Britt Wahlin is vice president for development and public affairs at Ibis Reproductive Health.
On May 25, Maryland officially became the sixth state (plus the District) to allow pharmacists to prescribe birth control. This is a game-changer for women and families in Maryland, who will now be able to go into a pharmacy, and, after a short consultation, receive birth control. Pharmacy access is a major step forward, but too many people believe it’s the same thing as birth control being available over the counter. It’s not, and given that a process is underway to make a birth control pill available over the counter, this conflation could be costly in the long run. After all, how do you win a campaign people think you’ve already won?
Pharmacy prescriptions and over-the-counter access make it easier for women to get birth control. Both eliminate the need to go to the doctor, which can be a non-starter for those who struggle to get time off work or secure child care, live in rural areas or are young and have unsupportive parents. Many doctors aren’t able to see patients right away, which means women sometimes have to wait for a prescription they need now.
But the key differences between the two are important to understand. “Over the counter” refers to something you can get off the shelf, such as ibuprofen and condoms. A pharmacy prescription is really more like “behind the counter”— it removes some barriers, but not all. Yes, it saves the trip to the doctor, but because it requires an interaction with a pharmacist, it is not the same as grabbing toothpaste and vitamins off the shelf and paying at the register. And while an OTC pill could be purchased at gas stations, supermarkets and online, pharmacy access to birth control is limited to pharmacy hours and specific locations.
The Maryland victory is a big step forward for women, and I’m hopeful other states will follow suit, but conflating pharmacy prescriptions with OTC access could prevent us from pushing for an over-the-counter birth control pill that is affordable, covered by insurance and widely accessible. There’s no reason women should have to luck into living in specific states to have access to birth control. These state policies affect only women who live in said states and have access to pharmacists trained to prescribe birth control, while OTC access is a broader solution that will have a meaningful impact for women and families in every state.
It may seem so in the United States, but an over-the-counter pill isn’t actually revolutionary. Worldwide, birth control pills are available over the counter in some form in more than 100 countries. The American College of Obstetricians and Gynecologists supports over-the-counter oral contraceptives, citing the overwhelming evidence of the safety and effectiveness of such an option.
There is strong bipartisan support for an over-the-counter option, though that would be approved by the Food and Drug Administration, not Congress. But we should consider it a victory only if insurance coverage is part of the equation. Otherwise, the need to pay out of pocket could leave birth control inaccessible to lower-income women. That — like the recent threat to roll back the insurance-coverage mandate, and many other proposals in the American Health Care Act that would gut coverage and make basic women’s health-care services prohibitively expensive — is access in name only and anything but in practice. Ignoring the need for insurance coverage makes over-the-counter birth control nothing more than empty hyperbole and shouldn’t be taken seriously.
As we continue to work on an OTC option, we can build on the exciting and important step forward that is pharmacy access. Pharmacists are underused in the health-care delivery system and are qualified and well-positioned to help more people access common medications that should not require the expense and trouble of a doctor’s visit. But there have been some unfortunate reports of pharmacists using their ideology to deny birth control to customers, and pharmacy access still requires a conversation with a pharmacist, potentially deterring some from making the effort. And requiring a prescription for something that is safer than allergy medicine and aspirin just doesn’t make sense, especially when the benefits of expanding access are so great.
Birth control is not just a perk for those who can easily get it; it’s an essential component of reproductive autonomy and an important way to advance equity for women of color and lower-income people who experience more health disparities. When women have a say in their reproductive health and family planning, they achieve higher levels of education and career advancement. We can all agree that what we need is more access.
Pharmacy access demonstrates real progress, and we should continue to expand it, but let’s keep the end goal in mind. An over-the-counter birth control pill is on the horizon. So, celebrate Maryland, and keep fighting.