April 5 – I usually take about an hour off work whenever I collect birth control pills from my regular government clinic every three months (it used to be every two months).
During each visit, a nurse will take a urine sample and check my blood pressure and weight before giving me three packs of Oralcon, a combined oral contraceptive. When I first started the pill at the government clinic, I had to get a doctor’s prescription.
I tolerate the inconvenience every quarter of the year because each visit to the government clinic only costs me RM1 for three packs of the pill, whereas one pack (which lasts for a month) at a private pharmacy can cost RM27.
At a private pharmacy, buying oral contraceptives does not require a doctor’s prescription, but I must write my name, address and telephone number down (why?) in a book before the pharmacist takes the pill out from behind a glass shelf. The pill is not available in online pharmacies.
The pharmacist does not do any screening at all or ask me if I have high blood pressure, one of the risk factors for blood clots (a tiny risk) when taking the combined pill, which defeats the purpose of banning over-the-counter oral contraceptives.
Taking the pill is pretty simple. Just take one at around the same time every day for 21 days; break for seven days, during which you’ll get a period-like bleed (which scientists now say is unnecessary); and resume taking the pill after.
There is no need for a doctor, pharmacist, or nurse to tell you how to take the pill. Clear instructions on the product will do. For combined oral contraceptives, the label can list the hypertension risk factor and women can simply measure their own blood pressure at pharmacies or at home with a machine before buying the pill.
Research from Mexico, which allows oral contraceptives to be sold without a prescription, reportedly showed that women who bought the pill over the counter at pharmacies in the country without going to a doctor were no more likely to have risk factors in using oral contraceptives than those who did see a clinician.
The pill is sold over the counter in more than 100 countries, unlike Malaysia that lists oral contraceptives under the Poisons Act 1952.
US physicians like the American College of Obstetricians and Gynaecologists, its Committee on Gynaecologic Practice, and the American Academy of Family Physicians reportedly support making oral contraceptives in the United States available without a doctor’s prescription.
A 2006 study with women participants from Seattle, the United States, showed a whopping 96 percent match between women’s self-evaluation and their health care providers’ medical evaluation on whether they could safely take oral contraceptives, including “well above” 90 percent agreement on critical criteria like hypertension. In areas of disagreement, women identified more risks than their clinicians.
The new Pakatan Harapan (PH) government should remove oral contraceptives from the poisons list and make them available to women over the counter without a prescription or clinical screening.
I have been on the pill for years.
Going on the pill should be as easy as ordering it online from a pharmacy, however many packs you want, and having it delivered to your home.
For government pharmacies, due to perennial concerns over medicine supplies running out, women can be restricted to a certain number of packs per visit. But they should be allowed to purchase the pill without a doctor’s prescription or a nurse’s screening.
Requiring a doctor’s prescription or a clinical screening for birth control pills restricts women’s access to reproductive health care.
It is patronising and harms low-income women who cannot get off work to do an hour-long screening at government clinics that are normally closed on weekends.
The pill empowers women to control their own bodies as they do not have to rely on men’s agreement to wear a condom which, incidentally, does not require a doctor’s prescription.
As Malaysia continues to struggle with baby dumping, expanding access to oral contraceptives will reduce unwanted pregnancies. The government, of course, should also promote condom use at the same time to prevent sexually transmitted infections (STI).
Making oral contraceptives available over the counter could also lead to lower prices at private pharmacies due to increased demand.
It is not a good reason either to ban over-the-counter oral contraceptives on grounds that women will otherwise avoid cervical cancer, STI or other health screenings if they are not required to visit a clinician.
What about women who do not take the pill then? Shouldn’t they also be doing pap smears? What about men? Should we make prostate exams compulsory when buying condoms so men will screen for prostate cancer?
Yes, my nurse at the government clinic does helpfully remind me about pap smears.
But reminders about regular pap exams (once every three years is recommended) to screen for cervical cancer should be extended to all women, not just those on the pill. The Health Ministry needs to think about how to do this, instead of simply relying on women to voluntarily get screened.
Medical professionals and the PH government, with its commitment to gender equality and access to health care, must stop infantilising women.
We must bring down barriers blocking access of the pill to restore women’s bodily autonomy and protect their right to reproductive health.