OTC Birth Control: Revolutionizing Access for Women’s Health

Executive Summary

Contraception is effective in improving health and well-being in women while reducing health care costs from unintended pregnancies and abortion. Women’s access to birth control is inadequate, and oral contraception should be available over the counter in Kentucky.

Introduction

Contraception is recognized by the Centers for Disease Control and Prevention as one of the ten greatest public health achievements of the 20th century (Committee on Health Care, 2015). It has helped to improve health, well-being, and economic self-sufficiency among women and has helped to reduce maternal mortality. According to The American College of Obstetricians and Gynecologists, “US births from unintended pregnancies resulted in approximately $12.5 billion in government expenditures in 2008” (Committee on Health Care, 2015). Making contraceptives affordable and easily accessible in Kentucky would improve health while reducing healthcare costs, unintended pregnancy, and abortion rates.

Obtaining Birth Control Pills

Birth control pills contain hormones that prevent pregnancy and work by stopping fertilization and ovulation. According to Planned Parenthood, “there are many brands of pills,” and “the pill is safe, affordable, and effective” (Parenthood, 2018). Most states in the United States (US) require a prescription to obtain the pill. Typically, women must make an appointment with a gynecologist in order to get a prescription for the birth control pill. While most people can make time to visit their doctor and get a prescription, it can be much harder for others. For example, women may not have the availability in their schedule or may have difficulty getting transportation to a doctor’s office. As beneficial as the pill is, access isn’t currently as available as it should be.

The pie chart above shows common contraceptive methods used by women in the US. The gray shades indicate approximately one-third of US women using sterilization as their method of birth control. About one-quarter use oral contraceptives, as shown by the area shaded orange. In the area shaded blue, one-fifth rely on their male partner to withdraw before ejaculation or to wear a condom. A tenth of women use long-acting reversible contraceptives such as IUDs, as shown in the green shaded area.

Source: Guttmacher 2015

California Law in Kentucky

Many argue a doctor’s visit is an unnecessary barrier to obtaining oral contraception. California law is now allowing pharmacists to provide hormonal birth control after administering a questionnaire and completing a short training (Karlamangla, 2017). Already, pharmacies are shifting from places where one solely picks up medicine to places where patients seek medical care, such as getting shots and checkups. Allowing pharmacists to prescribe oral birth control would be fairly easy to implement in Kentucky. With a short training and questionnaire, pharmacists could be able to prescribe oral contraceptives. They wouldn’t be over the counter, but women would have easier access as they wouldn’t have to go through their doctor or gynecologist to get an initial prescription and could instead go straight to their pharmacy.

Coverage Under the Affordable Care Act

Under the Affordable Care Act (ACA), the US Department of Health and Human Services (HHS) issued a mandate that requires employer healthcare plans to provide sterilization procedures, patient education, and counseling for women with reproductive capacity, and Food and Drug Administration (FDA) approved contraceptive methods which is a big step towards allowing women to control their reproductive health (Sobel et al., 2018). However, since it was issued, the mandate has been controversial, and two major cases about it have been brought to the Supreme Court by companies who did not wish to provide FDA-approved contraceptive methods. Now, there are developed accommodations to give coverage to women even if an employer has obligations to provide it. If a company is providing a healthcare plan, then contraceptive methods should be included. While this policy does help to provide contraceptives to women, this policy is not always implemented. The mandate is lacking as companies can opt out of this coverage, and accommodations are already being made.

Recommendation and Conclusion

Women’s reproductive health has been a topic of discussion in the political world. Critics point out that an over-the-counter pill could increase economic disparities among women, and there is no guarantee that over-the-counter birth control would be covered by insurance. Some also argue that an over-the-counter option would be a less effective form of birth control, and women would have less variety. However, an over-the-counter prescription in Kentucky allows women to control their sexual reproduction, protects women from unintended pregnancy, and has the potential to be cost-saving ((Kennedy et al., 2016). Multiple barriers currently prevent women from obtaining and using contraceptives effectively and consistently. Removing the prescription barrier to the birth control pill could increase the use of contraception and reduce healthcare costs. This policy should be enacted at the federal level so women can have access to affordable, FDA-approved oral contraceptives over the counter.

References:

1. Committee on Health Care for Underserved Women. (2015, January). Access to Contraception. Retrieved October 23, 2018, from https://www.acog.org/Clinical-Guidance-and- Publications/Committee-Opinions/Committee-on-Health-Care-for-Underserved– Women/Access-to-Contraception
2. Guttmacher Institute. Contraceptive use in the United States, fact sheet. October 2015. https://www.guttmacher.org/fact-sheet/contraceptive-use-united- states. Accessed July 19, 2016.
3. Karlamangla, S. (2017, December 13). Pharmacies now can offer birth control to women without a prescription, but few do. Retrieved October 23, 2018, from http://www.latimes.com/local/california/la-me-ln-pharmacist-birth-control-20171213- story.html
4. Sobel, L., Salganicoff, A., & Gomez, I. (2018, August 09). State and Federal Contraceptive Coverage Requirements: Implications for Women and Employers. Retrieved October 23, 2018, from https://www.kff.org/womens-health-policy/issue-brief/state-and-federal- contraceptive-coverage-requirements-implications-for-women-and-employers/
5. Kennedy, A., Jess, Z., & Dasari, N. (2016, March 31). The Over-the-Counter Birth Control Debate. Retrieved October 23, 2018, from https://publicpolicy.wharton.upenn.edu/live/news/1214-the-over-the-counter-birth -control-debate/for-students/blog/news.php
6. Over-the-Counter Access to Oral Contraceptives. (2012, December). Retrieved October 23, 2018, from https://www.acog.org/Clinical-Guidance-and-Publications/Committee- Opinions/Committee-on-Gynecologic-Practice/Over-the-Counter-Access-to-Oral- Contraceptives
7. Parenthood, P. (n.d.). Birth Control Pills | The Pill | Contraceptive Pills. Retrieved October 23, 2018, from https://www.plannedparenthood.org/learn/birth-control/birth-control-pill