The XX Factor: What women really think.

Busted for Birth Control

A high school student gets caught popping a pill at the lunch table. Had she been taking an illegal drug, Fairfax County's "zero tolerance" policy would have called for a 5-day suspension. But she was taking birth control prescribed by her doctor and purchased by her mother. A student who brings a "controlled substance" into a Fairfax County high school is subject to the same penalties as a student carrying a gun. So the girl was suspended for two weeks and "recommended for expulsion." Last Thursday, The Washington Post reports, "a long table full of school officials weighed her case at a hearing."

I don't doubt that Ortho Tri-Cyclen is extremely dangerous to a certain social order—far more so than is, say, heroin. But it seems like the kind of thing public high schools should be encouraging. 

More Places To Put the Pill

Emily, thanks for the link to that meta-analysis in cautious support of over-the-counter birth control. For what it's worth, I certainly didn't mean to imply that annual cancer screenings are a waste of time. I am arguing that doctor's visits made solely for the purpose of obtaining permission to access a relatively safe form of contraception are pointlessly and harmfully burdensome. I've had to make quite a few such visits, in part because I move frequently and am incapable of getting an overworked doctor on the phone with an understaffed pharmacy. It's possible that I am overgeneralizing from my own deeply annoying experiences.

I've lived in countries where the pill is kept behind the counter and would be more than happy with such a compromise. But the FDA, unlike its counterpart agencies in England and Canada, only very rarely considers this third option due to complex regulatory barriers. (When the FDA rejected OTC status for Merck's Mevacor, for instance, several panelists said they'd be comfortable with the drug as it is sold in British pharmacies; in other words, behind the counter. They weren't given such an option, so the panel overwhelmingly voted down the application.) It's not clear that the FDA even has the authority to create a third class of drugs. But thanks in small part to Plan B, it looks like our binary classification system might be changing.

More on the Pill-Selling Over the Counter

An answer from Slate medical columnist Amanda Schaffer to my question about why the Pill is a prescription drug. Amanda supports, with caveats, Kerry's argument that oral contraceptives should be sold over the counter:

The downside risks of the pill (strokes, breast cancer) are pretty small, especially with newer formulations. And the upside of reducing ovarian cancer risk (as well as preventing unwanted pregnancy, of course), has led some researchers to argue for over-the-counter access; in fact, a meta-analysis in the Lancet from last year had an accompanying editorial making this case. The counterargument is that women who smoke or get migraines should not be on the pill, and a doctor's involvement might prevent that from happening. Plus, since women stay on oral contraceptives for long periods of time, it may be wise to have more medical oversight.

Amanda and I disagree with you, Kerry, that annual visits to the gynecologist are a waste of time. Breast exams, pelvic exams—that's trouble-catching time.

The Trouble With OTC Birth Control

I, too, applaud the move to make Plan B available over the counter for 17-year-olds, but, Kerry, I have to raise one problem that could accompany making hormonal birth control OTC: insurance. Many insurance plans don't cover OTC medication, unless it's a special program intended to keep costs down, like providing an incentive for people to use a specific OTC heartburn medication instead of an expensive prescription drug that's not more effective. Insurance companies like the checks and balances of going through a doctor and a pharmacist before shelling out. Yaz, which you mention, costs about $60 per month retail, I believe, depending on the store, the state, etc. Planned Parenthood and other resources might step in to help, but those of us who already have high copays on birth control would feel the hit if we had to start paying full price. Considering the battles waged over getting insurance companies to pay for birth control, I can't imagine that many plans would be willing to alter their OTC policies to cover the an over-the-counter pill.