In a December 13 editorial in the Wall Street Journal, Louisiana Governor Bobby Jindal proposes that oral contraceptives should be sold over the counter (OTC) to women over the age of 18, removing the need for a doctor’s prescription. This unexpected suggestion from a Catholic pro-life politician has drawn criticism from Catholic bishops, priests, and pro-life leaders. Some have even suggested that this position removes Jindal from consideration as a 2016 presidential candidate.
I agree that Governor Jindal’s proposal is unwise, but I am not ready to conclude that he has abandoned his pro-life principles when he makes such a policy proposal. I believe his error is in trusting the American College of Obstetrics and Gynecology (ACOG) to accurately portray the safety of oral contraceptives.
This is not to downplay the concerns of faithful Catholics – the use of hormonal birth control within marriage unquestionably separates the procreative and unitive aspects of human sexuality, thereby violating both Natural Law and Catholic teaching on sexual morality. Even more troubling is the potential abortion-inducing mechanism of some oral contraceptives.
However, these facts alone do not warrant requiring a prescription for their use. Condoms are equally immoral because they also distort the procreative and unitive nature of sex, yet they are sold freely with no medical evaluation required. The justification for requiring a prescription must rest on more than Catholic doctrine and moral strictures.
The governor’s controversial article is based on a recently released American College of Obstetrics and Gynecology (ACOG) policy statement supporting over-the-counter access to oral contraceptives. Because the statement asserts that the risks of giving women such access are small when compared to the risks of unintended pregnancies, one can understand Governor Jindal’s readiness to support their recommendation.
Unfortunately, the ACOG statement minimizes or ignores real risks of contraceptive use. This trade organization has a history of suppressing information that conflicts with its ardently pro-abortion, pro-contraception ideology. For example, ACOG still cites a discredited 2003 National Cancer Institute (NCI) workshop as the basis for its position that induced abortion does not increase the risk of breast cancer. This position is in direct opposition to subsequent research by the president of the 2003 NCI workshop, Dr. Louise Brinton. Dr. Brinton’s later work in 2009 cites abortion as a known risk factor for breast cancer.
The ACOG recommendation to make oral contraceptives an OTC drug also ignores Dr. Brinton’s 2009 research that found a 320% increased risk of breast cancer in oral contraceptive users. The Center for Disease Control (CDC) warns of increased risks of breast cancer, liver cancer, and cervical cancer with oral contraceptive use. A 2002 study published in The Lancet found the use of oral contraceptives for greater than five years is associated with a three-fold increase in the risk of HPV infections progressing to cervical cancer. In 2011, University of Washington researchers found that hormonal contraceptives doubled the risk of HIV transmission.
These increased risks of breast cancer, cervical cancer, and HIV infection all point to the need for close medical surveillance of women taking oral contraceptives. Because this heightened need for screening is directly related to contraceptive use, it is entirely reasonable to require a medical evaluation and prescription for access to oral contraceptives.
ACOG, while acknowledging the need for sexually active women to be screened regularly for sexually transmitted diseases, breast cancer, and cervical cancer, unrealistically suggests that there will be no change in the health screening behavior of women when they no longer need to see a medical practitioner to get their birth control pill prescriptions refilled. Yet giving unfettered over-the-counter access to oral contraceptives removes most incentives to undergo regular medical evaluations.
Making oral contraceptives an over-the-counter medication gives the erroneous impression that these powerful hormones are safe and benign. In reality, those who wish to use oral contraceptives should be carefully screened for both absolute and relative contraindications to their use. For example, smoking in women over the age of 35 is an absolute contraindication to use of oral contraceptives, as are some migraine headaches. High blood pressure and elevated blood lipids are relative contraindications.
The American College of Obstetrics and Gynecology claims that women can use a simple checklist to self-screen for pre-existing conditions that would make them unsuitable candidates for oral contraceptive use.
But if no medical practitioner is involved in the distribution of birth control pills, how will women be adequately educated about the contraindications to the pill and the potentially severe adverse consequences of their use? Who is going to check a woman’s blood pressure? Who is going to monitor her lipid profile?
The ACOG policy statement on OTC oral contraceptives admits that in Mexican pharmacies where women buy oral contraceptives without a prescription, 13% of the women have at least one relative contraindication to oral contraceptive use. They then assert, without evidence, that American women will do a better job of self-screening.
In our pluralistic society, Catholic moral teaching alone will not make the case against the over-the-counter availability of oral contraceptives. An effective argument must be made based on the latest medical evidence. The significantly increased risks of breast cancer, cervical cancer, and HIV transmission belie ACOG’s glib statement that the risks of oral contraceptives are no worse than over-the-counter pain medications. The evidence is clear that women using oral contraceptives need regular medical follow-up and requiring a prescription is the best way to ensure this occurs.
Once again ACOG has put its political agenda ahead of women’s health. Hopefully, Governor Jindal will distance himself from the ACOG committee recommendations, and ensure that his preferred health policies are in the best interest of women.