Reason.com

Free Minds & Free Markets

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.

Photo Credit: Jenny Lee Silver

Editor's Note: We invite comments and request that they be civil and on-topic. We do not moderate or assume any responsibility for comments, which are owned by the readers who post them. Comments do not represent the views of Reason.com or Reason Foundation. We reserve the right to delete any comment for any reason at any time. Report abuses.

  • lap83||

    You assume the left are fighting in good faith. What they really want is socialism. The feminist rhetoric just makes it sound more compassionate and less like they're trying to crush freedom

  • Tony||

    So the slippery slope to total government control of industry didn't start with roads and bridges... it's birth control.

  • Devastator||

    Eh pretty sure lap83 has been listening to Alex Jones too much.

  • MarioLanza||

    So how do you explain the left's opposition to OTC birth control?

    I thought it was about access? Nope, foolish me. It is about the left wanting to control your activities in the bedroom.

  • Jay Dubya||

    How do you explain the rights opposition (ie heritage, as pointed out in the article, which u pretty clearly did not read)?

  • Nihil||

    I was lambasted as a religious loon for suggesting this in the libertarian subreddit. Even a coworker said I was nuts for thinking this since birth control isn't safe enough to just let everyone had it. I think I'm going to limit my conversations from now on to puppies or the weather.

  • MarioLanza||

    5% develop hypertension, so everyone starting should get their blood pressure checked in 6 weeks.

    No one over 35 and smoking should be on it.

    My confidence in people to follow this is zip: Google "Millennials: The Dumbest Generation in History?" or "4th of July Zombies - Americans Don't Know Why We Celebrate Fourth of July!"

  • Jay Dubya||

    Give it a rest w the millennial bashing. It's boring.

    @nihil doctors have, via the medical prescription system, established one of the most successful cartels in history. One of the basic tenants of libertarianism is the notion of self ownership; prescriptions rob individuals of the freedom to choose what to put into their own bodies. There are some externalities w very specific types of medication like antibiotics, but doctors have failed to prevent those externalities thru prescribing monopolies anyway.

  • Mickey Rat||

    There is absolutely nothing in an employer keeping their religious freedom that impedes any woman's access to birth control. The entire controveersy is based on the Left's insistance that birth control targeted at women be "free" and the unscrupulous lengths they will go to make that possible.

    If that is "dreaming" , theit is harmful.

  • ||

    Choking on our own rage has replaced baseball as the great American pastime.

    I blame conservatives.

  • BestUsedCarSales||

    There's no equivocation in baseball.

  • John||

    Birth control is legal and available to anyone willing to pay for it. The only fight here is over the Left's desire to force people to pay for birth control as a way to control and humiliate them. There is one way to settle that fight; tell the left to go fuck themselves. There really isn't anything else to it.

  • Mitsima||

    If they'd fuck themselves, birth control would be a bit of a moot point, wouldn't it?

  • John||

    Birth control needing a script is along with selling body parts for profit, the main planned parenthood rackets. Providing women with unnecessary medical exams so they can get a script for birth control is very profitable. conservatives should see making birth control over the counter as a good means of defunding that vile organization

  • BYODB||

    Planned Parenthood itself was an organization formed to look into ways to cull undesirable races from the United States, and empirically that is exactly what they have done all the way up to today.

    Nothing says Progressive like selecting certain races for extinction for their own good.

  • Tony||

    Martians could descend on earth and impose their version of theocracy and you'd still be blaming progressives. Do you people have any clue how ridiculous you sound?

  • BestUsedCarSales||

    What part of that do you deny? At the very least the first part is very true. Margaret Sanger was a eugenicist. Hell, sometimes Reason writer Peter Bagge did a whole book about her.

  • BestUsedCarSales||

    Well, comic book.

  • John||

    Planned Parenthood kills more black children in a month than the Klan has in its entire history. It operates as an enormous check on the rise of the black population. If it isn't Richard Spencer's favorite organization, it should be.

  • BYODB||

    I didn't say I was against abortion, but it's nice to see that you're completely ignorant of the formation of this particular organization as well as the ethos they held that black people were both inferior and needed to be culled.

    There is a possibility that Sanger wasn't a full-bore eugenicist but most of those involved were.

    Question: if planned parenthood was formed to rid America of black people, and they have primarily aborted black babies throughout their existence, than at what point did their original intention stop being the cause of the same action?

  • BYODB||

    I don't know why I bother. This is historical fact and it isn't really disputed by anyone yet Tony pretends it's some fringe belief.

    Egads.

  • Spinach Chin||

    All true, tho

  • MarioLanza||

    Tony: "Do you people have any clue how ridiculous you sound?"

    Hey, Tony, do you know how ignorant of history you sound?

  • Devastator||

    More Alex Jones conspiracy crap, Reason comment people I expect more out of you.

  • jimolivi@icloud.com||

    Planned Parenthood AND The Heritage Foundation are against this, therefore it must be a GREAT idea. Allowing OTC birth control removes a fund raising trope from the left AND the right!

  • BestUsedCarSales||

    To be fair, the Heritage foundation just has no comments. I wouldn't be surprised if they were against it.

  • MarioLanza||

    Did you pull this out of your posterior? I googled "Heritage Foundation over the counter birth control" and found zip. (They had plenty to say about the unconstitutional and unamerican obamanation that forced people to violate their religious principles.)

  • BestUsedCarSales||

    they don't need somebody else's help to determine what's in their own best interest. Imagine that.

    No

  • juris imprudent||

    Allow people to make their own decisions? That's just crazy talk.

  • BYODB||

    I do wonder what the narrative will be for the women that end up dying on birth control because of the birth control. Note that I think it should be over the counter, that is absolutely the ideal solution, but I suspect the narrative will soon shift to 'women need to be screens for everything' if it ever becomes an actual risk that these meds will be sold over the counter.


    It has never made a single bit of a sense that something like birth control is stated to be medically necessary for every woman; it isn't.


    Note who uses the overwhelming share of healthcare in this country. It isn't men, and that's reflected in our earlier deaths. Yet somehow the conversation is never about men dying because we don't go to the doctor as often, it's always about getting women to go to the doctor even more frequently than they already do. And it has nothing to do with men not being able to afford it, either.


    It's just weird, is all.

  • John||

    You never hear about the risks to women of using birth control pills because birth control and the ability to have sex without consequences is a sacred tenenent of feminism. Feminists are never going to acknowledge any risk associated with birth control.

  • BYODB||

    It's not a high risk of anything going wrong, but of course you'll have some portion of the female population popping BC pills from the time they're 16 into their early 40's wondering why they're suddenly dead.

    Again, it's not a huge risk but a fraction of women will die from it. This is certain. Not from misuse, or allergy, but needless to say that will happen as well.

    It's something I'm absolutely fine with, since they assume their own risk, but if there is one thing I know about the left they don't believe that people should face the consequences of their own decisions when it involves their pet demographics.

  • BestUsedCarSales||

    Also, my knowledge was that the risk is quite low. Someone can still got and ask a doctor about it, I can and have asked my doctor about ibuprofen consumption before. The current system precludes it being freely available, the other system doesn't preclude asking a doctor though.

    The thing I wonder about is other contraceptives. I don't know if women can easily insert an IUD themselves, but I wonder if it really requires a full OB/GYN.

  • BYODB||


    I don't know if women can easily insert an IUD themselves, but I wonder if it really requires a full OB/GYN.

    They can not, at all.

    I'd suppose there might be a few people flexible enough to shove their own hand all the way up into themselves, but I doubt many would try and even if they could I doubt they could dilate their own cervix.

    Intrauterine Devices could probably be installed by a trained NP but those in particular are more complicated than most other birth control types and I don't really think I'd trust just any average Nurse for that type of procedure.

    I don't disagree with anything you said, my only thought is that once the Progressives see a danger that they'll lose one of their primary scare tactics they'll switch it around and say that women need a doctor to screen them because some people died from OTC birth control. They can't let any of their cultural divide issues get settled.

  • BestUsedCarSales||

    I've been there for the insertion of quite a few IUDs, it certainly is a horrifying thing.

  • John||

    The risk is likely low. And I agree it should be OTC. But whatever the risk is, feminists will never honestly discuss it.

  • Paper Wasp||

    You sillies! Only men are supposed to face the consequences of their choices to have sex. Pay up, deadbeat dads who never wanted kids, or didn't want kids with some woman specifically.

    I'll only ever support "free" prescription birth control for women when the law goes both ways: men can opt out of the economic slavery of 18 years of child support for kids that they never wanted.

  • Rhywun||

    Agree that for the left it's all about the $$. Everything else is a smokescreen.

  • Leo Kovalensky||

    Just the left?

  • Uncle Jay||

    RE: How to End the Fight Over Contraception
    Birth control should be available over the counter.

    That makes sense.
    But since when does politics and common sense go together?

  • Rebel Scum||

    How to End the Fight Over Contraception: New at Reason

    Three words: Over the counter.

  • Citizen X - #6||

    Yes, that's what the article is about.

  • BestUsedCarSales||

    I'm getting really sick of Rebel Scum's consistent and sycophantic agreeing with everything Reason writes.

  • Bubba Jones||

    End the fight by winning it?

  • Bubba Jones||

    WTF. The article very carefully explains why a large group opposes OTC birth control, and then says the compromise is to provide OTC birth control.

    I agree with OTC birth control, but it quite obviously won't be seen as a compromise by the people who are demanding insurance coverage for birth control. Because it removes insurance coverage for birth control.

  • Leo Kovalensky||

    If the argument from those that want free birth control for all is that it's a right, then they should be clamoring on and on about why you need a prescription to exercise such right. I'm guessing the irony will be lost on them though.

  • Sigivald||

    The only argument I saw was "The group professed to be concerned about women having to pay more in the absence of insurance coverage."

    Which is hilarious, since it's part of employees' total comp package in either case.

    Do they really not realize that "insurance from your employer" is paid for by ... lowering your pay, in practice?

    (The $10 or so a month that The Pill, Holy Of Holies costs is ... not significant for most employed people, really?

    If you're that poor, won't PP still give you freebies now?)

    (Also ... last I checked every town of any size has people who give out condoms for free, to anyone who wants 'em? )

  • BestUsedCarSales||

    Which is hilarious, since it's part of employees' total comp package in either case.

    Do they really not realize that "insurance from your employer" is paid for by ... lowering your pay, in practice?

    No, this is absolutely not realized. This is why arguments over wage increase over time is so biased. It doesn't account for TC.

  • ToCa81||

    "(Also ... last I checked every town of any size has people who give out condoms for free, to anyone who wants 'em? )"

    Ew. I've never actually WANTED a condom, just begrudgingly used one at the end of a night of bad, alcohol fueled decisions.

  • Ron||

    What Hinkle is forgeting or ignoring is that the government does not like to give up control much like when they fine people for giving away free food to the homeless. the government does not like competition or the free exercise of self determination either

  • Paint Thinner||

    The group professed to be concerned about women having to pay more in the absence of insurance coverage.

    Especially since men don't have to for boner pills. Or a vasectomy. But go on, bash "secular liberals"

  • Derp-o-Matic 6000||

    If this is trolling, you really need to try harder.

    1) That's not true in most cases
    2) Catholics oppose that too
    3) You do understand the difference between a medicine that makes something function properly and a medicine that inhibits proper function, right?

  • BestUsedCarSales||

    3) I think your argument is not meaningful. I could argue that cancer treatment inhibits proper functioning of the tumour. That's not meaningful. That being said, the reason boner pills are covered are because they are still considered blood pressure medication. Vasectomies I do not know.

  • Lester224||

    Birth control pills are very frequently used to amend improper function like endometriosis, extremely heavy periods and even severe acne. O-care covers STD screening for both men and women and there's not anywhere near as much outcry over that.

    I'd say that pregnancy is not proper function if you have any sort of health risk that makes it dangerous. Even if you are healthy you could get stuck with a C-section if the baby is turned wrong at the time of delivery. Nine out of ten theocrats refuse to admit that pregnancy itself is very hard on the body and entails risk of permanent disability.

  • MarioLanza||

    OK, give me one conservative that says that rare complications even fatalities can't occur with pregnancy. Your anti-religious slur "theocrats" and your stupid straw man betrays your hatred of the religious.

    And BTW, every insurance policy that I have ever known covers std screening tests.

  • JeremyR||

    It won't happen because the left thinks it should be free

  • Mitsima||

    You, sir, are taking all the fun out of First World Privilege/Problems; spoil sport.

  • EscherEnigma||

    Seeing as parts of the GOP still want to overturn Griswold v Connecticut, I'm skeptical that this is the silver bullet it's presented as.

  • Longtobefree||

    Birth control is currently available over the counter. What's all the fuss?
    Oh, right; nothing to do with access to birth control.
    Solely a function of imposing government force on religious organizations despite the first amendment. Now I remember.

    Welcome to the revolution.

  • Derp-o-Matic 6000||

    As it stands, the only people legally entitled to "deny women access to birth control" are doctors and pharmacists. Not churches or evangelical employers.

  • Mark22||

    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.

    But then women would have to pay for contraception themselves. And we know that if women have to pay $15/month for contraception, we are denying them ACCESS to contraception, and the Handmaid's Tale will soon follow!

  • MarioLanza||

    Except it is available at wally world for $4 a month and your local county health department for $0 a month.

  • Lester224||

    Hormonal birth control is really quite safe. It should be over the counter.

    However I get really annoyed when everyone buys the meme that getting birth control as a no-copay option in your health insurance package is getting "free birth control". It's as free as every other no-copay preventative care option (annual physicals, statins, etc.). No-copay stuff is not free. It's paid for by your premiums, just with no-copay. If you object to no-copay stuff, object to all of it, not just birth control.

  • buybuydandavis||

    Reason discovers one class of drugs they think the peasants should be free to buy with having to submit to government enabled rent seeking.

    Why not the rest of them, oh "libertarian" magazine?

  • skellmeyer||

    People who pour bleach into their eyes because they WANT to be blind are crazy.
    People who cut off their legs because they WANT to be crippled are crazy.
    People who cut off their genitalia because they WANT to be the other sex are crazy.

    People who deliberately incapacitate perfectly healthy, functional body parts/organs are crazy.

    Contraception deliberately incapacitates perfectly healthy, functional organs.
    People who use contraception are crazy.

GET REASON MAGAZINE

Get Reason's print or digital edition before it’s posted online