Why is birth control not yet available over the counter?
Last month, the US Supreme Court delivered a once-in-a-generation setback to women’s health in overturning Roe v. Wade. As we look forward, we need to not only reclaim what we’ve lost, but also define what we expect of the future.
Oral contraception — another right currently upheld by SCOTUS — is widely agreed to be safe (especially progestin-only pills), non-addictive, and effective in preventing pregnancy. But access barriers are real.
Last week, I exchanged four phone calls with my pharmacy trying to refill a prescription for a discontinued birth control brand that they couldn’t substitute. Earlier this year, a PCP told me he could only write a script if I visited him every six months. Mid-pandemic, a receptionist insisted on a video visit to authorize a refill; weeks later, I connected with my provider, only to have her tell me it was unnecessary. I’ve lost count of how many times I’ve had to call about a “vacation refill” to get an extra pack for a lengthy trip.
This isn’t even considering the hurdles of finding and seeing a provider and picking up a prescription every month — not to mention doing that under financial distress, without insurance, or in an unsupportive community.
Last month, the American Medical Association announced it would advocate for OTC availability of hormonal contraception. They join the American College of Obstetrics and Gynecologists, the American Academy of Family Physicians, and Planned Parenthood, which have issued similar statements over the years. They also advocate for OTC oral contraceptives to be covered by insurance to avoid introducing yet another barrier (cost).
The AMA’s urgency reflects the fact that women’s bodily agency is at a decades-long low, and it’s unacceptable that simple, safe, affordable, and effective tools for pregnancy prevention, like oral contraception, aren’t always easy to get. I’m optimistic that they will prevail.
Let’s imagine that they do. Women will use self-screening tools and questionnaires at home to determine their eligibility for hormonal contraception. Will that data prove useful, and can we keep it private? How will the annual gynecological exam change? How often will women do pelvic and breast exams and cervical cancer and STI screenings? Can some of these screenings be done at-home? What risk stratification tools can we use to ensure that women who truly need annual screenings get them? How can communities ensure that women get emotional support and motivation to get screened?
We’re at an inflection point in women’s health. OTC birth control a step in the right direction, but there’s a long way to go. I’m optimistic that we’ll succeed as we join with advocates and practitioners to fight and launch mobile clinics to help women impacted by last month’s decision. And longer-term, we have the opportunity to not only reclaim what we’ve lost, but also define what we expect of the future.
