Advocacy for an over-the-counter oral contraceptive has been rising over the years. According to the Kaiser Family Foundation’s 2020 KFF Women’s Health Survey, 65% of reproductive-aged women are comfortable with pharmacists prescribing birth control and 70% support the idea of having access to an over-the-counter pill without a prescription. Free the Pill, a campaign to educate and engage the public in support of over-the-counter birth control pills in the United States, is one of many other organizations that are trying to minimize the barriers women of color are facing in contraceptive care.
Free the Pill doesn’t support any one specific oral contraceptive; they are generally supporting an oral contraceptive to be available over-the-counter that is affordable, covered by insurance and available to people of all ages.
Free the Pill educates the public by answering common questions, citing studies, sharing voices and listing resources.
Free the Pill originated out of the Oral Contraceptives Over-the-Counter Working Group, which was established in 2004. The working group is a coalition made up of over 100 reproductive health, rights and justice organizations, advocacy groups, researchers, etc.
Birth control pills have been shown to be effective. According to BedSider, a free birth control support network, the pill is 99.7% effective when tested in clinical trials and 93% effective in real world use.
Historically, Black women and other women of color have experienced exploitation and racism in the healthcare system. In fact, in the 1990s, state policies pressured women to accept sterilization or get the Norplant implant in order to receive public benefits or avoid incarceration, In Our Own Voice: National Black Women’s Reproductive Justice Agenda said.
Black women faced misinformation about oral contraceptives, coercive practices and often unethical testing methods for decades. This exacerbated racism in the healthcare system and created disparities that are still seen today.
“I would say difficulties in getting birth control and health care broadly fall harder on people of color, Black women, indigenous peoples, young people, immigrants and people in the LGBTQ community,” Victoria Nichols, project director of Free the Pill, said.
Today, there are disproportionate barriers in access to prescription birth control. Some factors include lack of insurance coverage, the inability to go to appointments because of needing to take off work or school, mistrust with healthcare providers and cultural or linguistic barriers for immigrant women.
The 2020 KFF Women’s Health Survey found that “Four in 10 women (44%) rate their provider’s contraceptive counseling as excellent, but the share rating counseling as excellent is lower among Black (36%) and Hispanic (38%) women, as well as low-income (35%) and uninsured (28%) women.”
Over-the-counter oral contraceptives are backed by the medical community. The American College of Obstetricians and Gynecologists (ACOG), the American Academy of Family Physicians and the American Medical Association are all in agreement that Americans should have access to over-the-counter oral contraceptives.
“A potential way to improve contraceptive access and use, and possibly decrease the unintended pregnancy rate, is to allow over-the-counter access to OCs,” ACOG said in their committee opinion from 2012.
Planned Parenthood, a nonprofit organization that provides reproductive health care, also supports eliminating health barriers through accessible oral contraceptives. “Birth control pills have been around for 60+ years. But, people still face barriers to accessing them—barriers rooted in systemic racism that began with the pill’s development and continue to this day,” they said in a tweet.
Although over-the-counter oral contraceptives have garnered support from a variety of medical professionals and organizations and are seemingly effective, some oppose moving them over-the-counter.
One argument is that women may not take the medicine properly. Other arguments include that women may be less likely to continue taking the contraceptive over time and they may have issues with costs because of pharmacy consultative services or being uninsured, ACOG said.
In 2022, Free the Pill anticipates that an application will be submitted to the Food and Drug Administration to move oral contraceptives over-the-counter. “Over-the-counter birth control pills are really overdue in the United States,” Nichols said.
More than 100 countries offer birth control pills over-the-counter, including Russia, Brazil, Morocco and Mexico.
“The ability to plan and space out a pregnancy and pursue your goals should belong to EVERYONE, regardless of who they are or where they live,” Dr. Raegan McDonald-Mosley, CEO of Power to Decide, said in a tweet.