On January 1, Oregon became the first state to allow women to obtain birth control without a prescription. Under the new law, women 18 years and older can go to their local pharmacies, fill out a questionnaire, and receive a year’s supply of oral contraceptives. It’s not a true “over the counter” transaction, but women no longer have to make a trip to a doctor’s office for a prescription.
Reproductive-rights activists who have advocated over-the-counter birth control for decades say that the new Oregon law is a win for public health. “Birth control is critical to health-care services,” says Megan Donovan of the Washington, D.C.–based Center for Reproductive Rights, an international advocacy group. Over half of pregnancies in the United States are unintended.
A 2015 Guttmacher Institute brief found that the rate of unintended pregnancies is linked to economic status: Nearly 14 percent of poor and low-income women aged 15 to 44 (137 out of 1,000 women) have unintended pregnancies, compared with roughly 3 percent of women in the wealthiest cohort (26 out of 1,000 women).
Low-income women of color use all types of contraceptives less often than other groups. When these women do use birth control, they are more likely to use condoms or other methods that do not provide as much protection against unwanted pregnancies.
Moreover, low-income minority women often lack health-insurance coverage, which means they face additional obstacles to obtaining birth control. In 2010, more than half of the women in the United States who needed contraceptives were low-income or under the age of 20, and relied on publicly funded family-planning services.
Yet fewer women will have access to these services because of federal funding cutbacks. Funds for family planning have dropped dramatically, from $317.5 million in 2010 to $286.5 million in 2014, a 10 percent decrease. State parental-consent laws also pose a problem for young women who are sexually active: 20 states require medical professionals to obtain permission from parents or guardians before minors can receive contraceptives.
The Oregon law may prod other states to increase access to oral contraceptives, which in turn could persuade more women to start using better birth-control methods. “Women use birth control more effectively when barriers are down,” explains Donovan.
Elsewhere, California is set to enact a similar law in March. Washington state and Colorado are also considering lifting restrictions.
On Capitol Hill, Democratic Senator Patty Murray of Washington and Republican Senator Kelly Ayotte of New Hampshire introduced separate bills that would permit the over-the-counter sale of birth control pills. The Center for Reproductive Rights supports the Murray bill because, unlike the Ayotte proposal, it specifically addresses the critical issue of requiring health insurers to cover oral contraceptives, even if they are sold without a prescription.
Despite push for greater access to oral contraceptives, not all pharmacists are sold on the idea. Some pharmacists have declined to provide contraceptives to women, citing their personal religious beliefs.
Oregon does have protections in place. “The Oregon pharmacy board says they can refuse, but that they have to refer the woman to another a pharmacist,” says Mara Gandal-Powers of the National Women’s Law Center in Washington, D.C.
But there have been cases in at least 25 states where pharmacists have refused to provide oral contraceptives, according to the law center. “We’re seeing challenges to access to birth control all over the place,” Gandal-Powers says. The attorney intends to keep a close eye on Oregon. “I’m sure we’ll see some pushback,” she says.
There has been some pushback from some physicians as well. The American College of Obstetricians and Gynecologists supports over-the-counter sales. But in a recent statement, the group expressed the concern that “women who choose to purchase [oral contraceptives] over-the-counter will forgo [cancer] screenings and other preventive services.”
Donovan says that there has to be movement on both fronts. “We need to promote preventative health care, but health care providers shouldn’t be holding birth control hostage to compel it,” she says.