Proscriptive Prescription

For many women, getting a doctor's prescription for birth-control pills or a diaphragm is simply a chore. But for others, especially poor women and teenagers, the cost of the medical exam and the prescription can be prohibitive. A growing movement among women's groups and family-planning organizations is seeking to improve access to birth control by making both the Pill and the diaphragm available over the counter.

Fueling the movement is a recent report from the National Research Council and the Institute of Medicine that the number of abortions in the United States (about half of the 3.5 million unplanned pregnancies every year) could be significantly reduced if highly effective contraceptives were more readily available.

"I don't think anybody knows how many pregnancies occur because of delayed refills, or just not getting pills on time. But it is really a lot. Anyone who works at an abortion clinic can tell you that," Felicia Stewart, a Planned Parenthood physician, told Ms. magazine.

Yet for many women's-health advocates, over-the-counter birth control raises the specter of health risks. While the only problem with diaphragms is getting the right size, the issue of oral contraceptives is trickier, they say.

Today, most physicians require an annual checkup before prescribing the Pill or renewing a prescription. Making the Pill available without a prescription would place the responsibility for preventive screening on the individual woman. Supporters of the prescription requirement argue that some women might end up with serious health problems that could have been avoided through such screening.

Opponents say that screening is a separate question and that giving women more birth-control options can only help. A Planned Parenthood task force is studying the issue and expects to make a recommendation by the end of the year.