Lina gave birth at a Catholic hospital, where contraception was neither prescribed nor dispensed. Since insurance and health-care providers are permitted to deny reproductive health care based on “conscientious objections,” the hospital could withhold contraceptive care. Lina, whose name has been changed for privacy reasons, had to wait until their six-week postpartum visit to even inquire about it.

When they finally were able to ask, their OB-GYN could not provide the intrauterine device they wanted and referred them to the local health department. After an appointment at the department, they had to schedule another visit to have the device inserted.

What should have been a simple health-care decision turned into months of medical appointments and mountains of paperwork, all while juggling and balancing transportation, child care, time off work, and expenses. I learned about Lina’s experience in a research study I conducted.

Since the overturn of Roe v. Wade, debate over access to contraceptives has become a proxy fight for abortion. It was a hot-button issue in state elections, including Georgia’s gubernatorial race. Some states successfully liberalized access in the midterms (California and Michigan), while others continue to try and restrict it (Indiana, Iowa, Kentucky, Missouri, and Wisconsin, to name a few). In states with abortion bans, college campuses have become a battleground in the fight over contraceptive access.

This fight is coming to a head, but it’s not new. For 20 years, the Free the Pill coalition of over 100 advocacy groups, researchers, and health-care providers has worked to ensure and expand access and options. It also calls on the federal government to mandate protections for oral contraceptives, including affordable pricing, allowing health-care plans to cover the cost, and making the pill available to people of any age. It has also long championed making oral contraceptives available over the counter without a prescription.

There was finally some significant movement on these fronts in Washington—the Food and Drug Administration was scheduled to review an application for the first over-the-counter birth control pill today. But it was indefinitely postponed in October. In July, the House passed the Right to Contraception Act, which would codify contraceptive access as a fundamental right, including to the pill; however, it was blocked in the Senate.

But defending access alone is not enough. Nearly everyone who is capable of getting pregnant uses at least one form of contraception at some point in their lives. This holds true for people of various ages, sexual and gender identities, socioeconomic backgrounds, religions, and racial and ethnic identities. Therefore, contraceptives must be available on demand, without restriction, and affordable to all regardless of insurance status. That was the point of expanding contraception coverage under the Affordable Care Act. Yet many who need contraceptive information, services, and methods still can’t get them.

It’s important to note that contraceptives aren’t solely used to prevent pregnancy. They also address other reproductive and general health issues, from managing acne, regulating periods, and reducing pain to managing symptoms from endometriosis and polycystic ovarian syndrome. Contraception is health care that millions need.

So instead of putting a burden of complex regulations on contraception, the federal government should make it easier to access. It should make contraceptives services and methods accessible and available at no cost to anyone who wants them. It will take a federal mandate to guarantee this.

This is a far cry from the system we have today. Lina’s experience represents what people go through today.

Currently in the United States, people who are young, poor, disabled, or identify as a racial or ethnic minority or LGBTQ have more challenges acquiring their preferred contraception method than others. To meet the needs of diverse users, the full range of contraceptive options, including hormonal and non-hormonal methods, must be freely accessible to everyone. The health-care system must support whatever contraceptive options people do or don’t choose, and it should also support switching and transitioning between methods if that’s what patients want.

Cost is a major barrier to contraceptive access for many in this country. Few can afford to pay out of pocket for their method of choice. Those with insurance, including Medicaid and employer-based plans, have some coverage, but their options are limited. They have to cope with multiple consultations with providers, long wait times, and hard-to-schedule appointments at specific clinics.

To be effective, contraception must be available and accessible. The FDA approving an over-the-counter birth control pill would be a step in that direction. But beyond that, we need a federal mandate for full coverage of all contraceptive methods, including hormonal and non-hormonal options, at no cost, for everyone. Only such a mandate can guarantee reproductive and bodily autonomy as a right and give people the practical ability to exercise it.