorLines, women of color are among those hardest hit by out-of-pocket costs. … http://www.huffingtonpost.com/the-media-consortium/weekly-pulse-the-religiou_b_646875.html

  • kirsten-moore

    (PS. Will repost with links to studies mentioned asap.)

    Regarding side effects, perception is certainly reality in any user’s mind. That being said, there is a fair amount of consensus (albeit not universal) that the impact of an unintended pregnancy on a woman’s health outweighs the risk of side effects of the pill.

     

    I would add that the question for consideration in an OTC switch is not whether there are side effects (there always are for any drug), but does the lack of a “learned intermediary” – like a doctor or nurse - make the experience of side effects better or worse for the user? You could say potentially worse, but there’s evidence to suggest that health care providers aren’t doing that great a job to begin with in answering these kinds of questions or in helping clients problem solve (see Guttmacher data). In other words, there’s some reason to believe that women can do as good as if not better than what health care providers are already doing.

     

    It might also be helpful to know that the most likely candidate for an over-the-counter switch is a progestin only pill. This would be a version of what we already have available in Plan B emergency contraception. In this case, there is very wide consensus within the healthcare community, and even within FDA, that there aren’t any significant contraindications for use with a POP. In other words, there is likely to be no enhanced risk to a consumer if she initiates use on her own.

     

    For an OTC switch to move forward though, research will need to be done to see if these conclusions hold up.

     

    Kirsten Moore

    Reproductive Health TEchnologies Project

  • arekushieru

    Sorry, just had to come back to this.  (Note:  I AM talking in general, here, but, at the same time, it can be applied specifically)  My main contention with this is not the risks, per se, but the database a prescription accumulates as opposed to over-the-counter drugs.  If you know your customer’s history, wouldn’t you be better able to ‘tailor to their needs’ so to speak?  Wouldn’t it be better to focus on otc as an alternative, rather than just on whether otc drugs should be permitted?  It just seems to me that that is how this is being presented, as an either we have it or we don’t, rather than an alternative, option.  Sorry in advance in the case that it is an incorrect assumption.  ><;