Should birth control pills be available without a prescription? This summer, two Republican senators—from New Hampshire and Kentucky—agreed that they should, and introduced Senate Bill 2605, the Preserving Religious Freedom and a Woman’s Access to Contraception Act, which would enable the Food and Drug Administration to explore whether such an option would be safe and effective.
The proposed bill was marked by a wave of Republican support, with four senate candidates coming out in its favor. As its title suggests, the bill was proposed as a solution to mandates for contraceptive coverage by insurance carriers that have clashed with some employers’ religious views. Regardless of the reason behind the bill, it is worthwhile exploring whether or not it would benefit women.
The pill is the most common form of reversible contraception used, but it has been documented that most women use four or more different methods over the course of their reproductive lives to adapt to their changing needs.
At first glance, such a move appears reasonable and even beneficial: no need to make an appointment with a health care provider could facilitate access. On closer inspection, however, it’s clear that it would impose a significant burden on a number of women: once medications become available without a prescription, insurance will not cover the cost. What had so recently become free to most women, thanks to provisions in the Affordable Care Act, would now have to be paid for out of pocket. For the 20 million women who live below the poverty line and rely on publicly funded services and supplies, this proposal could mean choosing between birth control and food, and an unplanned pregnancy would mean having to stretch already thin or non-existent resources to raise another child.
Furthermore, this proposal would not forward the goal of decreasing unwanted pregnancies, as we have seen in the case of emergency contraception. Plan B was made available over the counter in 2006 in the hopes that this would make a last resort more easily available to women. Sales of Plan B since 2006 demonstrate that access to emergency contraception has increased. However, this increased access has not reduced rates of unintended pregnancy. Those who can afford the $50-$60 price tag for Plan B have reduced their risk of unintended pregnancy, but women living in poverty have not experienced the same benefit. Insurance will cover emergency contraceptives, but only with a prescription, again undercutting the benefits of making it exclusively available over the counter.
Making birth control pills available without a prescription would likely have similar results. The cost would be prohibitive: Birth control pills can cost as much as $130 per month. Some pharmacies provide inexpensive generic brands for approximately $9 per month, but for many women, particularly single mothers, even this may be too expensive.
Many will argue that the only way to increase access to the pill is by making it available without a prescription. Certainly, in the context of a much larger strategy of increasing access to safe, effective birth control, over-the-counter availability could increase women’s access to birth control. Such programs have long been advocated by leaders in the field, including the Guttmacher Institute. But if we are to ensure access to all women, including those who cannot afford birth control without public access programs, insurance must continue to cover the costs of all associated care.
All contraceptive methods—not just the pill—should be more readily available to women. The pill is the most common form of reversible contraception used (approximately 28 percent of women who use contraception use the pill), but it has been well documented that most women use four or more different methods over the course of their reproductive lives to adapt to their changing needs. Thus, even among women who can afford to pay for the pill, providing over-the-counter access is only a partial solution.
Truly making birth control more accessible to all women and reducing the rates of unwanted pregnancy regardless of income will require a significant change in society’s attitudes toward women and sex. In the meantime, women need ready access to birth control that fits with their lives and reproductive goals. Although not an ideal solution, the women’s health component of the Affordable Care Act meets those needs. All women should make clear to their elected representatives that they will not tolerate the elimination of these hard-won gains.