Last week, City Desk reported that At-Large Councilmember David Catania’s birth control bill—which is based on existing processes in Washington state and would allow women who need birth control to get a prescription from a pharmacist rather than a doctor—would increase access, but wasn’t likely to affect the price of contraceptives.
But there’s much more to what Catania is proposing than the cost of a pill, patch, ring, or shot (which is largely set by health insurers, regardless of how it’s procured). The most important element might be the fact that though the stuff’s been referred to as “over the counter”—as in, for purchase off the shelf, like Advil—it isn’t.
Catania’s chief of staff, Ben Young, says, “I want to be careful. It keeps getting confused with over the counter. It wouldn’t be over the counter. You’d go to the pharmacist…they’d ask you some questions.”
Typically, obtaining birth control means an OB-GYN appointment, which involves a Pap smear and a urine test to screen for sexually-transmitted infections and cervical, ovarian, and breast cancers. While yearly OB-GYN appointments are critical to good reproductive health, birth control’s side effects are linked to heart conditions and migraines, not cancer or STIs. A June 2010 Newsweek piece quotes an anonymous researcher as saying, “At the moment, gynecologists are gatekeepers, insisting on regular vaginal exams that are really unnecessary.”
Logically, most pharmacists—who possess skills far beyond putting pills in bottles—should be more than capable of asking a patient questions and assessing whether hypertension, a history of heart disease, and other factors should prevent that patient from going on birth control. Under Catania’s bill, they would do just that, and write—or not write—a birth control prescription.
The procedures would likely require blood pressure tests and a series of questions familiar to any woman who’s filled out paperwork for birth control at a doctor’s office: Do you have migraines? Do you have a family history of heart disease? Do you smoke?
University of Washington clinical professor Don Downing conducted a study from 2003 to 2005 to determine whether or not pharmacist-prescribed birth control, which is legal in Washington state, was effective. (Short conclusion: It was indeed effective.) “If things settle down in D.C., they will likely do what we did in our study,” says Downing. “We decided we would only take care of women in the least-risk category: Women who didn’t smoke, with good blood pressure. Women around 40 years old with hypertension who smoke are in danger if they’re pregnant, too, and they need to see a doctor. We treat those with the lowest chance side-effects. Those with risk factors, we send them to doctors to get risk factors managed. That’s another service that this program developed. We screened people with high blood pressure, and sent them to doctors.”
Catania’s bill has the potential to do more than just ease access to birth control: It could encourage a woman who needs to see a doctor, but could not or would not previously, to do so.
Says Downing, “When pharmacists start becoming more involved in reproductive health, women who don’t have a doctor or are afraid to go to one or are scared of the police come into their pharmacy for help…there are just so many benefits beyond getting a packet of pills into somebody’s hands.”
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