The Agenda

Virginia Postrel on Making Birth Control Available Over the Counter

As Ramesh Ponnuru has suggested, Virginia Postrel’s argument that we should make birth control available over the counter offers the center-right an effective counter to the recent Democratic messaging regarding the GOP’s “war on women”:

Voters generally dislike arguments about social issues, and tend to oppose whichever side they perceive as the aggressor in a fight over them. Proponents of the mandate have skillfully exploited this fact: That’s the point of their claims that Republicans are waging a war on women, and it’s why the Limbaugh comments were so damaging. During the debate over Blunt’s amendment, Democrats made it sound as though it would work a radical change in American law by allowing employers to veto their employees’ contraceptive decisions. Republicans did not do enough to make the case that all they were doing was preserving current policy. From the dawn of the republic until this very moment, no federal law has required any employer to provide insurance with coverage he finds objectionable. This freedom has not left Americans deprived of contraception or forced them to get permission from their employers to use it. It is this benign status quo that the Obama administration’s regulation will upset.

Republicans would also be wise to reiterate their support for access to contraception. Writing in Bloomberg View, libertarian journalist Virginia Postrel has argued that there is no good reason to continue to require women to get prescriptions to buy the birth-control pill. Perhaps Republicans should undercut the Democratic attack by advocating a Food and Drug Administration review of the policy.

Leaving politics aside, Postrel makes a convincing case on the merits:

Requiring a prescription “acts more as a barrier to access rather than providing medically necessary supervision,” argues Daniel Grossman of Ibis Reproductive Health, a research and advocacy group based in Massachusetts, in an article published in September in Expert Review of Obstetrics & Gynecology.

Birth-control pills can have side effects, of course, but so can such over-the-counter drugs as antihistamines, ibuprofen or the Aleve that once turned me into a scary, hive-covered monster. That’s why even the most common over-the-counter drugs, including aspirin, carry warning labels. Most women aren’t at risk from oral contraceptives, however, just as most patients aren’t at risk from aspirin or Benadryl, and studies suggest that a patient checklist can catch most potential problems.

To further increase safety, over-the-counter sales could start with a progestin-only formulation, sometimes called the “minipill,” rather than the more-common combinations of progestin and estrogen. (Although we casually refer to “The Pill,” oral contraceptives actually come in about 100 formulations.)

Progestin-only pills, or POPs, have fewer contraindications. Unlike combination pills, they’re OK for women with hypertension, for instance, or smokers over the age of 35. The main dangers are fairly rare conditions such as breast cancer or current liver disease. “Not only are POP contraindications rare, but women appear to be able to accurately identify them using a simple checklist without the aid of a clinician,” declares an article forthcoming in the journal Contraception.

The beauty of the Postrel approach is that it is explicitly anti-paternalist. Indeed, one wonders if reviewing the prescription-only status of birth control should be part of a broader effort to reduce the authority of doctors, for the reasons Postrel goes on to outline in her excellent column. 


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