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Removing the Prescription’ Barrier

The FDA plans to consider the first non-prescription birth control pill for the U.S. market. It would have major benefits for marginalized communities lacking access to reproductive health care.

Women Opening Birth Control Packet
(nensuria/Getty Images)

Dyvia Huitron was 16 when she first tried to get a prescription for birth control. She had become sexually active, and she wanted to be responsible by using the pill.

Even though Huitron was fortunate in several ways — she had insurance, transportation, and the time and money to access care, which are advantages many people do not share — getting access to contraception was hardly simple.

Because she was a minor, Huitron needed her parents’ consent to get a prescription. She talked to her mother, who was reluctant at first but eventually agreed to bring her to a local clinic. Her insurance coverage presented another challenge. In her hometown in the Rio Grande Valley of Texas, there was only one clinic covered by her father’s medical plan. When she tried to make an appointment, she was confronted with a final, decisive barrier. It was the peak of the COVID-19 pandemic, and the clinic was only taking emergency cases. Providers weren’t willing to see Huitron, so she was denied a prescription. 

It felt pretty bad not to be given access to the method of contraception I felt most comfortable with,” Huitron said. I wish my needs had been taken more seriously.” 

This is about reproductive freedom.
Victoria Nichols project director for Free the Pill

Huitron, now 19 and attending college at the University of Alabama in Tuscaloosa, said she used other, less effective methods of contraception so that she wouldn’t accidentally become pregnant. But she saw friends in her predominantly Hispanic community who had problems getting the pill — often because of similar barriers around age, insurance coverage, and the pandemic — and ended up having unplanned pregnancies. It altered the course of their lives, denying them the opportunity to pursue their goals.

You would never assume that getting birth control is such a big problem, especially because it’s something that so many people need,” Huitron said. But it is.”

Huitron is one of millions of people who face barriers in accessing prescription birth control, and one of those barriers — a prescription — may soon get knocked off the table. This summer, the Food and Drug Administration (FDA) received an application for the first U.S. over-the-counter birth control pill, which evidence shows is safe and effective, and the FDA is expected to hold a hearing for it imminently; it recently postponed its scheduled hearing date set for November 18

This is about reproductive freedom,” said Victoria Nichols, project director for Free the Pill, a campaign of Ibis Reproductive Health that is driven by a coalition of over 150 members and organizations. It’s about the ability to control your future, the ability to determine how many children you have and when, and lots of other health benefits that birth control pills provide.”

Unequal Access

Access to birth control is currently as easy as getting a prescription and filling it, which for many marginalized communities, is a significant burden. In a 2016 survey, almost a third of women of childbearing age reported problems getting birth control prescriptions or refills. 

1 in 5

Number of U.S. women say they are not using their preferred method of contraception

Common issues include local healthcare provider shortages, costs, transportation, childcare, and lost wages from taking time away from work. Over 19 million low-income women live in contraceptive deserts,” where reproductive health care is not readily available. One in five U.S. women say they are not using their preferred method of contraception, and a quarter say that’s because they can’t afford it. That share is higher among uninsured and low-income women.

Under half of part-time workers have paid sick leave, and this gap disproportionately affects women. Meanwhile, 34% of families with young children face serious problems finding child care for things like doctor’s appointments, and in 2017 5.8 million people delayed medical care because they lacked transportation.

These barriers are deeply rooted in systemic racism and structural barriers within our healthcare system,” Nichols said, pointing to additional barriers faced by Black, Latinx, indigenous, Asian American, Native Hawaiian, Pacific Islander, and rural communities, as well as LGBTQ+ folks, immigrants, people with disabilities, and those working to make ends meet.

Black women, for example, are almost twice as likely as white women to be uninsured, and women without health insurance are far less likely to use oral birth control. Rural women are less likely to have access to reproductive health providers, and the facilities are often under-resourced, with clinicians less trained in contraceptive provision than in urban areas — problems that disproportionately impact immigrants and people of color.

COVID-19 has only exacerbated these problems, according to a 2020 survey by reproductive health experts Guttmacher.

Kat Sánchez, policy co-director at Bold Futures, a Free the Pill coalition member that works toward reproductive justice in New Mexico, is a first-generation immigrant and a queer woman of color who said that she has seen these problems play out in her predominantly rural state, especially near the Texas-Mexico border where she lives. 

If you’re trying to get a prescription, it’s largely going to be difficult for you,” Sánchez said. These barriers cause harm to people’s bodily autonomy and overall day-to-day health.” She noted that people need birth control for a variety of reasons, including reproductive variances and gender-affirming care. 

Young people like Huitron also face special barriers to access. A recent study by Advocates for Youth, a member of the Free the Pill coalition, found that 88% of those surveyed struggled to access birth control pills, while 55% couldn’t get on birth control at all.

Young people simply do not have the health care they need,” said Angela Maske, strategic projects manager at Advocates for Youth, and birth control is essential health care.”

These groups have expressed a strong desire for access to non-prescription birth control. Some 87% of adults say everyone deserves access to all birth control methods, and surveys of youth, Black, Asian-American, Pacific Islander, and indigenous women show a conviction that over-the-counter access to the pill would reduce unintended pregnancy and help to destigmatize contraception. 

Huitron has become an active supporter of non-prescription birth control access. Toward the end of high school, she became involved with Advocates for Youth and has taken a strong role in the Free the Pill campaign, speaking publicly about her experiences and promoting contraceptive access through social media.

Expanding Understanding

Members of the Free the Pill coalition met with members of Congress in September to educate lawmakers on the importance of equitable access to birth control. 

The Free the Pill campaign and coalition is rooted in principles of youth-adult partnership and reproductive justice,” Nichols said. For us, that means centering the experience, leadership, and expertise of communities who would benefit the most from fewer barriers and more equitable access to birth control pills.”

Similarly, the nonprofit Contraceptive Access Initiative (CAI) focuses on providing accurate, accessible contraceptive data to reduce stigma, bias, and coercion, directed at lawmakers, journalists, influencers, and the public.

There’s so much misinformation about reproductive care and women’s health in general,” said Elizabeth Toledo, co-founder of CAI. We want to make sure that when people are talking about this issue, whether that’s in the media, on social media, or in their professional lives, they have information that is accurate and in context.”

The FDA’s upcoming advisory committee hearing has the attention of both organizations. The hearing will review evidence around a pharmaceutical company’s application for a new over-the-counter birth control pill, including witness testimony. Following a recommendation from the FDA’s Nonprescription Drugs Advisory Committee and the Obstetrics, Reproductive, and Urologic Drugs Advisory Committee, the FDA will have 10 months to issue a final decision, which could make birth control available on shelves everywhere from pharmacies to grocery stores to gas stations in 2023.

The FDA will consider whether the drug is safe, with low potential for misuse and abuse; has clear, understandable labeling; and requires no clinician for safe and effective use.

Institutions including the American College of Obstetricians and Gynecologists and The American Medical Association have signaled their support for the new drug. Experts note that non-prescription birth control is available in over 100 other countries across the world, including many in Latin America, Asia, and Africa.

This is an easy call. The risks are very low and the benefits are tremendous for people who are living in communities with major needs and political environments that are suffocating for reproductive access.
Elizabeth Toledo co-founder of Contraceptive Access Initiative

Free the Pill is providing the FDA advisory committee with scientific evidence and member testimony, so it understands the widespread support for non-prescription birth control pills. CAI is also communicating with decision-makers at the FDA. Toledo noted that there is bipartisan support for this measure, even at a moment when the country can feel polarized about other matters of reproductive access.

Sixty years of use show that women know how to take birth control appropriately,” Toledo said. This is an easy call. The risks are very low and the benefits are tremendous for people who are living in communities with major needs and political environments that are suffocating for reproductive access.”

Huitron, for her part, still hasn’t managed to get a prescription for birth control. In her college town of Tuscaloosa, none of the local gynecologists take her father’s insurance, so she hasn’t been to a clinic. 

This experience has only redoubled her conviction that the country needs an over-the-counter birth control option. She visited Capitol Hill with Free the Pill, and plans to provide oral testimony to the FDA advisory committee.

Huitron is hopeful that these efforts will pay off, expanding birth control access for the many who need it. She would be ecstatic” if the over-the-counter drug were approved, she said. It would just take a burden off me and so many other people.”