Advocates continue to push for birth control pills to be made available over-the-counter, arguing that expanding access would help break down barriers that black women and other marginalized communities have long faced when seeking a contraception.
Two pharmaceutical companies are seeking approval from the US Food and Drug Administration (FDA) to move their oral contraceptive pills from prescription to over-the-counter status.
The prospect that birth control pills may soon be available without a prescription is “really exciting”, said Victoria Nichols, project director of the Free the Pill campaign. Newsweek.
But she said any over-the-counter pill should be affordable, covered by insurance and accessible to people of all ages.
Barriers to accessing birth control can include finding a health care provider, the cost of a visit and lack of insurance, Nichols said. These barriers disproportionately impact women of color, Indigenous people, immigrants, low-income people, youth and LGBTQ people, she said.
“The barriers are deeply rooted in systemic racism and other forms of discrimination and oppression and they are much harsher for people of color, especially black women,” she added.
The goal is to “remove unnecessary barriers to birth control pills. We want to make them available on the shelf of a local pharmacy, so that no one has to go through the kind of hurdles and barriers I’ve described to access safe and effective medicine.”
Dr. Raegan McDonald-Mosley, a practicing obstetrician-gynecologist and CEO of Power to Decide, a nonprofit organization that campaigns to prevent unplanned pregnancies, said the birth control pill meets the criteria the FDA has set for over-the-counter medications.
“People aren’t at risk for drug overdose and people can understand if it’s right for them,” she said. Newsweek.
Making it available without a prescription would be a game-changer, she added, especially for communities that are underserved or facing discriminatory treatment in the US healthcare system.
She pointed to a history of discriminatory treatment as well as personal experiences that made many black women suspicious.
McDonald-Mosley, who is black, said she was surprised when she moved to Baltimore to learn of a massive contraceptive implant campaign in the late 1980s and early 1990s. “People felt like there was a systemic plan to decrease the fertility of poor black women,” she said.
“That’s why it’s extremely important to have over-the-counter access. Not just because it’s safe and effective and meets the criteria, but because of the particular history of reproductive oppression in our country. It puts the control entirely in the hands of people who know what they want for their lives.”
Making the pill available without a prescription could also allow for new access points that could particularly serve people of color, Sh said. “So it could be available at vending machines, community centers, churches, beauty salons, hair salons, and by direct mail to someone’s home.”
Black women are “very supportive” of access to over-the-counter birth control pills, said Marcela Howell, founder and CEO of In Our Own Voice: National Black Women’s Reproductive Justice Agenda. Newsweek.
“What we heard was that people were excited about it, they were optimistic about it, and they said it was great for their own personal decision-making,” Howell said, citing results from eight discussion groups organized last November by her. organization in states like Pennsylvania, Ohio, Georgia, Texas, and California.
Howell said some women described the challenges they faced during the COVID-19 pandemic getting appointments with their doctors to get their prescriptions refilled.
“So they felt that having over-the-counter birth control pills would be a really good addition, because it would allow them more bodily autonomy,” she said. “And they saw that as a big benefit for women who didn’t have insurance coverage and for women who lived in rural areas.”
Some of the women were also keen to avoid health care providers who they believed were pushing other forms of birth control that they didn’t want, Howell said.
“They also raised concerns,” she said, “What would it cost? Would it be covered by insurance?”
Still, advocates said making the birth control pill available over the counter is long overdue given that the safety of oral contraception is well established.
“In over 100 countries, it’s a reality,” Nichols said. “Birth control pills have been around for a long time, with over 60 years of proven safety and effectiveness.”
McDonald-Mosely added that the attack on abortion rights across the United States and the Supreme Court’s indication that it could void or overturn the landmark Roe v. Wade emphasize the importance of expanding access to contraception.
“It’s time to break down these unnecessary barriers, especially given the attacks on reproductive health and access to abortion 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 associate that with access to clinics, because health centers and the health system as a whole were just overwhelmed with having to respond to the pandemic, so we have this terrible juxtaposition where people have more demand and need for contraception and less availability of services,” she said.
She acknowledged concerns about the risks associated with taking birth control pills. “They’re not insignificant, but they’re manageable,” she said, adding that these risks were present even if a person received a prescription.
The FDA’s process for an over-the-counter change revolves around “whether a label can be designed for people to take the product as directed, and with other information that would let them know if it’s a appropriate medication for them,” said Dana Singiser, co-founder of the Contraceptive Access Initiative and former aide to former President Barack Obama.
Studies have shown that women can use checklists to determine if the pill is right for them, but Singiser said Newsweek that “everything related to the promotion of reproductive health always faces additional burdens and obstacles, 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 seeking approval for the OTC change have been there for over five years and haven’t even not reached the stage of by submitting a formal request.”
She said the lack of urgency to move the over-the-counter birth control pill is “disturbing” but presented a “great opportunity for the Biden-Harris administration to make meaningful progress in access to contraception.”
Singiser said: “These products have been taken by tens of millions of women around the world over the past 60 years. It’s time. There’s no reason the pill shouldn’t be available over the counter. “
The FDA has been contacted for comment.