How to End the Fight Over Contraception
Birth control should be available over the counter.
Choking on our own rage has replaced baseball as the great American pastime. Earlier this month, the Trump administration gave people a chance to participate in it once again. The topic this time: what do to about birth control.
And this time, there might actually be a non-enraging solution.
Obamacare requires employers to provide insurance that covers contraception. The administration expanded a conscience exemption to that mandate for those whose religious scruples conflict with contraception. That mandate and exemption have provoked ferocious disagreement; the Supreme Court already has weighed in on the topic once in the Hobby Lobby case, and it may do so again in Zubik v. Burwell, the case that involves the Little Sisters of the Poor.
But the administration didn't wait; it said that imposing the mandate on "entities with sincerely held religious objections… does not serve a compelling governmental interest." Cue outrage from secular liberals.
However, the next administration could change the rules back—stoking outrage from religious conservatives. Unlike taxes or transportation funding, this issue is hard to resolve because it pits two incompatible beliefs against each other: the belief that government should not force people to violate their religious faith, and the belief that religious faith should not trump women's access to contraception.
Fortunately, in the case of contraception there is (pardon the expression) a way to split the baby: Make contraception available over the counter. Sell it without a prescription, like aspirin or condoms. Then women would not need to go through the inconvenience and expense of a doctor's visit, and the devout need not arrange for a service they consider contrary to their religious faith.
In most countries, this is already the norm. More than 100 allow over-the-counter (OTC) sales of birth control; fewer than 50 require a prescription (partly, no doubt, because some birth control serves other medical purposes besides preventing pregnancy). And here in the U.S., some states have begun loosening restrictions as well. California and Oregon permit women to obtain hormonal birth control after screening by a pharmacist for potential complications, for instance.
Even that might be unnecessary; research indicates that women can accurately self-screen—i.e., they don't need somebody else's help to determine what's in their own best interest. Imagine that.
The medical community largely agrees on OTC birth control, too. The American College of Obstetricians and Gynecologists says oral contraception "should be available over-the-counter," and women should be able to screen themselves. Even physicians, who have a modest pecuniary interest in requiring prescriptions for contraception, lopsidedly favor not doing so.
Lately, Republicans have been getting on board. Former GOP presidential candidate Carly Fiorina embraced the idea of OTC birth control two years ago. Republican Sen. Corey Gardner of Colorado introduced an OTC bill in 2015 as well, and gained a half-dozen GOP sponsors. Ed Gillespie, currently running for governor of Virginia, endorsed the idea three years ago.
But no good deed goes unpunished, and Planned Parenthood promptly blasted Gardner for proposing what it called an "insult to women." The group professed to be concerned about women having to pay more in the absence of insurance coverage.
And ideological opposition to OTC birth control still remains. You will not find any support for the notion from the supposedly free-market Heritage Foundation, for instance, even though OTC sales would eliminate the contraception mandate's threat to religious liberty — about which Heritage is extremely concerned.
Likewise, some liberals insist that women should not have to pay even a penny for contraception. But those who say so tend to subscribe to the unicorns-and-rainbows school of economics, in which not just birth control but all medical care is both free and unlimited. There's nothing wrong with dreaming a little.
More practical obstacles do remain, such as winning FDA approval for OTC sales and training pharmacists in states that require pharmacist involvement. America isn't going to get over-the-counter overnight. But on the straightforward policy merits, this seems like an easy call. No medical reason exists to keep women from buying birth control over the counter. And letting them do so would put one socially divisive issue to rest — leaving more outrage left over for people to vent on other things.
This column originally appeared at the Richmond Times-Dispatch.
