On May 9, 1960, the FDA approved the first oral contraceptive. While we’ve come a long way since then, we still have some hurdles to overcome. The emergency contraception known as Plan B contains three times the dose of the same formula as a daily oral contraceptive. Plan B is also available over the counter. So why isn’t Plan A?
Two Republican senators are working to rectify that anomaly. Just last month, Sens. Joni Ernst, R-Iowa, and Cory Gardner, R-Colo., introduced S. 390, the Allowing Greater Access to Safe and Effective Contraception Act. If passed, this bill would lower the burdens that often prevent women from obtaining hormonal contraceptives. The bill expands access in two ways: by urging the Food and Drug Administration to approve over-the-counter status for hormonal birth control and by extending flexible payment options for women seeking access to this medication.
In the United States, over 43 million women are at risk of unintended pregnancy, and in 2011, 45 percent of all pregnancies in the United States were unintended. These pregnancies can bring on a host of issues, both socioeconomic and medical. For teen mothers, only 40 percent finish high school and less than 2 percent graduate from college by age 30. For mothers of any age, unintended pregnancy is directly linked to depression during pregnancy as well as postpartum.
An unwanted pregnancy is an obvious strain on a woman’s health, but it is also a burden on public resources. Unintended pregnancies affect low-income women at a higher rate than others — in fact, women who fall at or below the poverty level are five times more likely to experience an unplanned pregnancy than women who do not. The medical costs associated with these pregnancies are often borne in part or in full by taxpayers. In 2010 alone, unintended pregnancies cost taxpayers over $21 billion. Expanding access to birth control can mitigate these financial burdens as well as the emotional and physiological consequences of an unintended pregnancy.
Current laws in 40 states require women to visit a physician to receive a birth control prescription, which often poses a barrier to women who lack health insurance or easy access to a physician. Fortunately, 10 states plus the District of Columbia have switched from this archaic physician-access model to a more accommodating pharmacy-access model, which allows women to obtain a birth control prescription directly through a pharmacist. Perhaps surprisingly given the polarized times we live in, states that have adopted pharmacy-access model range from deep-blue Washington to deep-red Utah, underscoring the bipartisan support for expanding contraceptives access.
While the state-by-state effort has moved steadily in the direction of increased access, the federal government has lagged behind. Passing the Ernst-Gardner bill would be the biggest step yet toward more contraceptive freedom. S. 390 would allow women to obtain contraceptives intended for routine use, like hormonal birth control pills, without a prescription. It would also ease the burdens on pharmaceutical companies seeking to make their contraceptive drugs available over the counter.
A secondary barrier to women’s contraceptives access is affordability. In a 2017 survey, one in three women claimed they could not afford to spend more than $10 a month on birth control. Unfortunately, restrictions put in place by the Affordable Care Act prevent women from using personal health saving accounts to pay for medications that do not require a prescription, meaning that providing for over-the-counter access to contraceptives alone would not improve women’s ability to afford this medication. S. 390 would repeal this provision as well as the ACA’s limit on pretax salary reduction HFSA contributions. Removing these restrictions would provide greater flexibility for women in their reproductive health choices.
The Ernst-Gardner bill would go a long way toward breaking down unnecessary market barriers to women’s contraceptives. The monetary and health costs of unintended pregnancy are far too high to continue holding contraceptives hostage to costly doctor’s visits, overregulation and unnecessary spending restrictions. Senators on both sides of the aisle should put differences aside and come together to support over-the-counter access and flexible payment options for birth control.