I would like to pose an alternative argument to the American College of Obstetricians and Gynecologists (ACOG) President James T. Breeden’s Message on “Contraception: Access is Essential to Women’s Health.” His remarks were part of an opportunity provided by USA Today which explored comments both for and against ACOG’s recent statement endorsing the “over-the-counter” status of oral contraceptives (OCPs). Breeden and the ACOG argue that “contraception is essential to women’s health and that improved access to contraception … will lower unintended pregnancy rates.”
ACOG wishes to make oral contraceptives available to women without a prescription. They are arguing that this will solve the problems of unintended pregnancy. They argue that OCPs are “essential to women’s health.”
Webster’s Dictionary defines health as “the condition of an organism or one of its parts in which it performs its vital functions normally or properly.” Another definition of health, however, is “the freedom from disease.”
Does the ACOG and Mr. Breeden not realize that the primary function of oral contraceptive pills is to render a major system of the body incapable? In other words, OCPs shut down the woman’s system of fertility. The pills render it inactive. They create the opposite of health by disabling it.
Moreover, OCPs can cause other diseases which have been well documented in the medical and scientific literature including: high blood pressure, dyslipidemia, migraine headaches, pituitary and liver tumors, breast cancer, cervical cancer, heart attack, stroke, blood clots, etc. This is not an exhaustive list. OCPs do not promote health, rather they do the very opposite exposing women to great health risks.
Secondly, Mr. Breeden then expands on the relative safety of OCPs as a drug class and admits that “any pill has side effects” and equates OCPs to allergy pills and anti-heartburn medications currently available over the counter (OTC). Unfortunately, this analogy falls short, because the harm caused by OCPs far outweighs any harm attributable to allergy or heartburn medications.
Many doctors have noted increasing numbers of young women in their practice with breast and cervical cancers attributable to oral contraceptives. Much of the data on OCPs note that women who take the pill before their first full term pregnancy have increased rates of breast cancer later in life. It is also well known that OCPs promote the cancer-causing effects of HPV (Human Papilloma Virus) which is a sexually transmitted disease that causes cervical cancer.
These facts are well known, and we also know that young women who don’t have a doctor or who don’t want to visit a doctor will be more likely to buy OCPs over the counter. These women will not have proper surveillance and monitoring of the diseases that the OCPs are likely to facilitate or cause. This is a dangerous situation indeed. Mr. Breeden also states that the risk of “clots” with OCPs is comparable to the pregnant state. However, the FDA in 2011 had to convene a special panel to examine the clot risks of several OCPs due to unacceptably high reports of clots (i.e. Yaz, Yasmin). Moreover, pregnancy results in the greatest good for the family and society, the gift of another child.
Finally, regarding his assertion that OCPs if made OTC will finally decrease unintended pregnancy is a tired assertion. Oral contraceptives have been available to women for over 50 years in multiple settings, such as Title X clinics, health departments, community health centers, and traditional doctor’s offices. Generic OCPs are free at some of these places and available for $10 per month at others.
Does Mr. Breeden really think that there is an access or financial barrier problem here in the United States? The Agency for Health Care Administration has made birth control visits “free” for women since last year. Doesn’t this solve the financial problem? All women will have to have insurance by 2014. Doesn’t this solve the access problem?
Perhaps the time has come to question the implied assertion that if we just had more contraception, or free contraception or OTC contraception, then there would be no unintended pregnancies. Unfortunately, the data shows that certain population groups just don’t use OCPs responsibly and that the discontinuation rates for OCPs is almost 70%.
Women do not like how they feel on the pill or they do not want to be bothered by taking it the correct way. No OTC status is going to create individuals who suddenly take their medication the proper way. The National Survey of Family Growth data shows us that the overwhelming majority of women use some kind of contraception, yet the unintended pregnancy rate of America remains high. This is not about lack of knowledge, access, or cost.
What about the availability of abortion? Women know that if their contraception fails that they can resort to an abortion. Although surgical abortion rates have started declining slightly, medical abortions (RU486, Ella), and increasing use of “morning-after” pills could most likely explain the downtrend of surgical abortions.
This is the contraceptive mentality that results from throwing contraception at people. In other words, when women know that there will be a backup solution for an unexpected pregnancy, this knowledge may cause them to use their contraception less reliably.
If we want to decrease the chance of an unintended pregnancy, we might want to dismantle the myth of “safe sex.” Perhaps when we start talking about sexual intercourse as something that committed, married people do in loving relationships, then maybe we will see unintended pregnancy rates go down. By dismantling “safe sex” we would also see the rates of sexually transmitted disease rates go down, among many other problems.
Women should be told that only abstinence keeps them from being pregnant and safe from STDs. Married couples should be told that there are other efficacious ways to avoid and achieve pregnancy, without any risks or harms to their bodies, which are available throughout the country without a prescription. Natural Family Planning and Fertility Awareness methods (such as Billings, Creighton, Couple to Couple League, Marquette, etc.) do not suppress a woman’s fertility and are truly healthy for women. ACOG and Mr. Breeden should instead spend resources promoting these safe methods.