Over-the-Counter Birth Control? Not Quite Yet…

Hormonal birth control options—like the pill, patch, and ring—are now available in Oregon without requiring a visit to the doctor. A new state bill allows women over the age of eighteen to obtain a year’s supply of contraceptives at the pharmacy after a consultation with a pharmacist trained to prescribe them. Similar legislation was passed in California in 2013 to allow access to contraceptives, nicotine patches, and certain other medications without a doctor’s prescription and is expected to be implemented later this year, now that the state’s Board of Pharmacy has finalized a set of protocols for pharmacists. Several legislators have introduced similar measures for consideration, mostly in states in the west, and other states already have “collaborative practice laws” that allow pharmacies to prescribe certain medications like birth control, antibiotics, and antihistamines if they have physician’s agreements that allow it (though it’s hard to tell which pharmacies have these arrangements and they’re often laborious to arrange).

Though this is somewhat of a step forward for women’s reproductive rights and access to contraception (even as anti-abortion legislators continue to limit access to abortion procedures and to defund Planned Parenthood), according to a statement released by the American College of Obstetricians and Gynecologists (ACOG), states can go further in removing the barrier to birth control by allowing complete over-the-counter access instead of adding the barrier of a pharmacist. In fact, the United States is in the minority by requiring a prescription for the pill as forty-four other countries do, with 102 countries allowing over-the-counter access or access after a simple screening process.

Opponents argue that only doctors are sufficiently able to determine the right birth control method based on medical history and that allowing women to access birth control at the pharmacy would give them less reason to visit their doctor for a pap smear and check-up, but these arguments are easily countered by evidence to the contrary.

As early as 2012, ACOG has formally recommended providing over-the-counter birth control, citing multiple studies that conclude women are not only capable of determining which hormonal birth control method is right for them, but can be even more judicious in their selection than doctors are. ACOG makes the additional argument that common over-the-counter medications like Tylenol (acetaminophen), Advil (ibuprofen), and aspirin carry side effects and contraindications—yet we’re trusted to make decisions about taking those drugs ourselves.

It’s also unfair to constrain access to birth control just to ensure women get checked for cervical cancer. As Dr. Nancy Stanwood, obstetrician and chairwoman of the board of Physicians for Reproductive Health told the New York Times, “We were holding pregnancy prevention hostage to cancer screening. They’re both worthwhile goals, but one should not be held hostage to the other.” (She also cites a study in Texas that shows women who receive birth control over-the-country still visit doctors for pap smears).

The economic and social advantages of reducing unintended pregnancies, unplanned births, and abortion rates—not to mention the primary benefit of granting women additional control over their own bodies—are too great to let any argument against over-the-counter access to contraceptives hijack the conversation. The burdens of unintended pregnancy and unplanned births have far-reaching consequences from creating single mothers who are unable to advance their education or advance in their careers, to children who grow up in poverty or as unwanted children. A 2012 study by the National Bureau of Economic Research suggests the availability of oral contraception has contributed to narrowing the gender wage gap since the 1980s.

The Guttmacher Institute, a think tank that focuses on sexual and reproductive health research and policy analysis, has found that more than half, 51 percent, of the 6.6 million pregnancies in the US per year are unintended, which is “significantly higher than the rate in many other developed countries.” (Their factsheet on “Unintended Pregnancy in the United States” can be found here.)

The rate of unintended pregnancies also tends to be highest among poor and low-income women, women aged 18-24, cohabiting women, and minority women—groups that are most likely to require state-funded public insurance programs to pay for birth costs. In fact, in 2010 two-thirds of the 1.5 million unplanned births were paid for via state-funded programs like Medicaid, and when Colorado’s Family Planning Initiative enacted free birth control options for teens, the state health department estimates it saved more than $80 million dollars (a return of $5.85 in Medicaid costs per dollar used to fund the initiative) and decreased the teen birthrate by 40 percent. If the pill were available over-the-counter free of charge or at low cost, UCSF reproductive health researchers estimate that “11 to 21 percent of low-income women would start using the pill, resulting in an estimated 7 to 25 percent decrease in unintended pregnancies.”

In Oregon, birth control is covered by insurance, but many women’s health advocates are concerned that making the pill available over-the-counter may be a double-edged sword if insurance plans don’t provide coverage. Many plans will cover contraceptive methods, including over-the-counter birth control if there is a written prescription, but not if there’s no prescription—as could be the case if ACOG and other advocates for universal access to birth control get their way. In fact, the fight for over-the-counter birth control is now being taken up by some Republicans ahead of the Supreme Court’s decision on whether religious organizations can be made exempt from paying for contraceptive coverage under the Affordable Care Act. Last May, Republican senators introduced the “Allowing Greater Access to Safe and Effective Contraception Act” to make it easier for drug manufacturers to make contraceptives over-the-counter by giving them priority filing with the FDA, a bill that ostensibly seems to support the same goals as women’s health advocacy groups, but would not guarantee coverage by insurance, making the pill unaffordable to those who need it. Senate Democrats countered with a bill requiring insurance companies to cover the pill even if it became over-the-counter.

So while this is a victory for reproductive rights, anyone following the issue must be careful to consider all angles of over-the-counter birth control. A century ago, in 1916, Margaret Sanger (1957 Humanist of the Year) started her clinic to illicitly provide contraception to women, saying that “preventing women from contraception is inhumane.” One hundred years later, the struggle for women to have full control over their bodies and lives continues.

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