Starting early in 2016, new policies in California and Oregon will allow women in those states to access hormonal contraception without a doctor's prescription. In both states, pharmacists will be empowered to conduct a pre-screening and then prescribe birth control, eliminating the need for women to visit—or even call—a doctor before they can obtain the pill, patch, or ring. Both medical practitioners and reproductive health experts say this is a huge step towards making birth control accessible for any woman who needs or wants it—and that it's about time.
"I wholeheartedly celebrate [those states'] effort to think about innovative ways to decrease barriers between women and the contraceptive care they need," says Dr. Nancy Stanwood, an associate professor of obstetrics and gynecology at the Yale School of Medicine and the board chairwoman of Physicians for Reproductive Health. "Healthcare needs to keep up with the changing world. If Amazon is going to drone-deliver something to my house half an hour after I order it online, surely we can think of a better way to help women get access to contraception."
With little resistance to the measures in either state, the policies are both huge landmarks in the fight to make contraception widely available and affordable. They also serve as reminders that further steps need to be taken. Easier access to contraception is particularly important for lower- and working-class women. "Some people think, Oh it's not that hard to get your birth control, but getting time off work, transportation, and childcare—it's not so easy, especially for people who are struggling to make ends meet," says Kelly Blanchard, the president of the international nonprofit Ibis Reproductive Health. "We think this is a great step, but we continue to be really excited about efforts to make the pill available fully over the counter. We see that as the goal."
While many countries allow women to access the birth control pill without a prescription, most in North America and Western Europe—with the exception of Portugal—formally require a doctor's prescription. Now, in two states that have often set healthcare and policy examples for the rest of the country, adult women without the time, means, or funds to get to a doctor and pay a co-pay for the visit will no longer face these deterrents. Women who find the current requirements simply annoying will also benefit from the added convenience, too, but doctors and researchers are particularly stressing the effects these measures could have on underage women who may face stronger familial or cultural barriers to access. As with the morning-after pill, which the FDA approved for unrestricted over-the-counter sale in 2013 (after a long and exhausting political battle), providing easier access to hormonal birth control is key to preventing teen pregnancy.
In California, there will be no age restriction on who can access contraception through a pharmacist; in Oregon, according to a representative from state representative Knute Buehler's office, women ages 15–18 will have to have been previously prescribed birth control by a doctor in order to take advantage of the new convenient policy. While Stanwood was positive about the gains these measures will make, she was skeptical about this provision in Oregon's policy, which will go into effect on January 1, 2016.
We know that these medications are safer than other things that are already over the counter, and we know that pregnancy is more dangerous than any birth control.
"Teens need to have confidential access to reproductive healthcare," Stanwood says. "We know that teens can safely do this, so why would we have an age restriction?"
Although detractors might argue that it's not that hard to get a birth control prescription from a doctor anyway, research supports the idea that easier access results in fewer pregnancies. According to a 2011 study done in El Paso, TX, and published in Obstetrics & Gynecology, women who purchased their birth control over the counter in Mexican pharmacies were less likely to discontinue use than those who got their pills with prescriptions at clinics on this side of the border. Another study, also published in Obstetrics & Gynecology in 2011, suggested that women who received supplies of the birth control pill in bulk were less likely to become pregnant than women who received a single month's supply at a time.
Ultimately, doctors agree that there is no medical reason hormonal birth control couldn't share a shelf with Advil. As far as hypothetical complications or contraindications that might go undetected by a pharmacist but caught by a doctor, Dr. Stanwood is quick to note that the checklist that pharmacists use to conduct screenings will be similar to the one she goes through with her patients when prescribing birth control. The questions are very straightforward: "Do you have a history of a blood clot in your leg or your lungs? Do you have hypertension? Have you ever had breast cancer, a heart attack, or a stroke? Do you smoke more than half a pack a day of cigarettes? Do you have severe migraine headaches?" While Dr. Stanwood does note that some women are confused about what exactly differentiates a migraine from a severe headache, she says this actually results in women being more conservative than doctors when they screen themselves.
"Whenever we talk about risk, it's so, so important to ask, 'Risk compared to what?'" Stanwood continues. "People go, 'Oh, isn't there a risk that people will stop doing this or start doing that? There could be unintended consequences.' We know that these medications are safer than other things that are already [available] over the counter, and we know that pregnancy is more dangerous than any birth control. That's a fact that sometimes people don't understand or hadn't thought about—that the medical risks of pregnancy are inherently more dangerous than [those of] any contraception."
"Hormonal birth control pills are some of the most well-studied and safest medicines we have," Blanchard says. "Evidence shows they could be completely available over the counter."