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'The prescription barrier': Birth control access comes into focus in post-Roe world

·4-min read

Approval to distribute birth control pills over the counter in the United States has swiftly become a crucial battle — particularly in the wake of the Supreme Court's decision to overturn Roe v. Wade, which had legalized abortion nationwide.

However, hope for the campaign remains promising for many activists.

"The prescription barrier, specifically, is something that keeps safe and effective birth control pills out of reach for many — often times because you have to go to a doctor or a provider's office to get a prescription and that can be difficult for people to do," Victoria Nichols, project director for Free The Pill, a campaign that focuses on bringing birth control pills OTC, told Yahoo Finance. "Getting them over-the-counter would really reduce and eliminate a lot of barriers that people face when trying to get access which are really rooted in systemic inequity."

Limited abortion access has sparked debate over diminishing access to abortion-inducing drugs. Under the Supreme Court’s ruling in Dobbs v. Jackson Women’s Health Organization, states rather than the federal government have authority to regulate abortion. And with that authority, state governments could more directly target the medication.

A map indicating the disparities in birth control access across the U.S. (Map: Power to Decide)
A map indicating the disparities in birth control access across the U.S. (Map: Power to Decide)

According to Power to Decide, an organization that promotes sexual health and well-being, more than 19 million women of reproductive age in the U.S. live in "contraceptive deserts," which means they lack access to a health center in their county that offers all methods of contraception. Additionally, according to the data, around 1.2 million of these women "live in a county without a single health center offering the full range of methods."

In addition to the Supreme Court’s ruling in Dobbs v. Jackson Women’s Health Organization, which overturned Roe and terminated the constitutional right to abortion, Justice Clarence Thomas suggested the right to contraception should also be examined.

In July, the House passed legislation to protect access to contraception nationwide. The measure, which passed 228 to 195, would protect the authority to purchase and use contraception without government restriction. It has yet to pass the evenly divided Senate, however.

'Systemic inequities'

Access issues include needing to get to an appointment for care, the cost of an appointment, and transportation, among other obstacles, Nichols explained.

"Often times, people have to take time off of school or work to get to the appointment and these barriers fall harder on Black, Indigenous, other people of color, and young people," she said. "Often times, people working to make ends meet and people in rural communities, they face these barriers due to systemic inequities."

Dr. Shelly Tien gives a patient medication to start a medical abortion at Planned Parenthood in Birmingham, Alabama, March 14, 2022. REUTERS/Evelyn Hockstein
Dr. Shelly Tien gives a patient medication to start a medical abortion at Planned Parenthood in Birmingham, Alabama, March 14, 2022. REUTERS/Evelyn Hockstein

For example, being insured is associated with being more likely to receive family planning services. According to 2019 data from the Kaiser Family Foundation, just 7.8% of white Americans are uninsured versus 20% of Latinos, 21.7% of American Indian and Alaska Natives (AIAN), and 11.4% of Black Americans.

Binging oral contraception over-the-counter would address many of these barriers and allow these underserved communities to obtain more access.

Similar to the morning-after pill (which is currently available over-the-counter), birth control uses levonorgestrel to prevent ovulation, making it more difficult for sperm to reach the egg if ovulation does occur. However, emergency contraception is only 95% effective, whereas the birth control pill is 99% effective.

Oral contraception first became legal in the U.S. in 1960 and has been safely used by millions of women since. While blood clots in veins remain a primary health concern — they are extremely rare, occurring in less than 1 in every 1,000 pill takers per year.

Last month, French pharmaceutical company HRA Pharma submitted an application to the U.S. Food and Drug Administration (FDA) to authorize an over-the-counter (OTC) birth control pill. If approved, the pill would be the first oral contraceptive available in the U.S. without a prescription, thus offering women broader access to birth control.

The routine timeline for the FDA responding to such applications is typically 10 months. That means it could take until mid-2023 for the drug to finally reach shelves. However, Nichols is confident there's strong evidence that supports the safety and efficacy of OTC birth control pills for people of all ages.

Two U.S. companies have FDA approval to produce and sell mifepristone, the first of two separate drugs taken to terminate pregnancy in a medical abortion: brand manufacturer Danco Laboratories and generic manufacturer GenBioPro. Another drug, misoprostol, also used to treat ulcers and other ailments, is used in the second step of the two-pill regimen.

The FDA process is one product at a time, which means they must review the data and the science for each product. Nichols said that process is squarely focused on the science and the data.

"I know there are people who are working on and exploring what might come next, including other hormonal methods for birth control pills," she said. "Who knows what the future may hold?"

Sandra Salathe is a senior editor at Yahoo Finance. Follow her on Twitter at @srsalathe.

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