Advocates are continuing to push for birth control pills to be made available over the counter, arguing that expanding access would help remove barriers that Black women and other marginalized communities have long faced when seeking contraception.
Two pharmaceutical companies are seeking approval from the U.S. Food and Drug Administration (FDA) to switch their oral contraceptive pills from prescription to over-the-counter status.
The prospect that birth control pills could soon be available without prescriptions is “really exciting,” Victoria Nichols, the project director of the Free the Pill campaign, told Newsweek.
But she said that any over-the-counter pill needs to be priced affordably, covered by insurance, and available to people of all ages.
Barriers to accessing birth control can include finding a healthcare provider, the cost of a visit and lack of insurance, Nichols said. Those hurdles disproportionately impact women of color, indigenous people, immigrants, low-income people, young people and LGBTQ people, she said.
“The barriers are deeply rooted in systemic racism and other forms of discrimination and oppression and they’re far harder on people of color, particularly Black women,” she added.
The goal is to “remove unnecessary barriers for birth control pills. We want to make them available on the shelf at a local pharmacy, so no one has to go through the kind of obstacles and the barriers that I described to get access to safe and effective medication.”
Dr Raegan McDonald-Mosley, a practicing OB-GYN and the CEO of Power to Decide, a nonprofit that campaigns to prevent unplanned pregnancy, said the birth control pill meets the criteria that the FDA has set for over-the-counter medication.
“People aren’t at risk for overdose from the medication and people can understand if it’s appropriate for them,” she told Newsweek.
Making it available without a prescription would be a “game-changer,” she added, especially for communities who are inadequately served or face discriminatory treatment in the U.S. healthcare system.
She pointed to a history of discriminatory treatment as well as personal experiences that has made many Black women mistrustful.
McDonald-Mosley, who is Black, said she was surprised to learn when she moved to Baltimore about a widespread campaign promoting the contraceptive implant in the late 1980s and early 1990s. “People felt like there was a systemic plan to decrease the fertility of poor Black woman,” she said.
“That’s why having over-the-counter access is critically important. Not only because it’s safe and effective and meets the criteria, but because of the particular history of reproductive oppression in our country. It fully puts the control in the hands of people who know what they want for their lives.”
Making the pill available without a prescription could also allow for novel access points that could particularly serve people of color, sh said. “So it could be available in vending machines, community centres, churches, beauty salons, barber shops, and by direct mail to someone’s house.”
Black women are “very supportive” of having access to birth control pills over the counter, Marcela Howell, the founder and CEO of In Our Own Voice: National Black Women’s Reproductive Justice Agenda, told Newsweek.
“What we heard was that people were excited about this, they were optimistic about it and they said that it was it great for their own personal decision-making,” Howell said, citing the results of eight focus groups carried out last November by her organization in states including Pennsylvania, Ohio, Georgia, Texas and California.
Howell said some women described the difficulties they faced during the COVID-19 pandemic in getting appointments with their doctors to have their prescriptions renewed.
“So they felt that having birth control pills over the counter would be a really good plus, because it would allow them more bodily autonomy,” she said. “And they saw it as as a big benefit for women who did not have insurance coverage, and for women who lived in rural areas.”
Some of the women were also keen on the idea of avoiding healthcare providers who they felt were pushing other forms of contraception they did not want, Howell said.
“They also raised concerns,” she said, “What would this cost? Would it be covered by insurance?”
Still, the advocates said making the birth control pill available over the counter is long overdue given the safety of oral contraception is well-established.
“In over 100 countries, this is a reality,” Nichols said. “Birth control pills have been around for a long time, there has been 60 plus years of proven safety and efficacy.”
McDonald-Mosely added that the attack on abortion rights across the U.S. and the Supreme Court’s indication that it may gut or overturn the landmark Roe v. Wade ruling underscores the importance of expanding access to contraception.
It’s time to break down these unnecessary barriers, especially given the attacks on reproductive health and abortion access in the United States,” she said.
McDonald-Mosley also pointed to research that showed the pandemic was changing people’s minds about whether they wanted to have children.
“Then you couple that with access to clinics, because the health centres and health care system overall was just being overwhelmed with having to respond to the pandemic, then we have this terrible juxtaposition where people have more demand and a need for contraception and less availability of services,” she said.
She acknowledged concerns about the risks associated with taking the birth control pill. “They’re not negligible, but they’re manageable,” she said, adding that but said those risks are present even if a person was given a prescription.
The FDA process for an over-the-counter switch revolves around “whether a label can be designed for people to take the product as instructed, and with other information that would inform them whether it’s an appropriate drug for them,” said Dana Singiser, a co-founder of the Contraceptive Access Initiative and a former aide to former president Barack Obama.
Studies have shown that women can utilize checklists to determine whether the pill is right for them, but Singiser told Newsweek that “anything in the category of advancing reproductive health always faces additional burdens and hurdles and attacks and misinformation.”
She added: “Nobody knows exactly what’s going on inside the walls of the FDA, but we do know that the two companies that are seeking that OTC switch approval have been at it for more than five years and haven’t even reached the stage of submitting a formal application.”
She said the lack of urgency in moving the birth control pill over the counter is “disturbing” butt presented a “great opportunity for the Biden-Harris administration to make meaningful advancements in access to contraception.”
Singiser said: “These products have been taken by tens of millions of women around the world for the past 60 years. It’s time. There’s no reason that the pill should not be available over the counter.”
The FDA has been contacted for comment.