Between New York legalizing abortion up until the point of birth and Alabama banning it with the sole exception of saving the life of the mother, our national impasse on abortion seems to finally be coming to a hostile head. The debate is nasty and divisive with little room for compromise.
But there is one partial solution which would both ameliorate the nation’s demand for abortion, protect religious liberty, and most importantly, empower women’s choices prior to conception. That is, we ought to make birth control available over the counter.
To little fanfare, Republicans have attempted to expedite the push to make oral contraceptives over the counter for the past decade. The latest bill from Senate Republicans Joni Ernst of Iowa and Cory Gardner of Colorado would not only allow women to purchase oral contraceptives without a prescription, but it would also undo some restrictions imposed by the Affordable Care Act to allow women to use their health savings accounts to pay for it.
The reasons for Republicans to enthusiastically endorse the Ernst-Gardner bill are numerous. For one thing, employers would no longer be liable for covering it through health insurance plans, removing any religious liberty complications involved in court challenges to the contraceptive mandate. It would also immediately change the drug’s elasticity to consumer demand and make its list price cheaper for all women, including uninsured ones, who currently pay an artificially high price for a drug that insured women can get for free.
While studies have not definitively proven that the real cost of birth control would fall as a result of making “The Pill” over-the-counter, Amazon’s recent foray into the nonprescription drug market demonstrates the cost-cutting capacity of empowering patients with consumer choice. Less than a year selling over-the-counter drugs, Amazon has massively undercut competitors, with a Jeffries Group report finding that Amazon’s private label drugs are cheaper than 84% of Walgreens’ and 72% of CVS’s private label drugs.
Doctors often prescribe birth control for a number of medical reasons, such as Polycystic Ovary Syndrome and endometriosis. But screening for contraceptives purely to prevent pregnancy is remarkably simple. Absent preexisting conditions such as coronary artery disease or lupus, the overwhelming majority of women who are neither over the age of 35 nor smokers safely use birth control without a physician’s guidance. In practice, women screen themselves effectively.
The American Congress of Obstetricians and Gynecologists, the American Academy of Family Physicians, and the American Medical Association have all publicly endorsed over-the-counter status for oral contraceptives, and numerous studies demonstrate that deregulating contraception would increase the share of women using it and markedly reduce our unintended pregnancy rate. As Title X’s effects indicate, available birth control also slashes our abortion rate by the hundreds of thousands annually.
In a perfect world, women would be seeing their doctors annually regardless of their contraceptive use. But in practice, just three out of four American women between the ages of 18 and 64 have had a pap smear in the past three years, primarily due to low income, a lack of health insurance, and associated effects.
Women who want the guidance of a doctor when using birth control absolutely ought to get it, but those unable to afford or access a physician’s care shouldn’t be held hostage by bad regulations in their pursuit of a pharmaceutical that ACOG says is comparable to Tylenol in safety. In short, the elimination of abortion doesn’t have to begin with the courts or legislation.
