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Liberation (By Prescription)

By Juliet S. Samuel

Finally, scientists have invented a contraceptive pill that does away with a woman’s period entirely. Lybrel, the new pill, can be taken continuously without the monthly bleed that most pills require and, since its approval last month by the Food and Drug Administration (FDA), it now seems possible to release women everywhere from their wretched biological “curse.” In short, welcome liberation; goodbye Tampax.

But before celebrating this newfound emancipation from Kotex ads, let us not forget that one barrier will yet stand in the way of the average woman and her chemical relief: a doctor’s prescription.

Any upstanding member of the public with sniffles can currently go into a pharmacist and buy Tylenol (full of potentially deadly acetaminophen), Sudafed (a methamphetamine precursor), and even the last-minute emergency contraceptive Plan B (15 times the regular contraceptive pill dose) no questions asked.

But when it comes to a woman buying a regular contraceptive pill, the FDA has put its foot down: Get thee back to the maternity ward, woman! The regular contraceptive pill is not, and has never been, available over-the-counter (OTC) in any American pharmacy. In order to get hold of “The Pill,” a woman must first see a doctor, who will politely grill her on her sexual history, suggest strongly that she have a pair of tongs stuck up her vagina for a pap smear, and send her on her merry way with a renewable prescription for control over her own body.

Currently, both knowledge and consistent use of oral contraceptives is surprisingly low (there are just 10.4 million users in the U.S.) given that the pill provides both the convenience of managing menstruation and the security of control over pregnancy. Spreading oral contraceptive use would increase women’s physical and mental autonomy over pregnancy, and probably result in fewer abortions. So unless you think all contraception is immoral, encouraging pill use is a positive goal.

Despite these advantages, this basic, safe and responsible method of controlling conception is unnecessarily regulated, even though research indicates that making oral contraceptive available OTC would dramatically increase its usage. According to a survey by Louis Harris and Associates, quoted in a policy report for the Institute For Women, “20.4 percent of sexually active women who currently do not use the Pill would be very likely to switch to that form of birth control if it were available over-the-counter,” which, the report adds, would lead to an increase of 6.96 million users.

But those in support of the status quo rally two arguments to their cause. The first, an eminently practical argument, is that there is significant educational value to making a woman have a nice sit-down with her doctor, who can quiz her on her sex life and tell her what to do if she misses a pill. Supposedly, a good chat with the doc is likely to increase proper usage and knowledge of the potential risks.

Unfortunately, this argument supposes not only that patients listen to their doctors, but also that they actually use the information. In fact, a brief warning about consistent use is almost certain to sail over the disinterested patient’s head, while those with a genuine desire for information can easily ask their pharmacist, or read the leaflet that comes with every pill package. The very act of sitting down with a doctor does not create a responsible attitude to birth control, and proper usage information is readily available for anyone who wants it.

The moral argument against non-prescription oral contraceptives is that sex, and all that jazz, should be a big deal: If women are allowed to purchase the pill willy-nilly then they will all go around have lots of sex and being generally licentious. Again, this argument puts the cart before the horse, assuming doctors’ appointments uphold moral attitudes. Most individuals make decisions about sex based on their own personal moral and social circumstances, not on the availability of pills and condoms—after all, anyone can pick up the latter freely at CVS. And even if the moralists are right and contraception does make sex more popular, who is the government to decide that more sex is immoral sex? No troop of bureaucrats in Washington is better qualified to make moral and personal decisions about sex than individuals.

But while the pill doesn’t cause sex—over a fifth of teens don’t even use contraception their first time—it does place control over the consequences of sex more firmly in the hands of the woman who risks pregnancy. Currently, the pill’s prescription status imposes a significant cost on women who want to be responsible for their own sex lives. According to Institute For Women, the pill’s prescription status costs women approximately $695.3 million in pill-related doctor’s appointments per year, which averages to about $67 per user, plus the repeated inconvenience of appointments.

Perhaps if the pill were potentially lethal, like say, alcohol, one could argue that the government has a legitimate role in imposing this cost on women. But the pill has not been shown to have any severe long or short-term risks; none of its possible side-effects—nausea, headaches, slight weight gain and, with lifetime use, delayed menopause—are serious enough to warrant a prescription. Nor is there any real chance of abuse or drug extraction: An overdose of ethinyl estradiol and levonorgestrel (two common pill ingredients) is more likely to result in vomiting than any kind of high.

For too long, medical authority has stood in the way of choice and convenience. But menstruation is not a disease and the pill is not a dangerous medicine; it’s a convenient technological innovation that gives women the option of managing their biology, and no government or doctor should be involved in the decision to take it. Stripped of the moralizing rhetoric, it’s hard to see why requiring a prescription for the pill is any more justified than requiring permission for use of the flushing toilet.

Juliet S. Samuel ’09, a Crimson associate editorial chair, is a social studies concentrator in Eliot House.

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