Health

Birth Control Has Been Around for 60 Years — Why Is It Hard to Get?

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The American College of Obstetricians and Gynecologists (ACOG) announced hormonal birth control should be available over the counter. Getty Images
  • Hormonal birth control has been around for decades, and top medical experts think it should be sold over the counter.
  • But getting a prescription can still be difficult for people in the United States.
  • At least 100 other countries allow women to get hormonal birth control without a prescription.

Currently, women in the United States need a prescription from a healthcare provider in order to get ahold of birth control.

It may sound simple, but obtaining a prescription is actually one of the main barriers preventing many women from getting the medication they need. It’s difficult for many people to find the time to schedule and travel to a doctor’s appointment, and oftentimes, it’s too expensive.

But, as of last week, we’re a bit closer to being able to purchase birth control over the counter.

Last month, the American College of Obstetricians and Gynecologists (ACOG) announced its recommendation that hormonal contraception should be available over the counter.

The organization stated that many types of hormonal birth control — including oral contraceptive pills, vaginal rings, contraceptive patches, and certain injections — are safe and should be readily available to women of any age.

The American Academy of Family Physicians (AAFP) also supports over-the-counter (OTC) access to birth control, stating that access and costs are the main reasons women don’t use contraception.

The fight to remove the prescription requirements has been a long one. The United States lags behind more than 100 other countries that already allow women to access birth control without a prescription.

“This has been about a decade long in coming. The recommendation prioritizes getting patients contraception in the most convenient way for them rather than using contraception as a way to get people into care for preventative screening,” said Dr. Jennifer Karlin, a board-certified family physician and research fellow with the Bixby Center for Global Reproductive Health at the University of California, San Francisco.

There’s an abundance of evidence suggesting it’s safe to provide birth control over the counter.

“Birth control pills are some of the best-studied medicines on the market today, enjoy long-standing support from medical and public health experts, and decades of research and experience show they are safe for over-the-counter use,” Britt Wahlin, the vice president for development and public affairs at Ibis Reproductive Health in Cambridge, Massachusetts, told Healthline.

“An over-the-counter birth control pill is long overdue in the United States. In fact, the pill is already available over the counter in more than 100 countries,” Wahlin said.

Some states have helped cut down on hurdles to getting the medication. There are 13 states that allow a pharmacist to prescribe the drug, which can cut down on the difficulty of getting it since people don’t have to make a separate appointment with their physician.

The biggest concern for many medical experts is that combined contraception, or those that have an estrogen component in addition to progestin, could increase the risk of a blood clot or stroke in some people. Others worry about harmful drug-drug interactions.

According to Karlin, evidence shows that a 15-question screening tool can effectively help people screen themselves to determine whether or not they need to meet with a doctor before starting birth control.

Furthermore, both of those risks are extremely low, and most women will not experience any health issues. In fact, birth control is just as safe — if not more — than many other types of medications sold over the counter. Aspirin, NSAIDs, and even Tylenol are more dangerous than birth control, Karlin says.

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The first hormonal birth control pill was approved by the FDA in 1960. Getty Images

If it’s safer, then what’s been preventing birth control from being available over the counter? According to health experts, it boils down to a few issues.

First, there are the regulatory hurdles. In order for a drug to become available over the counter, drugmakers would need to submit a request to the Food and Drug Administration (FDA), Wahlin explains.

For example, her organization — Iris Reproductive Health, which operates Free the Pill and works to educate people about OTC birth control — is currently partnering with pharmaceutical company HRA Pharma to ensure the FDA has all the research it needs to make a decision.

The FDA then evaluates the application based on the safety and efficacy of the drug and either approves it or rejects it. This process is not only time consuming, but also expensive given the many types of birth control out there.

An FDA approval alone is not enough. Insurance coverage and affordable prices are also paramount to help reduce the financial burdens of birth control, Wahlin says.

So far, several states have already passed laws ensuring there will be insurance coverage of a OTC pill. Plus, the Affordability Is Access Act would make sure it’s covered on a federal level.

“Policymakers understand that over-the-counter birth control pills must be affordable, covered by insurance, and available to people of all ages,” Wahlin said.

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Aside from pills, hormonal birth control is now available in IUD, implants, shots, and patches. Getty Images

On top of all that, birth control has long been a divisive issue.

For one, religious and political beliefs can interfere with care, according to Dr. Mary Rosser, an OB-GYN with Columbia University Irving Medical Center. At Catholic or other faith-based hospitals, some women have had difficulty obtaining birth control or other reproductive care.

“Many other medications do not impart moral or ethical reactions — relating to sexual activity — hence this becomes part of a moral issue rather than what it really is, a health issue,” Rosser said.

Additionally, Karlin says surveys have shown that some healthcare providers are still hesitant to support OTC access, citing concerns there could be a decrease in preventive screenings or a loss in patients and revenue.

“Women know what’s best for themselves, their bodies, and their futures,” Wahlin said.

Allowing women of all ages to access birth control over the counter would give them full control over their sexual and reproductive health, she adds, and support the health and economic well-being of them and their families.

Last month, ACOG announced its recommendation that hormonal contraception be available over the counter. The notion is a long time coming, as many people have been fighting for OTC birth control for years. Even though hormonal birth control is safer than other OTC drugs, there are still many hurdles to jump through before we’ll actually see it on the shelves.


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