Political debates over whether abortion should be legal will rage until the end of civilized time. But until recently, it seemed that public policy on birth control was a non-issue, except for a few extremists and the Catholic Church.
Amazingly, the ethics of preventing pregnancy resurfaced during the past year's political campaigns, partly because of the Obama administration ruling that insurance plans offered by all but strictly religious organizations had to cover contraception. We suspect this hint of broader challenges to women's reproductive rights even beyond the right to choose was one reason women flocked to the Obama ticket.
Now comes an interesting proposal by the American College of Obstetricians and Gynecologists' Committee on Gynecologic Practice. The doctors recommend making birth control pills available over the counter, as they are in many other countries.
There are medical and cost questions to resolve, but the benefits to women could be substantial. Such broad access, once given, would be all but impossible to revoke.
Most women of adequate means - including some 90 percent of Catholic women - use birth control at some time. But the rate of unwanted pregnancy in this country is about 50 percent and has been for 20 years. That brings with it huge public and personal costs: Women who unexpectedly become pregnant, even if they're married, may face diminished financial prospects. Women in their 20s are at greatest risk.
Doctors disagree on the safety of the pill without medical screening. Side effects can include blood clots and strokes, particularly if users smoke or are overweight. But proponents say these dangers are higher in an unwanted pregnancy and higher still in childbirth.
As it is, factors such as poverty and immigration status can prevent women from seeing doctors to get birth control. This is thought to be a major factor in the higher-than-average rate of pregnancies among Latinas.
The over-the-counter cost of the pill is a concern. Women who have insurance might pay more than they do now if their plans cover only prescription drugs. But when other drugs have gone over the counter, sales dramatically increased, and the volume helps bring prices down.
The college's recommendation is a first step. Now a pharmaceutical company must apply to the FDA for permission to sell over the counter. And then the debates over safety and cost will escalate.
Let's at least base the debate on the science. If the medical risks to young women of taking the pill without a doctor's advice are greater than the possible harm of an unwanted pregnancy, then keep the current practice. But if easier access to the drug will be a net benefit to women's health, let's try it.
Reducing unwanted pregnancy surely would reduce the number of abortions. And can't everyone agree that would be a good thing?