Health Care/Joan Retsinas

Opill: A Victory for Women (and their Male Partners)

Sex and procreation: the linkage between the two has been a source of joy, as well as anguish. Many people who enjoy sex do not want to be parents. In the United States, where “unwanted” children plunge into an abyss of poverty and despair, governments — Uncle Sam and his state minions — bizarrely often emerge as pro-natalist warriors, as though the country needs babies from unwilling and unable parents.

We have restricted abortion, with restrictions that vary by state, with a hodgepodge of rules: how many weeks after conception? How old the pregnant woman? How involved the father? Will insurance pay? What about the health-of-the-mother? What about rape? Fetal viability? … Physicians, depending on the state, run a gauntlet of questions before performing an abortion. South Dakota legislators now want to issue a video expressly for physicians, clarifying the rules.

Contraception is less fraught with moral queasiness, moral quandaries; yet even with contraception some states have reared their pro-natalist banners, arguing that contraceptive devices are a variation of abortofacients.

For middle class women who live in “blue” states with no draconian restrictions, contraception is easy. A prescription from a woman’s regular obstetrician, a nearby pharmacy, insurance coverage — all render the quest for contraception simple. In New York City, Governor Hochul just signed an order letting women buy contraceptive pills, rings, or patches without a prescription.

But other women live in obstetrician deserts (thank you, United States Supreme Court for giving us that new demarcation, that new term) where obstetrician/gynecologists, fearful of legislators’ oversight, have decamped to friendlier states. Some women live in rural areas, far from physicians. Young women, old enough to be pregnant (sometimes from rape, sometimes from incest), may not be old enough to buy contraceptives.

As for pharmacies, depending on the state, pharmacists who think contraception immoral can cite a “conscience” clause that will let them refuse to fill prescriptions. Instead of “loco parentis,” we have “in loco pharmacist.” (Admittedly, the pharmacies themselves may be obligated to find a pharmacist willing to fill a specific woman’s prescription.) And health centers, like those administered by Planned Parenthood, face the funding cuts that have blocked women’s access to contraceptives (a legacy from President Trump). Power To Decide, which helps guide people to birth control, estimates that more than 19 million lower-income women who need publicly funded birth control live without access to centers that offer a full range of contraceptive methods. We have spawned another new term: contraceptive deserts. (Stateline, “Some States Some States Already Are Targeting Birth Control, May 19, 2022)

So thank you to Opill, a progesterone-only pill.

In much of the world, women don’t need a prescription for Opill. Ironically, higher income countries require prescriptions; lower-income ones, like China and India, do not, though the United Kingdom recently reversed course. But the United States and 44 other countries do require a prescription; 56 countries require a prescription in theory, not in practice; 35 countries allow access so long as the woman is screened for suitability.

Happily, change is afoot. The American College of Obstetricians and Gynecologists, the American Medical Association and the American Academy of Family Physicians have OK’d measures to let women buy birth control without a prescription. At last it will happen. Women who want to escape the linkage between sex and procreation can take charge of their fertility. They can buy Opill (cleared by the FDA) easily at pharmacies or online.

This spring has brought bleak news on a host of political fronts. Let us savor this victory for women, and their male partners.

Joan Retsinas is a sociologist who writes about health care in Providence, R.I. Email joan.retsinas@gmail.com.

From The Progressive Populist, May 1, 2024

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