Increase Birth Control Pill Access

June 28th, 2015

Map of where BCPs available

As the map above shows, birth control pills are available throughout most of the world without a prescription. People in the United States are recognizing that the medicalization of contraception is not necessary, and acts as a barrier to obtaining needed contraception. Go to https://www.facebook.com/freethepill for updated information about the movement to “free the pill”.
The map below is courtesy of Ibis Reproductive Health, and comes from an article in Contraception, “Prescription requirements and over-the-counter access to oral contraceptives: a global review”, 2013.

Should you have to go to a doctor for a prescription in order to buy a medication that is safe, can prolong lives, prevents cancer and helps people feel better?

Although the press often vilifies oral contraceptives whenever a study shows that there is a risk to taking them, the reality is that they are amazingly safe. What is seldom discussed is that they have beneficial side effects. Of course, women react differently and there are many different “pills”, so I cannot promise that every woman will have these benefits.

Acne is a problem for many young women, and one of the best treatments is oral contraceptives (OCs). Likewise, heavy periods, cramps and menstrual irregularity can be eased with these hormones. Because of lighter periods, pill-takers are less prone to anemia. OC users are less likely to develop benign breast cysts, ovarian cancer or cancer of the uterine lining. And, oh yes, if they are taken properly they prevent unwanted pregnancies! Remember, effective contraception has been shown to be the best way to avoid abortion.

A study of over 17,000 women in England taking OCs proved their safety. To quote the conclusion of the study: “Long-term follow-up strongly suggests that OC use slightly reduces all cause mortality.”

What care is essential before starting on OCs? You should know your blood pressure; if it is elevated, you may not be a candidate. You definitely shouldn’t take pills that contain estrogen if you have ever had a stroke or heart attack or a blood clot in your legs. Even if you have a relative who had one of these at an early age you might want to consider another method of contraception. Women who smoke have a greater risk of all these circulatory problems whether or not they take “the pill”. The combination of oral contraceptives and smoking becomes dangerous in women over 35 years of age. Fortunately there are pills without estrogen (progestin only pills) that may be safe for high-risk women.

The upshot is that oral contraceptives are amazingly safe and have health benefits in addition to preventing unplanned pregnancies. Even though there is a slight risk to taking them, the risk to a woman’s life or health of carrying a pregnancy to term is much greater.

Several medications that once required prescriptions have been shown, with experience, to be safe. Ibuprofen (Advil®) and loratadine (Claritin®) are examples. Now there is a push for this transition to happen with birth control pills. The American College of Obstetricians and Gynecologists (the organization that sets the standards for my specialty) came out in favor of over-the-counter (OTC) access to oral contraceptives more than 2 years ago. They recommend that women self-select by using a checklist.

Senator Cory Gardner has introduced a bill to do just that. The major fear is that women with insurance would actually need to pay more for their birth control because currently all insurance policies pay 100%. Unfortunately, most insurance plans don’t pay anything for OTC medications. Another, better Senate bill, introduced by Senator Patty Murray of Washington State, would assure that insurance would continue to pay even if “the pill” went OTC.

For years women have had to go to a provider to get a prescription for “the pill”. This usually involved stripping off clothes and some needless, embarrassing exams. We now recognize that most of this ritual is unnecessary, expensive and acts as a barrier keeping many women from their needed contraception. Women have been able to go to Planned Parenthood and answer a few questions, have her BP checked and leave with her pills. Why shouldn’t a similar program be available at her local pharmacy?

How times have changed! Just 50 years ago the US Supreme Court made contraception legal to all married women. Comstock laws prevented dissemination of birth control literature or supplies before then. Congress passed the first Comstock law in 1873, with the goal of causing “suppression of trade in, and circulation of, obscene literature and articles of immoral use”. Many states passed similar laws. The last of these laws, in Connecticut and Massachusetts, were only struck down in 1965—50 years ago this month.

We are progressing slowly in this country to make safe contraception available to all who want it. Hopefully this will reduce unintended pregnancies—it is sad that now about half of all pregnancies in the USA are unintended. Their financial cost was estimated to be $21 billion in 2010! Much more distressing, however, is the psychological cost of unplanned pregnancies.

© Richard Grossman MD, 2015

Celebrate 20 Years of Population Matters!

May 24th, 2015

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Twenty years ago this spring Morley Ballantine (then the Herald’s editor) gave me the responsibility of writing a column on human population issues. I want to take this opportunity to give an update on population and to thank some of the people who have been involved.

I believe that this is the only regularly appearing newspaper column about issues of human population. Indeed, it is probably the only regularly appearing treatment of this most important subject in any medium. It started as an idea for a book with short chapters, each with a verb in the title, and with a positive message about what individuals can do about population. Gail, my wife, and I were able to think of just 17 chapters initially and we worried that there might not be enough content for a whole book. About 240 essays later I have a long list of possible future topics!

Bill Roberts has been my editor and friend throughout these two decades. We seldom see each other, but have mutual respect. Bill has been great in keeping me in line: “stick to the subject” read one of his emails. Richard Ballantine has taken over his mother’s concern for population. He has provided support not only for these columns but also financial support through the Ballantine Family Fund for relevant events in our community.

For several years a group observed World Population Awareness Week in Durango. We brought in speakers and had events—but too often they competed with the wonderful Lifelong Learning series at Fort Lewis College. Fortunately Rich Hoehlein, organizer of this series, has agreed to have occasional talks on topics related to population rather than splitting the audience.

Gail is my first sounding board. I trust her reaction to an idea or draft article more than my own. She finds mistakes in drafts that I’ve been over many times, and comes up with solutions to writing problems. I am lucky to have such a talented writing partner.

When Population Matters! first hit the press, world population was about 5.7 billion; it has increased by a billion and a half to 7.2 billion in the past 20 years. This rapid increase is partially due to the International Conference on Population and Development, which shifted the focus away from population. The word “population” was tinged by a past history of coercion; instead the Conference focused on “reproductive health”.

Now we can measure the consequences of population and consumption using the “Ecological Footprint” concept, and have discovered that we are using resources much faster that the planet can provide. We also know that climate change is a repercussion of population growth, as are the decreasing numbers of wildlife and loss of species.

We have made many improvements in family planning since 1995. Emergency Contraception has helped prevent unplanned pregnancies. EC was rarely prescribed 20 years ago, but now EC pills are available in over 50 countries, in many without prescription. We have recognized Long Acting Reversible Contraception (LARC) as being much better than methods that require daily or weekly usage. Another LARC, a new IUD, will soon be available.

The Affordable Care Act (“Obamacare”) has taken a positive step to lower our high unintended pregnancy rate. It provides contraception without co-pay for any enrollee. (Unfortunately it does not pay for vasectomies!) An experiment in Colorado showed that it is possible to lower the teen pregnancy rate (and to decrease the number of abortions) by providing LARCs without charge to uninsured women. Unfortunately, a Colorado legislature killed funding to continue this program.

Even before EC pills were available without prescription it was possible to get them over the Internet. This same model is being used to provide birth control pills. But isn’t “the pill” dangerous? There are some risks with hormonal contraception, but a study in England has shown that women who used oral contraceptives, on average, lived longer than women who did not. Planned Parenthood has been providing pills safely for years to women without an exam—just a blood pressure reading. This miracle medicine is now available at: https://www.prjktruby.com for just $20 per month. This fee also helps to pay for birth control for women in the developing world, thanks to PRJKT RUBY.

My sense is that people are becoming more aware of population issues. FP2020, the program to provide quality family planning services for many of the world’s poorest countries, is a barometer of this change. My hope is that the USA will continue to see programs that will lower our high unintended pregnancy rate.

© Richard Grossman MD, 2015

PS: I have been distributing these monthly columns by email to people all over the country–and a few outside the USA. I promise only one email a month. If you would like to be added to the listserv, please contact me at: subscribe@population-matters.org
Thanks!
Richard

Subscribe to Population Matters!

May 24th, 2015

I have been distributing these monthly columns by email to people all over the country–and a few outside the USA. I promise only one email a month. If you would like to be added to the listserv, please contact me at: subscribe@population-matters.org
Thanks!
Richard

Creative Commons Attribution 3.0 United States
This work is licensed under a Creative Commons Attribution 3.0 United States.