Free the Pill To Unshackle More Healthcare

Since the first oral contraceptive pill was approved for use in the United States in 1960, American women have relied on hormonal birth control—not just as one of the most widely used forms of contraception, but also as an effective treatment for a wide variety of other health concerns.

The vast majority of American women who have had sex—a full four out of five sexually experienced women—have taken birth control pills at some point in their lives. An estimate 11.2 million U.S. women aged 15–44, or 18% of all women, currently use oral contraception. 

More than half (58%) of these women use oral contraceptives, at least in part, for purposes other than pregnancy prevention, and 14%—more than 1.5 million women—rely on the pill for solely non-contraceptive purposes. 

And yet, the United States, the supposed bastion of free markets, is on a short list of countries that do not allow women to purchase birth control pills over-the-counter. Instead, the U.S. stands with Saudi Arabia as one of the few nations requiring its female population  to jump through bureaucratic hoops to access oral contraceptives. In this aspect, American women are less free than women who live in communist Cuba and China. 

In 2012, the U.N. Population Fund (UNFPA) declared that access to contraception is a universal human right, stating that “the ability for a couple to choose when and how many children to have…is also one of the most effective means of empowering women. Women who use contraception are generally healthier, better educated, more empowered in their households and communities and more economically productive.” 

Not to mention, unintended pregnancies can have serious social, economic, and health consequences, and yet, roughly half of U.S. pregnancies—more than three million each year—are unintended. 

Roughly 43 million of the 61 million women of reproductive age in the United States—a full 70%—are sexually active, but aren’t trying to get pregnant. 

American women on average spend about three years pregnant, postpartum or attempting to become pregnant, and about three decades—over three-quarters of their reproductive lives—trying to avoid an unintended pregnancy.

By age 45, more than half of all U.S. women will have had an unintended pregnancy. 

Notably, while U.S. abortion rates have been falling since 1973 when the U.S. Supreme Court recognized constitutional right to abortion in Roe v. Wade, the proportion of unintended pregnancies that are ended by abortion has not. Rather, the evidence suggests that increased usage of and access to contraceptives has influenced this trend. 

The U.S. Department of Health and Human Services lists increasing the proportion of pregnancies that are intended as one of its top goals, perhaps in part because of the sheer financial cost—U.S. government expenditures resulting from unintended pregnancies totaled $21 billion in 2010 alone. 

The solution is simple: only 5% of all unintended pregnancies in the United States occur amongst women using contraceptives both consistently and correctly, and, according to the Center for Disease Control, the failure rate of oral contraceptives when used as directed is a measly 0.3%. 

Yet, while the conversation about contraceptive access in the United States has largely centered around public funding for birth control, the government’s own policies restricting access to birth control pills—in particular the FDA’s requirement that a patient must obtain a prescription to purchase oral contraceptives—are amongst the chief roadblocks to effective usage. 

In 2011, one third of American women at risk for unintended pregnancy who tried to obtain a prescription for contraception reported having trouble doing so. 

In most states, before a prescription for birth control pills can even be filled, women must get a physical exam from a gynecologist (sometimes requiring a referral from a general practitioner) and explain their reasoning for wanting a prescription. Women were twice as likely to cite difficulty scheduling and attending these appointments as a barrier to  obtaining birth control as they were to blame the cost of either the visit or the prescription itself. 

Those who oppose making birth control available over-the counter often argue that doing so could negatively impact women’s health. However, according to one study, women’s self-evaluation of whether hormonal contraceptives were a good fit for their medical needs matched doctors’ evaluations roughly 90% of the time. Even more notably, the 10% of situations when women’s evaluations didn’t match doctors’ was predominantly because the women erred on the side of caution, rather than increased risk. 

And let’s not forget that emergency contraceptives or “morning after” pills, which contain the same hormones as oral contraceptives, albeit at higher dosages, have been available without a prescription since 2006.

The vast majority of American medical professionals—including 76% of physicians—support increasing access to hormonal contraception, including moving to at least a pharmacy-access model, with many advocating going even farther and making birth control fully over-the-counter. 

Since 2012, the American College of Obstetricians and Gynecologists, which represents 58,000 ob-gyns across the United States, has advocated for over-the-counter birth control. In 2016, the organization publicly issued a statement declaring that, “we know from evidence and experience that oral contraceptives are safe enough for over-the-counter access, and do not require any prescription at all.” 

The birth control pill has over 60 years of success as a safe and effective method of family planning in the United States. It’s well past time that the U.S. join the modern world and remove paternalistic nanny state regulations that deny American women reproductive agency. Free the pill.