Don’t Sell the Pill Over the Counter : Birth control: This is a serious medical decision that can go wrong without a checkup and counseling.

There is one very good reason for making the Pill available over the counter: the prevention of unwanted pregnancies. But there are other consequences, unintended but certain to occur, that should make us reluctant to put the Pill on retail shelves next to the aspirin and cough drops.

At the Los Angeles Free Clinic, hundreds of women walk through our doors every day seeking birth control. Some of them are girls as young as 12; some are women who have already had four or five children. After taking their medical history, we give them a pelvic exam, as well as advice about the most appropriate form of contraception and life-saving education about protecting themselves from AIDS and other sexually transmitted diseases. They would get none of these things by walking into a drugstore and buying a month’s worth of the Pill.

This would not be a problem for women who routinely go to the doctor for physicals and Pap smears. But for our clients--homeless women, runaway teens, women without health insurance, education or resources--it would be disastrous.

For many of these women, getting a prescription for the Pill is their only impetus to see a doctor. Many of them are too embarrassed to ask for medical care, and too afraid of judgment or rejection for “shameful” conditions. However, their need for education and counseling about birth-control options is strong enough to get them through our doors.

Once they’re here, we find that about 75% of them have medical problems that need immediate attention, ranging from dangerously high blood pressure to venereal disease to HIV infection. Some of these problems need to be addressed before they could safely take the Pill, or require monitoring after starting the Pill. When we talk with women during exams we hear about less evident underlying problems: domestic violence, homelessness, drug or alcohol abuse and depression. We can respond to these; the Pill cannot.

The Pill is an excellent form of birth control for many women; for others it is not the right choice. For instance, women with high blood pressure, diabetes or a history of breast cancer should not take the Pill. In addition to medical reasons, there are lifestyle reasons not to take the Pill. Women who have sex twice a year should not take a daily Pill.

Yet without counseling, women would not be able to make an educated choice about the method of birth control that is best suited for their lifestyles and their health.

For instance, the Pill cannot protect women from AIDS. And the Pill cannot even protect women from pregnancy if it is used incorrectly. Visits to the doctor can provide the necessary knowledge and support.

None of this is foolproof. The best doctor in the world can’t show up every morning to make sure someone takes her Pill (or stick around every night to make sure she uses a condom). But at least we try to address the whole woman. She knows there’s a human being she can turn to for help, not a printed information sheet that she may or may not be able to read.

Perhaps most important, women get the Pill (or condoms or a diaphragm or an IUD or Norplant) absolutely free at our clinic. Even if they’re cheap, they will not be free at the drugstore, and how many women will decide to skip a day, week or month of Pills because they run out of money? At the Los Angeles Free Clinic, we believe that birth control should be universally available. Every unwanted pregnancy is a tragedy that should have been prevented. But instead of putting the Pill on drugstore shelves, we should be increasing the availability of free, quality medical care.

When women get the Pill, they should know what they’re getting and how to use it. They should know that it’s the best birth control for them. They should know the risks of HIV transmission.

They’re not going to get any of that from a box or an information sheet or even an 800 number, simply because no 800 service can take a woman’s blood pressure, or look into her eyes and know that she needs more than just the Pill.