When I first learned of Oregon and California's move to allow pharmacists to prescribe birth control pills, patches, and rings, I thought, Jackpot! Women skip the doctor, hit the pharmacy, and experience a greater sense of autonomy over their own bodies. I saw it as progress not only for women but especially Latinas, whose relationship with birth control is fraught with issues. For a variety of social, cultural, and economic reasons, we report lower rates of birth control use than non-Hispanic whites and non-Hispanic blacks.
My second thought was, Universal over-the-counter birth control has to be the next logical (and socially just) step. Remove the pharmacist screening and allow us to walk up to a drugstore and pick what we need. As someone committed to reducing barriers to women's health, I was convinced that OTC birth control was the solution; we just needed the legislation to make it possible. Judging from my Facebook feed alone, my friends agreed. When I texted my sisters for their opinions, their responses were even more enthusiastic than mine: “I trust myself, doctors are idiots” and “HELL YES!”
But I wanted to find out what Latinas outside of my social circle thought, too. So I reached out to a few young Latinas, as well as established Latina health-care professionals, for their insights and opinions.
Liseth Magaña, 27, who lives in Santa Rosa, California, fully supports OTC birth control. “It's following this trend of giving back people's rights,” she says. “It's one of those things where it's almost like, why hasn't it already happened? There are no cons, other than political ones.”
While Juliana Ramírez-Rodríguez, program coordinator of the Lifting Latina Voices Initiative at the Feminist Women's Health Center in Atlanta, agrees with the spirit of the new legislation, she's not sure it's the best solution.
First, Ramírez-Rodríguez mentions the challenge of education, explaining that not all women will do their research or know their family health history. That's why doctors exist: To consult them so we can make informed decisions about our bodies.
“When women do not get a chance to develop strong relationships with their health providers, they are less likely to understand the benefits and risks involved with each [birth control] method,” says Ramírez-Rodríguez.
Paola Piers-Torres, 26, who lives in New York agrees that birth control should become more widely available, but doesn't believe OTC is necessarily the answer. “Birth control has so many side effects, like if you're on antibiotics or smoke cigarettes,” she says. “Women should know all of the warning signs, which are not very clearly labeled. Even my birth control doesn't tell me those things.”
She says that her mother smoked while on the pill and suffered from blood clots that almost blinded her. But she admits that her mother got her birth control through a doctor and still suffered.
Ramírez-Rodríguez also argues that the advent of OTC birth control means the advent of less preventative care for women. She's afraid that women won't necessarily get screened for STDs or cervical cancer as often as they should because they won't be visiting the doctor regularly.
“Ultimately, [women] won't have the same access to the education that they need to make the best decisions in regard to their health as someone who visits her health providers regularly and has developed a [trusting] relationship with them,” she says.
Since Latinas are more likely to lack a primary care doctor than non-Latinas, this could pose a real problem to our health.
“Given that Latinas are the group least likely to have a regular source of care, a major concern is where does making over-the-counter birth control fit into a Latina's overall health?” says Jane L. Delgado, doctor and president of the National Alliance for Hispanic Health. “Latinas also have higher rates of cervical cancer. We need to look at the health needs of a total person — body, mind, and spirit.”
That's why Piers-Torres supports the Affordable Care Act's measure making annual gynecological exams free, though she believes exams should be free to the uninsured as well. “Every woman should have the right to a free checkup with a gynecologist every year,” she says. “And, in general, birth control should be more accessible to women. It's our bodies. We use the pill as a birth control method or as a period regulator or for a host of other reasons.”
Another point to consider for OTC birth control is, how many of us received scientifically based sex education in the first place? If we weren't properly informed about our bodies as children and teens, can we make informed choices as adults?
“There's a cultural aspect that needs to be taken into account when analyzing Latinas' usage of the pill and other methods of birth control,” says Ramírez-Rodríguez. “Historically, birth control has been seen with suspicion. Part of this suspicion is related to religious beliefs, cultural norms, gender roles, and expectations about family formation.”
In her work at the Feminist Women's Health Center, Ramírez-Rodríguez says she and her colleagues see that sex remains taboo among many Latinos, which leads to misinformation.
If we women are going to be making intelligent decisions about our bodies, we also need the right information, and we need it starting as girls. The U.S. needs to pair the freedom of choice with honest sex ed — in all public schools, at every clinic, and in all public health campaigns. Parents must talk to their children about birth control, too — but they shouldn't be the only ones carrying the burden. Our state and federal governments must fund accurate, sex-positive health education. (Boo-ya to President Obama for recently cutting federal funding for abstinence-only education.) Sex ed shouldn't stop at adolescence either. Those of us who are grown and sexually active need trustworthy sources of information online and in our communities so we can refer to them as our bodies and habits change.
"I'm a huge proponent of public health messages,” says Isabel del Canto, 24, who lives in New York and believes that birth control should be accessible to all women, including those under 18. She thinks that for every “freedom, there comes responsibility,” and that women should have the right to choose which freedoms and responsibilities work for them.
Another concern with OTC birth control is the cost of the pills, rings, and patches themselves. As is always the question in American health care, who should foot the bill?
“[OTC birth control would] force people to pay out of pocket for the birth control that they are getting now for free through the Affordable Care Act, which is absolutely demoralizing and will definitely affect people's access to health care in the long run,” says Ramírez-Rodríguez.
That is part of the reason why Oregon and California require that women still go through a pharmacist: Under the Affordable Care Act, health insurance companies must cover contraception. Maybe then the solution is to pass legislation to federally subsidize OTC birth control.
“There should never be a hinderance to birth control,” says Magaña. “It should be made more convenient and it should be made over the counter. Ongoing outreach and education can enhance that.”