Over the Counter

Savannah remembers feeling “extremely uneasy” on the first day of her first year in college—and it wasn’t as simple as freshman jitters.

She was headed to the student health clinic to ask for birth control, and she only had $25 in her bank account. She knew that was not nearly enough pay for both the visit and the contraception she needed.

Four hundred dollars later, Savannah was right. She spent the next three months using her paychecks from her job at Subway to pay off the balance.

“I was forced to choose between buying groceries and maintaining my reproductive health,” she says.

For millions of women across the country who face a similar dilemma, the contraceptive coverage benefit under the Affordable Care Act (ACA)—which requires most private health plans to fully cover contraception and well-woman visits with no cost to the patient—has provided some much-needed relief.

But what if a woman’s schedule means that she needs to get birth control after office hours, over the weekend, or while out of town? What if she doesn’t have the time or resources for a separate doctor’s appointment to get a prescription?

A new report from the Center for Reproductive Rights shows that access to birth control could be expanded even further by making oral contraceptives available without a doctor’s prescription. An over-the-counter (OTC) pill would offer increased accessibility and convenience for those unable or unlikely to visit a health care provider for a prescription and could help reduce the number of unintended pregnancies in a country where more than half of all pregnancies are unplanned.

The report highlights the findings over the last decade of a working group of reproductive health, rights, and justice organizations, nonprofit research and advocacy groups, university-based researchers, and prominent clinicians who have been exploring the potential of OTC birth control to reduce disparities in reproductive health care and to increase women’s opportunities to access a safe, effective method of birth control.

“Research suggests that oral contraception can be provided safely without a prescription. And we’ve started to see bipartisan interest in bringing the pill over the counter—which is great,” says Megan Donovan, federal policy counsel at the Center and the author of the report. “But through our work we’ve also determined that to make an OTC pill a viable option for women, we need to make sure that it is available with comprehensive insurance coverage and to all ages.”

Although the authority to permit OTC birth control ultimately lies with the Food and Drug Administration (FDA), the federal government can take important steps to ensure that access to an OTC pill is as broad as possible by making provisions for insurance coverage. Oral contraception costs can amount to as much as $600 each year—a potential deal breaker for countless women. Yet reliable, affordable birth control is particularly essential for women in precarious financial situations, where the added expense and burden of an unplanned pregnancy could be catastrophic.

For an OTC pill to remain affordable and accessible to as many women as possible, enrollees in Medicaid and other public insurance programs—many of whom face significant challenges accessing medical providers—must be able to obtain an OTC pill without a prescription. Similarly, the ACA contraceptive coverage benefit must be extended so that women with private insurance can access no-cost coverage of OTC birth control without a prescription.

It is also essential that an OTC pill be available to women of all ages, as young woman are likely to be among those who most benefit from eliminating barriers such as cost, transportation, and access to a health care provider.

In addition to support from lawmakers on both sides of the aisle, an OTC pill has broad support from the medical community—including the American College of Obstetricians and Gynecologists, the American Academy of Family Physicians and the American Medical Association—and, not surprisingly, the public. Seventy percent of Americans are in favor of moving a pill over the counter.

“Access to contraception is a human right, as it is critical to an individual’s ability to control his or her own life and reproduction,” notes Donovan. “Taking the next step to put oral contraception where it belongs—on the shelf in the family planning aisle—is absolutely essential to expanding birth control access for all.”