Millions of American women have used hormonal birth control since its introduction to the market 60 years ago. Today, birth control is a staple of preventative medicine. Its safety and effectiveness as a family planning method and treatment for many health conditions make it essential for many women, with 91 percent of Americans saying birth control is morally acceptable.

However, despite its widespread use and acceptability, outdated federal and state regulations create undue burdens for consumers trying to obtain birth control, like the highly effective hormonal birth control pill. This contributes to the persistently high unintended pregnancy rate in the United States, which hovers at just below half of all pregnancies. Initially, regulations
governing access to hormonal contraceptives ensured user safety by requiring medical clearance from a physician. But now, decades of research on birth control has led the majority of medical professionals to endorse easier access to contraception.

In a new R Street Policy Study, “Bringing Hormonal Birth Control Over the Counter,” my co- authors and I examine the major forms of hormonal birth control and their current regulatory landscapes. We determine that there are several opportunities to improve birth control access in a safe and reasonable manner. First, using the Food and Drug Administration’s own criteria for
over-the-counter (OTC) drug sales, we find that the birth control pill falls squarely in the category of drugs that could obtain OTC status. For instance, the birth control pill cannot be abused, risks are minimal, dosage directions and purpose for use are easily understood, women can self-screen for contraindications and medical intermediation from a doctor is unnecessary.
These features explain why leading medical associations in the United States, like the American Medical Association and the American College of Obstetricians and Gynecologists, endorse over-the-counter access to birth control.

Second, we discuss the success of the pharmacy access model for hormonal birth control and call for its implementation in states that have not yet embraced it. With the pharmacy access model, pharmacists can prescribe hormonal birth control methods like the pill, patch and ring directly to patients. Rather than scheduling a doctor’s appointment, the patient just needs to give their medical history to a pharmacist and have their blood pressure assessed to determine if there is a risk of hypertension, the primary contraindication for hormonal contraceptives. This model, now in place in 11 states and the District of Columbia, has led to a decrease in unintended pregnancies and healthcare costs associated with them. This expansion of
pharmacists’ scope of practice has eased access for patients who have trouble seeing a doctor regularly, which makes it easier for them to maintain a birth control regimen.

Finally, we argue that long-acting reversible contraceptives (LARCs), such as intrauterine devices and hormonal implants, while not candidates for OTC access due to their internal placement, are also suitable for expanded access through regulatory reform. In the case of LARCs, state regulations often restrict some medical professionals from inserting and removing LARCs, increasing barriers to access because underfunded clinics often cannot afford to keep a physician on staff full-time. However, research about IUD administration has found that registered nurses (RNs) in countries like Australia, Turkey, Korea and Brazil are capable of safely performing IUD insertions and removals and report interest in doing so. Expanding the number of medical professionals trained and authorized to perform insertion and removal procedures could also lead to lower healthcare costs for patients.

In sum, our paper concludes that regulatory barriers contribute to the difficulties associated with obtaining a birth control prescription and maintaining consistent use. In the interest of public health, it’s time to dismantle these barriers. In the year ahead, policymakers at all levels of government should focus on removing the regulatory barriers to birth control access.

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