Sen. Cory Gardner on Thursday made good on his campaign promise to introduce a measure to make certain methods of birth control available over the counter. With his Republican colleague Kelly Ayotte as co-sponsor, Gardner introduced the Allowing Greater Access to Safe and Effective Contraception Act sounding a whole lot like Margaret Sanger.
“It’s time to allow women the ability to make their own decisions about safe, effective, and long-established methods of contraception,” he said in a statement. “Making this medication available over the counter would increase access in rural and underserved areas, save consumers money by increasing competition and availability, and save women time by increasing the ease of getting the safe contraception they need.”
But the Colorado Republican, then as now, is full of shit. The measure isn’t about access, it’s a transparent attempt to chip away at the Affordable Care Act, particularly its contraceptive requirement. And, in conjunction with the rest of the Republican platform on healthcare and gender equity, will do very little to expand access, particularly to low-income women in rural areas who are most in need.
The American Congress of Obstetricians and Gynecologists, which has long supported over the counter birth control, immediately called foul after Gardner introduced his stunt proposal.
“The Affordable Care Act removed many barriers to preventive care that keeps women healthy," ACOG president Mark DeFrancesco said in a statement to the Huffington Post. "By making contraceptives available to women without a co-pay, it has truly increased access to contraception, thereby decreasing unintended pregnancies, and allowing women to better plan their futures. Unfortunately, instead of improving access, this bill would actually make more women have to pay for their birth control, and for some women, the cost would be prohibitive."
“As women’s health care providers, we welcome robust and productive dialogue about the indisputable role that contraceptives play in the health, well-being, and productivity of American women,” he continued. “We would welcome any legislation that would do what this proposal purports to do -- help women. As it stands, however, we cannot support a plan that creates one route to access at the expense of another, more helpful route.”
Birth control is expensive. Oral contraceptives can cost, in some places, more than $600 a year. And that cost can be prohibitive for women already struggling to support themselves. And as funding cuts to family planning clinics continue to devastate access for low-income women, making full-price birth control available over the counter does virtually nothing to counter that.
Even in the best of circumstances, for women on the kind of financial footing that enables them to pay out of pocket for medical expenses, the expansion of “religious freedom” legislation across the country compromises access at pharmacies, too. A law that would put some forms of birth control on the shelves will do nothing to help women who are turned away by a pharmacist who says contraception is a violation of his conscience. (This is not a hypothetical scenario.)
And contrary to some of Gardner’s earlier musings about how making the pill available without a prescription will bring down costs, research indicates that the over-the-counter availability of emergency contraception like Plan B has done little to bring down costs.
Kelly Cleland, a research specialist at Princeton University’s Office of Population Research who monitors the cost of emergency contraception, told FiveThirtyEight last year that prices have remained static since it was made available over the counter. Selling it at pharmacies sans prescription has done nothing to remove cost barriers to low-income women. “When the generics [of Plan B] were about to go onto the shelves I thought there might be a price war that would push the cost down,” she explained. “But that really hasn’t happened, and I don’t see a sign that it will.”
And no cost reduction through market force could match what’s offered by the new healthcare law: no cost. There simply is no competing with zero dollars when it comes to access. And Joshua Cohen, a health economist at Tufts University, told FiveThirtyEight that such measures may improve convenience, but not cost. “Any improvement in access is likely to be merely a convenience issue,” he said. But that women “would pay more out-of-pocket for the OTC contraceptive than they would for the prescription product.”
The measure also does nothing to expand access to long-acting birth control like the highly effective but, without insurance, often cost prohibitive copper IUD. The IUD also requires insertion by a medical technician or physician. There is no pharmacist in the country who will sell you an IUD over the counter and leave you to insert it into your uterus, DIY-style.
And the bottom line is that women should be able to see a doctor if and when they want to see a doctor. Maybe they want to talk about which birth control method works best for them. Maybe they have questions about hormonal versus non-hormonal IUDs. Maybe they have basic medical needs that need to be met, like cancer screenings, regular pap smears and, you know, flu shots. This requires seeing a doctor, but Gardner -- like most of his Republican colleagues -- wants to repeal the healthcare law that has expanded coverage to millions of people and put safe, effective contraception in reach for more women than ever.
Gardner may be striking a feminist pose about expanding access, but he's selling a bill of goods. Women aren't buying.
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