The supposedly pro-woman Left has erupted into fury this past week, denouncing new legislation proposed by Senator Cory Gardner (R., Colo.) that seeks to encourage over-the-counter status for birth control. Salon’s Katie McDonough called the senator perpetually “full of s**t.” Planned Parenthood’s president claimed that the bill “is a sham and an insult to women.” NARAL Pro-Choice America’s president called the idea “nothing but political pandering to trick women and families into thinking we are covered while dismantling one of the most critical gains in the Affordable Care Act.” And Slate’s Amanda Marcotte called it “just a feint.”
The Left’s reflexive criticism of Gardner’s plan derives from a deep public-sector and special-interest-backed paternalism that wants to control women’s health choices just as much as any other supposed patriarchy. Removing the pharmacy-counter barrier between women and their birth control would give them vastly more, not less, power over their own health-care choices, also reducing health-care costs and improving access.
Right now, the federal government requires a prescription for birth control, even though other over-the-counter drugs (acetaminophen, for example) bear higher health risks, the directions are straightforward, and there’s no risk of overdose. Practically speaking, the prescription requirement keeps women beholden to their gynecologist, forcing them to submit to intrusive and uncomfortable once-a-year doctor’s visits in exchange for a pink slip for the pill. But while pelvic exams and Pap smears can help physicians detect everything from sexually transmitted diseases to cervical cancer, these procedures tell them basically nothing about whether a woman can safely take birth control. Authorities as prestigious as the World Health Organization and the American Congress of Obstetricians and Gynecologists have confirmed that doctors can safely prescribe the pill without a full examination. Just as with other low-risk drugs, women are perfectly capable of reading the warning label and self-screening for safety.
Nevertheless, in 2010, the journal Obstetrics & Gynecology found that 29 percent of doctors always required a pelvic exam before penning a prescription, while an additional 45 percent of them “usually” did so. While preventive care is valuable, this requirement is much like linking men’s access to condoms to annual prostate exams. In 2013, the New York Times estimated that American women undergo more than 63 million pelvic exams a year. That comes at a huge cost to our health-care system, even disregarding the time women are forced to take off work to visit the doctor. The examination alone costs around $125, and a Pap test adds roughly $40 to the expense, according to reports by the American Board of Internal Medicine’s nonprofit ABIM Foundation. Planned Parenthood alone makes around $1.2 billion each year from contraceptive services.
With that big cash in mind, is it any wonder special-interest groups from gynecological associations to Planned Parenthood to NARAL have come out swinging against Senator Gardner’s proposal? There’s also major political motivation for liberals to oppose a Republican bill encouraging OTC birth control, even though many on the left have sought it for years. Seeking to woo women voters, the Left has forced insurers to offer “free” birth control, as enshrined in the Affordable Care Act. That’s a handy trick; instead of engaging in a debate on the economics of the health law with opponents, they can simply shout misogyny, dusting off the war-on-women rhetoric.
By paving the way for an OTC pill by giving the medication priority review at the Food and Drug Administration and waiving filing fees, Gardner and his Republican allies would deprive liberals of one of their most cynical political tricks. Contrary to what Gardner’s opponents say, making birth control over-the-counter won’t necessarily cause insurers to stop covering it. In fact, Senator Kelly Ayotte (R., N.H.), a co-sponsor of the bill, told S. E. Cupp that “nothing in our bill changes current insurance coverage for contraceptives or prevents insurance companies from continuing to cover contraceptive costs.” But even if insurers did drop coverage of the pill, over-the-counter status would increase competition, which would exert downward pressure on the price of birth control. There’s ample precedent: Less than a year after Claritin went over-the-counter in 2002, its price had been cut in half, and today, consumers buying bulk bottles with more than 100 pills can get a month’s supply for less than $3.
Making birth control over-the-counter would also vastly expand access, resulting in fewer unplanned pregnancies and abortions. In fact, unwanted pregnancies could decline as much as 25 percent, according to a new study released in February by the University of California–San Francisco, and nonprofit Ibis Reproductive Health. “Women who are currently using methods that are less effective than the pill — mainly condoms or nothing — would use it,” the study’s author concluded. “Particularly low-income women.” The case for offering the pill without a prescription is strong, as is public support for the measure. A recent Reason-Rupe poll found that 70 percent of Americans support making birth control available over the counter. Women’s health-care choices shouldn’t be limited by the greed of special-interest groups or the political calculations of jaded congressmen.
Jillian Kay Melchior writes for National Review as a Thomas L. Rhodes Fellow for the Franklin Center. She is also a senior fellow at the Independent Women’s Forum.