For continuing coverage of how COVID-19 is affecting reproductive health, check out our Special Report.
Though I have three kids, I have spent a lot more time trying to prevent pregnancy than I have trying to become pregnant—and I know I’m not alone in that.
In the United States, over 99 percent of people for whom pregnancy is a possibility have used some form of birth control over the course of their reproductive lives. And yet, as people across the country find themselves navigating the COVID-19 pandemic, their ability to prevent pregnancy is increasingly being compromised. For those who rely on nonpermanent methods of hormonal contraception like the pill, patch, ring, or shot, access can be particularly complicated.
Largely, that is because these methods require a prescription. This is something that has not changed since the pill first came on the market in 1960, when moral and medical arguments about contraception were very different. Today, however, nearly 8 in 10 adults in the United States consider birth control to be “a basic part of women’s health care,” according to results from a national telephone survey. And despite earlier concerns about medical risks, studies have found over-the-counter (OTC) sale of contraception—something that already occurs in many countries—is safe for both adults and teens.
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Dr. Daniel Grossman, director of Advancing New Standards in Reproductive Health, advocates for OTC access to birth control and contraception. “As an OB-GYN, when I’m screening someone who wants to take the pill, most of the assessment is really based on me asking the person questions about their health history. So someone can just as easily go through a checklist and figure out if they have certain conditions or not,” Grossman said.
He is not alone in this view. Groups including the American College of Obstetricians and Gynecologists and the American Academy of Family Physicians also support making birth control available over the counter to people of all ages.
In recent years, some states have begun to allow pharmacists to prescribe birth control. But most states still require a visit to a health-care provider. Last June, U.S. Rep. Ayanna Pressley (D-MA) and Sen. Patty Murray (D-WA) introduced the Affordability Is Access Act, which would ensure that if oral contraception becomes available at pharmacies without the need for a prescription—a decision that only the Food And Drug Administration can make—then insurance companies will still be required to fully cover the costs.
Pressley’s bill would make sure that access and cost are addressed at the same time. These two very real issues, which we know can make it difficult to use contraception consistently, disproportionately affect people who are already marginalized by issues like poverty, racism, immigration status, transphobia, and weight bias.
As already existing barriers to accessing contraception are amplified by the COVID-19 pandemic and as more cities go into lockdown, we will likely begin to see new obstacles emerging.
For example, teens or college students may need to keep the fact that they are on the pill private from parents: Being isolated at home can mean they are less able to obtain birth control confidentially, especially if they aren’t able to leave their family’s home or receive a package in the mail discreetly. Socially isolated and quarantined survivors of domestic abuse and reproductive coercion may not be able to employ the strategies they normally use to access birth control. Those who access care at LGBTQ clinics may now find those spaces shuttered.
“The pandemic essentially exacerbated those barriers which disproportionately impact young people, people of color, and people struggling to make ends meet,” said Britt Wahlin, vice president for development and public affairs at Ibis Reproductive Health, an organization that operates a Free the Pill campaign to overturn the prescription requirement.
It’s not that accessing birth control is impossible under current conditions. June Gupta, a nurse practitioner and the director of medical standards at Planned Parenthood Federation of America, explained that the majority of Planned Parenthood health centers across the country are open and seeing patients. But Gupta has also been hearing from patients facing new obstacles, like a lack of transportation, that impede their ability to come in for a visit or pick up a prescription. “Patients have also expressed concerns about health risks for themselves or household members,” she said.
Such concerns are increasingly being voiced in virtual spaces. Last week, for example, one woman posted to Reddit: “Last month when I was at the doctor I asked to have my birth control prescription renewed while I was there. He said I need a separate appointment for that. My doctor does not do prescriptions over the phone. I have an appointment next week. I don’t want to go because I don’t want to get this coronavirus. But I also don’t want to have unplanned babies. Which risk am I going to take?”
A lot of people are asking that same question right now. Most providers are now offering telemedicine as an option. Gupta advises those who use Planned Parenthood’s health centers to call before coming in. “This will allow us to determine if the care you need requires an in-person visit or if it can be delivered virtually by phone, video visits with a provider, or using the Planned Parenthood Direct app.”
But virtual visits aren’t accessible to everybody, including people who lack internet or devices, primary care doctors, or insurance (a number that’s growing as more people lose their jobs and their health coverage as a result).
As it stands, nearly half of all pregnancies in the United States are unintended—a far higher rate than in many countries where contraception is much more accessible. The additional barriers to accessing prescription birth control imposed by the pandemic mean that looking ahead, this statistic could climb even higher. And in some states, abortion access may be hindered as well.
“When you have to stay home, and as more resources are directed toward the public health crisis, requiring that prescription for birth control is a particularly challenging barrier at this time,” Wahlin said.
Though we are living in uncertain times right now, the situation should help open our eyes to the reality that over-the-counter hormonal birth control is long overdue.