The summer before I left for a four-month trip to India, I made daily phone calls to my insurance company from my apartment’s emergency exit stairwell. Gripping the banister until my fingers yellowed, I would ask through clenched teeth: “Have my birth control pills been approved now?”
“Not yet, ma’am,” the customer service agent told me. “First, I’d like to confirm your address.” While he spelled out “N-E-W-J-E-R-S-E-Y” letter by letter, I pondered why a request for four months of birth control pills—just one month more than my usual prescription—was so complicated.
Weeks passed by. I had to take refuge in the stairs to avoid those looks from my mom. “I knew you going away was a bad idea,” I heard her voice announce in my head. “You should have known the insurance process takes this long. And if you had cleaned your room…”
Birth control pills came on the market more than 50 years ago—in fact, today marks the 59th anniversary of the FDA’s approval of the pill. But too many barriers remain in place for women to get their hands on them.
First, we have to get past the doctor’s consultation. Then, we have to go to a pharmacist—and, on occasion, suffer through hours of on-hold jazz jingles and a bureaucratic bridge troll—before getting a three-month pack of the pills we’re entitled to.
During my fifth or sixth phone call from the stairs, my insurance company requested my travel itinerary to verify that my highly-regulated uterus was indeed going to India with me. Why did I have to prove I was going out of the country? Imagine a world where men were required to submit a travel agenda before purchasing a condom. (“Trip around the world” would take on an entirely new meaning.)
Birth control pills can’t offer women the freedom to make their own decisions if the methods to do so are micromanaged by gatekeepers. Decades of research and experience show it’s safe and effective for over-the-counter use, and while having a yearly gynecology exam is important for other health reasons, it isn’t necessary to start birth control pills.
Neither is sending your whereabouts to insurance companies.
Nevertheless, I was required, before this trip, to book an appointment with my doctor—which entailed three hours of driving, waiting rooms, stirrups, a paper robe, time away from my summer job, money lost on gas and a co-pay. But after the dozens of stairwell calls, I finally received approval for the fourth pack of pills. I drove to the pharmacy. I picked them up. Then I forgot them in my hot car for four days.
Through tears, I explained my situation to yet another customer service representative. “Yes, yes. I know I’ve called. But I left them in the car.” Heat, I discovered on another teary phone call with a pharmacist, reduces the efficacy of birth control. “I need another month’s pack.” I could hear eyes roll through the phone.
Like most women, I do not make plans with my birth control refill schedule in mind. When I prepared for my four-month trip to India, preventing pregnancy for one month more than my usual refill hadn’t been on the top of my to-do list—malaria prevention pills, Japanese encephalitis vaccinations and preventing heat stroke took priority. While “leaving-the-very-pills-you-called-about-for-weeks-in-a-car-during-a-summer-heat-wave” is an exceptional scenario, forgetting to pack your pills or taking your last pill the day your flight leaves are not.
When birth control became readily available for the first time, women were better enabled to pursue education and travel, have sex without becoming a parent before they were ready and control their reproductive destinies. The promise of that freedom should allow for us to be forgetful or make a mistake every now and then, too.
Over-the-counter birth control access would shift these scenarios, allowing women to be human and be responsible. Some countries with over-the-counter birth control pills even show higher trends of contraceptive continuity: Women in the U.S. who get the pill from a clinic are 60 percent more likely to discontinue pill use than U.S. women who get it in Mexico, where a prescription is not necessary.
Once I got to India, I was surprised to learn that birth control is available over the counter in more than 100 countries, including the one I had just landed in. I found birth control at every street-side chemist shop. (This would have been nice to know before developing my apartment building reputation as the woman who whispers in stairwells.)
Why do we accept a system that requires women to trudge through bureaucracy to delay having a child? Women are capable of making their own reproductive choices safely, and that shouldn’t require verification, signatures or prior authorizations.
Shifting birth control to an over-the-counter medication would lessen the bureaucratic and financial burdens, allowing birth control to be used for what it was made to do—give women the freedom to follow their own life path.
