Bait and Switch: Will Over-The-Counter Oral Contraceptives Expand Access and Use Among Women of Color and Low-Income Women?

One in 20 American women has an unintended pregnancy annually; these rates are disproportionately high among low-income women and women of color. Poor women at risk of pregnancy are less likely to use contraceptives than women above the poverty line. This disparity in part reflects differentials in insurance: poor women are twice as likely as women overall to have no health insurance. Additionally, spending under Title X, the only federal financing stream for family planning services for low-income women, has shown a steady decline.

The FDA continues to consider an Rx-to-OTC switch of oral contraceptives based on their extensive safety and efficacy records. A larger population of oral contraceptive users will certainly result in lower incidences of unwanted pregnancies, decreased risk of certain reproductive health problems, and lower financial and time costs associated with seeing a physician for refills. However, these benefits may not be realized among low-income women and women of color. An increase in the number of women using OTC OCs will mean higher out-of-pocket costs for women and increased incidences of adverse events for those groups that are at higher risk of negative side effects. Women who choose to forgo their annual gynecological exams following a switch may also face increased risk of undiagnosed health problems and a delay in treatment of conditions that could be detected during an exam.

Without a thorough cost-benefit analysis of OTC OCs, the FDA may simply ‘switch' one set of health disparities for another among women of color and low-income women.