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Autonomy, Paternalism, and Access to Contraception

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opednews.com Headlined to H2 2/5/09

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Now that we have a pro-choice president again, anti-abortionists will certainly be making their opposition even more strident. Want to make abortion scarce? - allow hormonal contraception available without a prescription.

American women already have one of the highest of rates of unintended pregnancy and teen pregnancy among developed nations, and the recent Health and Human Services (HHS) “conscience” regulation, allows healthcare providers increased opportunities to refuse to provide contraceptives and accurate health information to women (so much for the importance of the patient- clinician relationship). Hormonal contraception meets the Food & Drug Administration’s (FDA) standards for non-prescription status: clinicians are unnecessary, potential for misappropriate use is low, consumers can easily identify indications and assess contraindications, directions for use are uncomplicated, and the benefits outweighs the risks. Yet not only is hormonal contraception still not available without a prescription, many clinicians force unnecessary medical examinations before allowing women access, and now have the right to outright withhold prescriptions, and even give patients inaccurate medical information, if they so choose. Hormonal contraception has been proven to be safe (the health risks of pregnancy are far greater than the risks of using contraception).

[Contraceptive pills] can bring about a stroke or heart attack, as can [many] nonprescription drugs, but this is extremely rare. Acetaminophen, available without a prescription, is much more likely to cause liver damage than pills are likely to cause stroke or heart attack.

Requiring a trip to the doctor's office for access to contraception creates an unnecessary obstacle for women, thus reduces contraception access, puts women at risk, and perpetuates the idea that either 1.birth control is dangerous or 2.women aren’t competent enough to assess their needs and make informed choices. Not only is hormonal contraception being denied to women without prescriptions, women are often forced to have unnecessary physical examinations and tests in order to receive their prescriptions. The World Health Organization’s medical eligibility requirements for hormonal contraception don’t require breast and pelvic examinations, yet many clinicians in the United States require these exams before allowing patients their prescriptions. Regular physicals, including breast exams, pelvic exams, and pap smears, are recommended in order to maintain good health, but they do not provide medical information regarding hormonal contraceptives.

One concern is that women will stop going for annual exams and pap tests if health centers do not have a policy of withholding contraception. According to that logic, no one should be allowed any medications unless they have all recommended physical exams. Over 50 and haven’t had a colonoscopy? Sorry, no flu shot for you. Since pelvic exams and a pap smears are medically unnecessary in order to prescribe birth control, a better standard of care would be for health care providers to recommend that their patients have physicals, but ultimately respect their patients’ decisions.

There are, of course, women who want to have the examinations and give their consent voluntarily, but telling women that examinations and pap tests are mandatory to receive birth control is a form of coercion, not informed consent. Informed and voluntary decision making is instrumental to patients’ rights. Don’t patients, including women of child -bearing age, have the right to autonomy and bodily integrity? Withholding contraception from a woman if she does not wish to submit to unnecessary physical exams and tests is nothing short of provider bias and paternalism. This is medically unethical.

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Another concern is that women might not understand how to take their contraception or they might choose the wrong kind if they don’t first consult with a physician. Medical information is readily accessible these days and women are capable of making sophisticated choices about their health. According to research conducted by Family Health International and published in the journal Studies in Family Planning, “over-the-counter provision of oral contraceptives by pharmacists is a safe, effective, and practical way to distribute this popular contraceptive method in Jamaica.” Are American women any less capable of making informed decisions about their health than Jamaican women? Let’s let women decide what contraception they need, especially since we can’t feel confident that we are getting accurate information from our health care providers now anyway.

Lift the prescription status of hormonal contraception, allow women easier access to contraception, and the right to decide for themselves if they wish to have medical examinations. Not doing so is unethical, violating to women, and counterproductive.

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Suzanne Newsome an associate for an international development contracting company. She is a 2007 graduate of the University of Denver, where she received an MA degree in International Studies with a concentration in Human Rights. She served as a (more...)
 

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Autonomy, Paternalism, and Access to Contraception

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