by Malcolm Potts
Sixty years ago, one of the most consequential events of the past century occurred: the first sale of a drug called Enovid. At the time, it was illegal to use any form of contraception in Massachusetts, where Enovid was developed. But soon everyone just called Enovid the Pill.
Recently, the revolutionary power of the Pill was brought home to me at a party in San Francisco. A guest came up to me and said, “Dr. Potts — you changed my life.” In the 1960s in Cambridge, England, I helped found a clinic to offer the Pill to the unmarried. The woman remembered every word I had said half a century ago. I didn’t “change her life,” but the Pill did.
Today 100 million women around the world use oral contraceptives, including more than 10 million in the United States. The Pill offers women the autonomy that is their birthright. It helps young women complete their education and develop their careers. It is a major factor in reducing the abortion rate and breaking the cycle of teenage poverty.
Under the Obama administration, many millions of women gained access to modern contraception. By working to dismantle the Affordable Care Act, defund Planned Parenthood and allow companies to deny women access to contraception however, congressional Republicans are setting the stage for the number of unintended pregnancies to rise nationwide. In Texas, where political decisions have reduced funding for Planned Parenthood and other family planning clinics, resulting in many women’s health clinics in the state cutting back services or closing, the number of unintended pregnancies already has jumped by 27 percent between 2011 and 2014.
Just as an unintended pregnancy in the 1960s would have been life-changing for the woman I met at the party, any effort to deny women access to modern contraception could have profound impact on the lives of countless women today. One way to remove barriers to access is to make some oral contraceptive pills available for purchase without a prescription, over the counter. The American College of Obstetricians and Gynecologists and several other professional institutions endorse over-the-counter sale of the Pill.
Over-the-counter contraception will be a lifeline for uninsured and undocumented women. One study suggests that over-the-counter sale can prevent half a million unintended pregnancies annually.
The Pill has always been synonymous with what are called combined oral contraceptives, containing both progestin and estrogen hormones. There is also an alternative formulation called a progestin-only pill. Of 100 American women using the Pill today, 94 choose the combination pill and six the progestin-only pill. We need both available over the counter, but we also need to understand the difference between them. Progestin-only-pills have fewer complications except in one important area: failure rates rise if progestin-only pills are not taken at the same time each day.
Combined pills imitate the natural hormone patterns of breastfeeding. Our ancestors spaced their pregnancies by long intervals without ovulating with breastfeeding. Unlike modern women, who can have more than 300 menstrual cycles, our ancestors may have had as few as 30. The Pill, in part, returns women to a more natural pattern of reproduction.
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One British study followed 23,000 women using the Pill and 23,000 who did not for up to 39 years. Women using the Pill actually lived slightly longer than those not using it. They had a 50 percent reduction in ovarian and uterine cancer. One million American women, including 30 percent of adolescents, choose the Pill for its non-contraceptive benefits, such as less painful, more regular menstrual periods.
Nevertheless, most drugs also carry risks and the Pill is no exception. Women over age 35 who smoke, or who have high blood pressure, must not use combined pills because of a significant risk of blood clots, heart attacks and strokes.
The mission of the U.S. Food and Drug Administration is “ensuring the safety and efficacy “ of drugs. For 60 years, it has judged the benefits of using combined oral contraceptives to outweigh the risks. Cadence Health is the first U.S. company gathering the scientific evidence needed to demonstrate that if the Pill is sold over the counter, then American women will understand and follow the instructions on the package before making a purchase.
If you’re a woman — or a man who loves a woman — I hope you will agree with me that American women, as these studies are completed, will prove that they do not need a physician, the pope or a patriarchal president standing between them and the choices they make about childbearing.