New laws in California and Oregon will soon allow pharmacists to prescribe hormonal contraceptives—including the patch, the ring, and the pill—enabling women to access more effective forms of birth control without a trip to the doctor’s office. Though this won’t make birth control available “over the counter,” it should make it a nearly as-convenient one-stop-shopping affair. Also exciting: Republicans in these two states generally supported the legislation, and embraced the larger economic argument for preventing unintended pregnancies that seems to elude so many of their fellows. “I feel strongly that this is what’s best for women’s health in the 21st century, and I also feel it will have repercussions for decreasing poverty because one of the key things for women in poverty is unintended pregnancy,” state Rep. Knute Buehler, a Republican who sponsored Oregon’s law, told the New York Times.
As the Times reports, women’s health advocates are viewing this less as an unvarnished victory than as a compromise between, on the one hand, the burdensome model that forces women to go to the doctor’s office every time a prescription runs out, and on the other, an ideal world in which birth control would be available over the counter. “My basic tenet is there should be nobody between the patient and the pill,” Mark DeFrancesco of the American Congress of Obstetricians and Gynecologists told the Times. “I’m afraid we’re going to create a new model that becomes a barrier between that and over the counter. I worry that it’s going to derail the over-the-counter movement.”
But since insurance companies aren’t required to cover over-the-counter medications, the Oregon and California bills may represent the best model for opening access without raising costs. Either way, these state-level experiments are coming at a particularly fortuitous time: This past summer, U.S. senators introduced two bills aimed at making birth control over the counter, at least in some cases. Those efforts predictably stalled, but the experiences of women in California and Oregon may help indicate a path forward for policymakers.
There are plenty of reasons to think that letting pharmacists dispense birth control will have positive results. One of the most resounding endorsements comes from women themselves: Two-thirds of respondents said in a 2013 study that they were in favor of over-the-counter birth control. “[A]bout 30 percent of women using either no birth control or a less effective method—such as condoms—said they would likely take the Pill if it was sold without a prescription,” Reuters reported at the time. Hopefully, women will feel the same way about a prescription that can be obtained right at the pharmacy.
An oft-cited 2011 study also suggests that eliminating trips to the doctor’s office could encourage safer sex. Researchers in El Paso, Texas, followed two groups of women: one that got their pills over the counter at a Mexican pharmacy and another that obtained contraceptives by prescription at a family planning clinic. The first group was more likely to stay on birth control (although when the family clinic dispensed six months or more in a single visit, the gap disappeared). The researchers concluded that convenience was the key to continued use, and the prescription requirement was getting in the way.
The economic incentives to make birth control more accessible are equally clear. When the state of Colorado made birth control free and available to teens, it estimated that it saved $5.85 in short-term Medicaid costs for every dollar spent, and perhaps more over the long term. (Teen moms disproportionately end up relying on public assistance.) And birth control enables women, individually and collectively, to contribute to the economy and attain educational and professional goals. A 2012 study suggested that broadening use of the pill in the 1980s accounted for a full 10 percent of the narrowing of the gender wage gap in those years.
Most importantly, there’s no reason to think taking doctors out of the equation will be harmful to women’s health. “The science on this is clear: The pill is one of the best-studied medicines on the market today, and it's certainly safe enough to be available without a prescription,” U.C.–San Francisco professor and vice president for research at Ibis Reproductive Health Daniel Grossman wrote in the L.A. Times this past summer. “Some women have conditions that might make it more risky to take the pill, but studies show that women can use simple checklists on their own to figure out whether the pill is right for them.” Nancy Stanwood, chairwoman of the board of Physicians for Reproductive Health, told the Times that the research doesn’t support the argument that contraception is necessary to bring women in for Pap smears and other important gynecological care. “We were holding pregnancy prevention hostage to cancer screening,” she said. “They’re both worthwhile goals, but one should not be held hostage to the other.”
Of course, policies don’t always play out according to plan. Women’s health activist and journalist Robin Marty has written about a few ways that over-the-counter birth control—and perhaps prescribed-by-your-pharmacist birth control, too—could shift the contraceptive landscape in not completely positive ways. For example, it could make women less likely to pursue long-acting contraceptives—such as intrauterine devices and hormonal implants—that require insertion by a trained doctor, but which have considerably lower failure rates than the pill, patch, and ring. This kind of unresolved question makes it even more significant that California and Oregon will become laboratories for a new kind of birth control provision—and will hopefully lead the way for the rest of us.