The U.S. is still behind the rest of the world on access to birth control pills

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There are 102 countries in the world where you can buy birth control pills without seeing your doctor, but the United States isn’t one of them.

American College of Obstetricians and Gynecologists (ACOG) has endorsed the idea of true access to over-the-counter birth control since 2012 and 76 percent of doctors and 70 percent of other health care providers have said that people should have over-the-counter access.

One common concern is whether people who can get pregnant can assess whether or not birth control pills are dangerous for them. But as ACOG explained in 2012, easily accessible drugs such as aspirin and acetaminophen have their risks, such as gastrointestinal bleeding and serious liver damage. And the rate of birth control’s most notable risk, venous thromboembolism, is “extremely low” for birth control users, said ACOG.

There are several barriers for low-income people and women in rural areas to getting an appointment in a timely fashion, explained Denicia Cadena, policy and cultural strategy director at Young Women United, an organization focusing on organizing and policy efforts in New Mexico. On a press call for the Free The Pill project last week, Cadena explained that a doctor’s appointment can be a real barrier for people who lack access to child care or transportation. And many people have jobs that don’t allow them the flexibility to go to doctor’s appointments as often as they would like.

There are only a few states — Colorado, California, Oregon, and New Mexico — that allow pharmacists to provide pills so that people who can get pregnant don’t need to make two separate trips. The drawback for Californians has been that pharmacists aren’t always interested in getting the training to learn the process for providing the pills, which can be time-consuming, the Los Angeles Times reported. Still, reforms like this are key for people living in rural areas, Cadena explained.

“Our rural health care is affected by health care provider shortages and patients are facing three to six months wait time for any primary care and even longer for speciality care,” Cadena said. “Eleven of the state’s 33 counties have no OB-GYN … These barriers to contraception disproportionately affect people living in rural communities, low income people, and indigenous people.”

But that may change soon. HRA Pharma partnered with Ibis Reproductive Health, a nonprofit research organization, to conduct research for an over-the-counter progestin-only birth control pill and submitted an application to the FDA to make it accessible over the counter. The process to get a birth control pill on the market could take years, however.

Although Republicans have taken on the over-the-counter birth control cause, Democrats and reproductive rights advocates say that their efforts are not sincere. In 2015, Republicans proposed legislation that would have sped up the process for FDA-approval of over-the-counter birth control, but people would have to be over the age of 18 to get the pill.

Given the fact that teenagers are some of the people most in need of over-the-counter pills and given the barriers or discomfort they face in telling their parents or health care providers, reproductive health advocates considered this restriction unacceptable. Democrats said it was simply a ploy to undermine the Affordable Care Act’s birth control mandate.

Republicans have argued that an over-the-counter pill would easily replace the ACA’s birth control benefit, an argument that has been challenged many times by reproductive rights advocates and health care experts who say it should instead be an additional tool, largely because women should have access to a wider range of options than just the pill, such as IUDs.

Dr. Daniel Grossman, a professor at the Department of Obstetrics, Gynecology and Reproductive Sciences at the University of California, San Francisco, said during the call that there is no reason to think that the pill couldn’t be delivered safely over the counter.

“The pill has been around for 60 years and it is one of the safest and best studied medications on the market today. It’s so safe, effective, and simple to use that the pill should meet the criteria for over-the counter-sale [for the FDA],” Grossman said. “People can use simple checklists on their own to determine whether they have one of these conditions or if they’re taking medications that may interfere with the pill. No complicated tests are needed.”

But Grossman and other medical providers emphasized the need for such a pill to be accessible to everyone. An over-the-counter birth control pill shouldn’t be available to only the privileged few, they say, which is why insurers need to cover it.

Grossman co-authored a University of California, San Francisco 2015 study, which found that the use of over-the-counter pills would be highest among low-income women if it were only covered by insurance.

“In the era of no-co-pay contraception, there is still a need for over-the-counter birth control to fill the gap when women run out of pills while traveling, for example, or for those who find it inconvenient to get to a clinic,” Grossman said when the study was released. “But to reach the largest number of women most in need, it’s critical that a future OTC pill be covered by insurance.”

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