Over the past several weeks, an increasing number of GOP lawmakers have come out in favor of making birth control pills available over the counter, a move that’s angered reproductive rights organizations who say candidates are merely pretending to care about women’s health issues to win over female voters. Experts say that the question of access is actually more complex.
According to two policy experts from the Guttmacher Institute — who recently published an article in Health Affairs on the topic — moving birth control over the counter is a really important step. But there are several other policies that should be pursued concurrently.
“We know that unintended pregnancy is a major public health issue in the United States; more than half of all pregnancies in the U.S. are unintended,” Sneha Barot, a senior public policy associate at Guttmacher and one of the authors of the article, told ThinkProgress. “But there are a lot of barriers to women using and continuing contraceptives. We have to think about a number of ways to make it easier and more affordable for women to use contraception…There have to be a number of strategies.”
Here’s what the Guttmacher Institute recommends — and what Republican candidates could start talking more about if they want to convince the reproductive rights community they’re serious about expanding birth control access:
1. Protecting insurance coverage for all forms of birth control.
“We strongly believe that the contraceptive coverage guarantee under the ACA is a real game changer in getting to the larger goal around increasing contraceptive access and use among women,” Barot said. Guttmacher doesn’t want to see that coverage compromised, especially because there are some forms of contraception that will never be able to move over the counter. Long-lasting forms of birth control, like the IUD, will always require a doctor’s appointment for the insertion.
Plus, the convenience of being able to buy the pill over the counter is only one piece of a larger puzzle. It’s also important that women don’t face financial barriers to contraception. So, even if the pill moved over the counter, efforts to repeal Obamacare or roll back the health law’s contraceptive coverage provision would represent a serious threat to women’s ability to afford the different types of birth control they may need. That’s especially true considering the fact that it’s possible the cost of the pill will increase once it goes over the counter, something that happened with emergency contraception.
2. Ensuring that insurance plans will cover birth control without a prescription.
Right now, Obamacare stipulates that insurers must cover over-the-counter birth control. But in order to take advantage of that coverage, women still have to get a prescription for it. Similarly, federal Medicaid funds can’t pay for over-the-counter medications without a prescription. Advocates argue that eliminates most of the benefits of over-the-counter access because women will still need to make a trip to the doctor first.
And without changing those policies, experts are concerned that women will be forced to choose between easily buying birth control without going to the doctor or getting birth control without a co-pay. “Some women may make the calculation for them that it’s worth it to pay some out-of-pocket costs because of the convenience of getting the pill over the counter, and saving the costs associated with child care or taking time off work,” Barot said. “But for other women, the cost is more important than the convenience.”
3. Eliminating age requirements for buying birth control over the counter.
It’s not entirely clear what will happen if birth control is moved over counter, but the recent policy changes around Plan B — the most popular type of emergency contraception — provide a rough parallel. Once the FDA approved over-the-counter access to Plan B, the government imposed an age restriction on it, stipulating that young adults under the age of 17 still needed to get a prescription.
It’s possible that over-the-counter birth control pills will face a similar age cut-off for teenagers, something that advocates point out will limit resources for some of the women who are most at risk of unintended pregnancy. Some Republicans have already indicated that their recent embrace of over-the-counter birth control comes with these strings attached. Sens. Kelly Ayotte (R-NH) and Mitch McConnell (R-KY) recently introduced a bill urging the FDA to consider implementing the policy, but only for adults.
4. Letting the FDA move birth control onto pharmacy shelves without any political interference.
The battle over emergency contraception involved what one federal judge referred to as unnecessary “political interference” into the policy. The Obama administration essentially overrode the FDA to impose age restrictions on Plan B that weren’t based in science. Experts are concerned that approving over-the-counter birth control — which would likely require drug manufacturers to submit an application to the FDA — could face similar hurdles. Guttmacher is calling on Congress and the White House to stay out of that future medical process, as well as avoid a situation in which only certain birth control pills are approved for over-the-counter use.
The Guttmacher Institute concludes that increasing access to contraception requires a multi-pronged approach, and “political talking points will not do it.”
That sentiment has been echoed by several other leading players in reproductive health policy. The American Congress of Obstetricians and Gynecologists (ACOG), the advocacy arm of the largest group of OB-GYNs in the country, released a statement this week warning GOP candidates against using over-the-counter birth control as a “political tool.” And several experts from Ibis Reproductive Health, a group coordinating a task force that advocates for moving oral contraception over the counter, recently published an op-ed accusing Republicans of employing a “political maneuver.”