**DISCLAIMER: I am not a medical professional or anything close. The following are my personal opinions and should not be considered medical advice. **
While waiting at the pharmacy counter the other day, I heard the young woman next to me ask for "the cheapest birth control pills you have."
Birth control pills are available without a prescription here in Chile. This means you can simply walk into a pharmacy and ask for the pill you want -- or, in the case of my fellow customer, whichever costs less -- without having to set foot inside a doctor's office.*
I have mixed feelings about this. On the one hand, I believe contraception should be readily available to women and men who wish to use it. Selling birth control pills over the counter makes them more accessible to women without the means or the time to make a doctor's appointment. It also makes them much easier to obtain for girls and women who wish to keep their decision to go on birth control private. On a more symbolic level, there's a lot to be said for being able to take the pill without having to ask anyone's permission first.
On the other hand, I can't help but suspect that this system makes it easy for women and their partners to make important decisions about their reproductive health without being properly informed. At the risk of sounding like the condescending voiceover on a TV commercial, I'd like to remind everyone that every birth control pill is different. Different pills have different doses of hormones, different modes of use and different potiential side effects. A pill that works swimmingly for one woman may be detrimental to the health of another. That's why part of a gynecologist's job is -- or should be, in my opinion -- to help patients choose a birth control method that is right for them.
It strikes me that a woman who asks for "the cheapest birth control pills you have" is very likely not making an informed decision. Of course, she has the right to make a choice based on whatever criteria she wants. Certainly, cost is an important factor for many women, especially given the fact that Chile's public health insurance provider, FONASA, does not cover birth control pills purchased in pharmacies.** Still, I'd be willing to bet there's more than one low(er)-cost pill out there, meaning women and couples on limited budgets still have options to weigh. But it can be difficult to know what your options are when nobody tells you, especially when it comes to a specialized field like medicine.
Of course, one could make the argument that consumers have the responsibility to inform themselves. As long as information is freely and widely available and easy to understand, I would tend to agree. However, I don't think this is the case when it comes to medication. As anyone who's ever glanced at them knows, the informational pamphlets that come with medication aren't exactly easy reading for those of us without medical training. Searching for information on the internet -- which, it should be noted, not everyone is able to do -- presents its own problems. First off all, it can be difficult to separate reliable information from B.S. Plus, when you research a product on its own website, you're getting your information from a company that wants you to buy what it's selling.
This lack of access to reliable information is even more worrying to me when I consider the spotty reputation of sexual education in Chilean schools and the misinformation about reproductive health -- "But virgins can't use tampons!" -- that circulates here and in the world in general.
I'm not saying that selling birth control pills over the counter is necessarily a bad idea. Like I said before, I think it has a number of benefits. What I do think is a bad idea, however, is selling birth control pills over the counter without providing women and their partners every opportunity to make informed choices. I'm guessing that whoever sold my fellow customer her birth control pills didn't ask her about her medical history, other medications she may have been taking, or whether or not she smoked (which a lot of young Chilean women do) -- factors that, as far as I know, are generally thought to be important when a woman is considering hormonal contraception.
But what if the pharmacy employee had been required to ask her if she had any questions about the pill or how to use it? If the pharmacy had been required to have someone on hand who was qualified to give detailed answers to all these questions? If pharmacies, educational and medical facilities, government agencies and NGOs distributed accurate and user-friendly information about birth control options in multiple formats, including on the radio, the internet and TV? And what if --gasp! -- prices were low (or nonexistant) enough so that monetary considerations would never have to outweigh health-related ones? Maybe then the young woman at the pharmacy would have asked for whichever pill she considered right for her and not whichever one was cheapest.
Needless to say, this is a topic that requires more than one opinion. So please, share. What do you think of the birth control situation in Chile (or in whichever country you happen to inhabit)? Any suggestions as to how to improve things? Is there a Chilean health insurance provider that covers birth control? Obviously, I'm not going to demand that anyone share his or her personal experiences, but if you want to, please feel free to do so.
*To get the morning-after pill, however, you have to make an appointment with a doctor, get a prescription, and find a pharmacy that has the pill in stock.
**In theory, women who have public health insurance are able to get free birth control pills at their local public clinic (consultorio). However, I don't know what pills consultorios give out or how many options they offer. Also, many consultorios operate on a "first come, first served" basis when it comes to appointments, and not all women are able to get up at the break of dawn to stand in line.