Last week, a young woman came into my pediatric clinic with heavy periods that were preventing her from participating in her regular activities. This is a common symptom that can easily be managed with the birth control pill. As the visit continued, she also disclosed that she is sexually active and not interested in becoming pregnant. We began to talk about options to figure out which made the most sense for her and she told me that she had never talked to a physician about these concerns in the past. Nor had she learned about contraception in her high school health education class.
Her story is, unfortunately, not uncommon. Many young people don’t have a trusted adult to talk with about contraception or sex, and that includes doctors. Pediatricians, in particular, don’t routinely broach the topic of sex and birth control with their patients, placing the uncomfortable burden of bringing it up on the teenager or leaving this topic completely unaddressed.
To get to the point where that conversation is a possibility, my patients need to find their way to my office first. In 24 states, most minors are required to get their parents’ permission to get birth control. In the other 20 states where young people can make the decision for themselves but don’t have a parent’s help navigating the process, they need to know that a clinic exists, understand the phone appointment system, know about insurance information, and have payment, get time off during clinical hours, and have the transportation to get there. If there is a subsequent prescription to pick up or a referral that needs to be completed, there are even more tasks to complete. That’s a list daunting even for many adults.
I once had a patient who was referred to an OB/GYN to start birth control by another provider, but she never got a call for that next appointment. When she came to my clinic, she was pregnant. It is also common to have a patient prescribed birth control and return to tell you months later it wasn’t covered by their insurance and they never received it, even after the Affordable Care Act passed.
The truth is, while there are important reasons to make regular visits to the doctor, getting the birth control pill doesn’t have to be one of them.
It’s safe for use for virtually everyone – much safer than pregnancy would be – but the prescription requirement is a road block. Making the birth control pill available over the counter for people of all ages would mean no clinic visit or required prescription, enabling people to avoid those hurdles and purchase contraception at a local pharmacy or grocery store any time they are open.
Research shows that one in four teenagers not using a birth control method said they would try an over-the-counter pill. Making the pill available over the counter wouldn’t be a substitute for comprehensive sex education or making other forms of birth control accessible. However, it does offer one more option without many of the barriers that currently exist.
As a pediatrician, I am aware that my patients struggle to obtain birth control and I also see how access improves their lives. I know (and research supports) that if my patients can plan if and when to have children, they will be able to attain higher levels of education and career advancement and have a higher likelihood of getting out of poverty. They will be better equipped to determine their own life path, and make decisions about their bodies and their futures.
Young people deserve our full support, and access to contraception is a key part of that commitment.
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