口服避孕藥品分類政策與女性經驗：健康權觀點

Abstract

根據臺灣現行《藥事法》規定，口服避孕藥為處方藥，須經醫師診斷開立處方箋後方可取得；然而實務上，部分使用者可直接於藥局購得，亦有民眾即使持有處方箋卻無法順利取得，顯示政策與實際執行間存在落差。生育健康與自主權為多項國際人權公約所保障之基本人權，惟臺灣對於口服避孕藥藥品分類政策之討論，長期以來多由專家主導，缺乏實際使用者作為權利人的參與及聲音。 本研究分為檔案分析與深度訪談兩部分。檔案分析以五項國際人權公約及相關國家報告、影子報告等資料為文本，分析其中關於避孕、性健康與生育健康權利之論述；訪談部分則針對 12 位半年內曾服用口服避孕藥之女性進行半結構式深度訪談，深入了解其取得藥品的經驗、資訊來源、與藥品分類政策觀點。 檔案分析研究結果顯示，性與生育健康議題在歷年各項公約的審查中日益受到重視，懷孕相關議題的提及次數顯著多於避孕。雖然政府持續提出多項改善方案與規劃，但性教育資源不足、相關服務及資訊難以取得等問題依然存在。訪談結果發現，多數受訪者認為口服避孕藥能提升自身的生育自主性，然而在取得過程中往往面臨資訊不足、自我摸索時間長、經濟負擔不一等問題。以 PANEL 指標（Participation, Non-discrimination/equality, Empowerment, Accountability, Legality）分析及比較國際人權公約報告與使用口服避孕藥受訪者的論述結果顯示，目前政策討論中使用者參與有限，問責機制薄弱，且可近性與教育資源仍有待強化；而關於口服避孕藥分類政策討論，除安全性及可近性外，尚有其他因素應納入考量。 雖然本研究中的受訪者對於口服避孕藥藥品分類並未表達一致的立場，且作為權利人亦未明確表示目前該政策是否已完全實現其生育健康權，未來政策制定仍應強化使用者參與、跨部門協作與結構性障礙之排除，朝向更具人權導向與實證基礎的口服避孕藥品政策改革。

According to Taiwan’s current Pharmaceutical Affairs Act, oral contraceptives are classified as prescription drugs, meaning they must be obtained through a physician’s diagnosis and a written prescription. However, in practice, some people can buy them directly from pharmacies. Conversely, others cannot get them even with a valid prescription—highlighting a gap between official policy and real-world practice. Reproductive health and autonomy are fundamental human rights protected by various international human rights agreements. Nonetheless, policy debates about how oral contraceptives are classified in Taiwan have long been dominated by expert opinions, with little input or representation from actual users as rights-holders. This study has two parts: documentary analysis and in-depth interviews. The documentary analysis reviews five international human rights conventions, relevant state reports, and shadow reports to assess how issues related to contraception, sexual health, and reproductive rights are presented. The interview section involved semi-structured, in-depth interviews with 12 women who have used oral contraceptives within the past six months, aiming to understand their experiences accessing the medication, sources of information, and opinions on drug classification policies. The documentary analysis showed that concerns about sexual and reproductive health have gained increasing attention in the periodic reviews of international agreements over the years, with pregnancy-related topics being mentioned much more often than contraception. Although the government has proposed several improvement plans and strategies, issues such as limited sex education resources and restricted access to relevant services and information persist. Interview findings indicated that most participants viewed oral contraceptives as enhancing their reproductive autonomy; however, they often faced challenges like a lack of adequate information, extended periods of self-exploration to find suitable products, and varying financial burdens. Comparing both the international human rights discourse and interview results using the PANEL framework (participation, non-discrimination/equality, empowerment, accountability, legality) revealed limited user participation in policy discussions, weak accountability mechanisms, and ongoing gaps in accessibility and educational resources. Additionally, discussions about the classification of oral contraceptives should consider not only safety and accessibility but also other user-centered factors. Although the interviewees did not present a unified stance on how to classify oral contraceptives, and rights-holders did not explicitly state whether their reproductive health rights were fully realized under the current policy, this study suggests that future policymaking should strengthen user participation, enhance cross-sector collaboration, and eliminate structural barriers—aiming for a more human rights-based and evidence-informed reform of oral contraceptive policy.