Making contraception easier and promoting women's health: What is the role of the Rx requirement for the Pill?

Women experience many barriers to correct, consistent oral contraceptive (OC) use, leading to high discontinuation rates and a persistent gap between theoretical efficacy and real-world effectiveness. For years, reproductive health advocates have discussed whether eliminating the prescription requirement for OCs would reduce logistical and financial barriers thereby increasing access and improving women's health. Many countries distribute OCs without involving doctors, and research shows that OCs meet most of the Food and Drug Administration's (FDA) criteria for over-the-counter status. The FDA's decision to make emergency contraception available without prescription to women 18 and older, and the possibility that the political environment at the FDA may soon improve have recently renewed interest in this proposal. Some women's health advocates raise concerns about whether the switch might create new barriers for some, particularly low-income women and women of color. Without insurance coverage, the cost of OCs might be prohibitive; and the loss of the health care services that are provided along with contraceptive care in many family planning clinics might eliminate access to care for some underserved communities. Moreover while the safety of OCs for most women is well-established, there are outstanding questions about women's ability to self-screen for hypertension, a concern particularly in those communities of color where hypertension is more prevalent. Exploring these concerns through dialogue, research and education is critical to determining whether switching to over-the-counter distribution in the U.S. would benefit women's health and addressing them is essential to building unified support from women's health advocates for the proposal.