When the Food and Drug Administration first approved the use of the birth-control pill 61 years ago, doctors were forbidden from prescribing the pill as a contraceptive. Instead, the agency only allowed women to use the pill to treat severe menstrual disorders.
Suddenly, though perhaps not surprisingly, “an unusually large number of women” reported having such menstrual disorders. Three years later, the FDA succumbed to the reality that women were using those menstrual disorders as a pretext and approved the pill for birth-control purposes. The rest, as they say, is history.
The pill has since become a popular method of contraception in the United States. The Centers for Disease Control reports that 62 percent of women of reproductive age currently use some form of birth control, with 28 percent using the pill. And although decades of research has confirmed the safety of such products — and years of changing attitudes and laws about women’s health and contraception have made their use more acceptable — both FDA regulations and state laws still unnecessarily hinder widespread access to hormonal birth control. This means that even in 2019, women still have to jump through hoops to gain access to a legal product that allows them to control their own contraceptive choices.
The solution to this unacceptable situation is simple: The FDA needs to allow people to buy oral contraceptives over the counter.
Currently, the FDA does not allow the pill to be sold without a prescription from a doctor. Unfortunately, many low-income women do not have health insurance and are unable to pay for the routine doctor’s visits necessary to obtain a prescription for the pill. Many women who live in rural areas also lack access to OB-GYNs and other doctors. And even for women of higher incomes who live in suburban and urban areas, getting a prescription involves the hassle of setting up an appointment and taking time off work.
This may sound like a low burden, but in reality, many women simply do not want to go through the rigmarole. Instead, they make do with condoms and other less-effective means of contraception. This explains, in part, why Americans have one of the highest rates of unwanted pregnancy in the developed world.
There’s little health risk to using oral contraceptives. Researchers have studied the pill extensively since the end of the Second World War. As the nation’s largest association of OB-GYNs notes, not only have “decades of use … proven that oral contraceptives are safe for the vast majority of women,” the pill is in fact “safer than many other medications that are already available over-the-counter.” Moreover, multiple studies confirm that adults — and even teens — tend to be savvy about their own health care and would not forego routine exams if they could purchase birth control without a doctor’s visit.
Reforming the FDA is a long process. Fortunately, a realistic reform effort is increasing women’s access to the pill right now. As is often the case, this effort comes from outside the federal government and from within state governments. According to a new report from the R Street Institute, 10 states and the District of Columbia currently allow pharmacists to prescribe oral contraceptives. Commonly referred to as the “pharmacy-access model,” this system permits women to walk into a pharmacy, ask a trained pharmacist for a quick and nonintrusive birth-control examination, and walk out with her prescription in hand at a relatively low cost. This practical approach boosts women’s health, consumer choice and individual freedom — and therefore has its advocates from both sides of the political aisle.
This should be a noncontroversial solution: It steadfastly avoids hot-button social and healthcare-funding issues; it costs less than a doctor’s visit; and it’s a boon for women in rural areas, given that pharmacies are widely available. In fact, states on both ends of the political spectrum — from deep-red Utah to deep-blue California — have addressed the birth-control access problem by adopting the pharmacy-access model. Several other states are likely to consider similar legislation this year.
These states should embrace the pharmacy-access model without delay. However, the best possible reform would come from the FDA. Making birth control easier to access is an important priority for women’s health care, and both levels of government should work together to do so.
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