Why Are Doctors Making It Such a Pain in the Ass to Get Birth Control?

Much fuss has been made over hoops politicians want to force women to jump through in order to get anyone to help them pay for birth control, from the suggestion that women should be forced to prove to their religious employers that their prescription is for non-slatternly reasons to "personhood" devotees who believe that hormonal contraception is akin to homunculus homicide and shouldn't be covered by insurance. But what about the hoops that already exist? Why, despite the recommendations of medical authorities, do doctors continue to require women to receive unnecessary medical exams before providing women with birth control prescription refills? You get two guesses.

The problem of birth control being "held hostage" is highlighted by Mother Jones' Stephanie Mencimer, who found it to be a frustrating pain in the ass to obtain a renewal of her birth control prescription without undergoing an annual exam, even though the US Preventative Services Task Force and the American Congress of Obstetricians and Gynecologists have declared that the exams aren't warranted when prescribing birth control. She even confronted her doctor with these guidelines, and he responded by telling her that he was going to have to see her for an exam, anyway. Because there could be all kinds of cancer n' shit going on in the complicated, foldy tubing that is the female anatomy.

But this isn't actually the case. In fact, a growing body of evidence indicates that your annual bad date with a speculum followed by a gentle scrape of the cervix might actually cause women to receive unnecessary, and ultimately harmful medical treatment; irregular pap smears require follow up testing. Mencimer once had to have a newly-inserted IUD removed in order to allow for post irregular pap exams, costing her hundreds of dollars, significant pain and discomfort, and that holy shit I have cancer anxiety that can only follow an irregular pap. American women have hysterectomies as a much higher rate than their European counterparts, often as the result of more stringent women's health guidelines. Fun for no one in the family. These cases would be unfortunate but unavoidable collateral damage if annual exams were as successful at finding cancer as they purport to be, but even with recommended annual exams, doctors often miss early signs of cancer and disease.

Furthermore, many medical professionals suggest that women should be able to obtain hormonal birth control pills over the counter, as they're much safer than most prescription medications. And the barrier of the pelvic exam may lead some women to eschew birth control entirely, which may lead to more unplanned pregnancies and abortions. Can we conclude, then, that birth control isn't available over the counter because of lingering moral fear that women who take birth control will immediately transform into human vaginas gobbling up every cock in sight?

Yes, and no.

Hoops between a woman and her birth control exist for a couple of reasons. The first and most duh of the reasons is money; doctors need patients to need doctors, or they're out of a job and a golf club membership and there goes any hope of getting that golden stethoscope of their dreams. A physician who requires women to come in for an exam every year as a prerequisite for prescribing a medication that the women will do nearly anything to get assures that his appointment book is satisfactorily filled.

It's the same principle that requires me to come in for an annual eye exam even though I don't drive, my prescription for contacts hasn't changed in years, and I don't have any risk factors associated with glaucoma. No one has ever gone off their rocker after putting in like six contacts in each eye; no one has died from wearing -1.75 lenses when what they really need is a -1.5. And if they have, I'm sure there was mitigating stupidity involved.

The second reason that getting birth control from doctors continues to be a pain is, uh, also money. Because doctors are required to keep up their certifications with continuing education and continuing education and training are often sponsored by pharmaceutical companies and medical supply manufacturers, of course the training recommends that the doctors use as many pharmaceuticals and medical supplies as possible. That's capitalism, baby.

That combined with slut panic of the holy rollers in Congress creates the perfect storm of paternalism necessary to make it more annoying than it should be to make sure you can have sex without getting pregnant. If women controlled the legislative branch, they'd combat this by simply making it illegal for doctors to subject patients to unnecessary screenings in order to obtain prescription renewals. And in those pelvic exams deemed absolutely medically necessary, they'd make it mandatory for the speculum to be brought to room temperature first.

Photo by Apple's Eyes Studio/Shutterstock.

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Saturday, May 5, 2012