Last year marked the 60th anniversary of the birth of the birth control pill, a revolutionary step that provided millions of women with greater reproductive control. Nearly two generations later, however, accessing the pill remains challenging for many.
SB1082, sponsored by Sen. Michelle Ugenti-Rita, R-Scottsdale, would allow a physician at the Arizona Department of Health Services to issue a statewide standing prescription permitting a pharmacist to dispense self-administered hormonal contraceptives “without any other patient-specific prescription drug order.” In effect, this removes the need for a trip to the doctor for the sole purpose of obtaining a prescription that is then filled at the pharmacy. Last year, the same bill, branded as SB1493, was unanimously passed in the state Senate – the Legislature, however, adjourned due to the Covid shutdown before it could be heard by the House. As a medical student who will also graduate with a master’s degree in public health, I believe that this is a step in the right direction in removing barriers to care, empowering patient autonomy, and allowing evidence-based decisions for care.
It is imperative to recognize that social disparities in health directly impact patient care, and it is dangerous to assume that every patient who needs access to contraception can safely and reliably go to a physician’s office to meet that need. Recent research suggests that one-third of women in the United States who have tried to obtain prescription contraception have reported barriers to care (Grindlay & Grossman, 2014) and one-third of women say they would be more likely to use birth control if it were available without a prescription (Grossman et al., 2013). The frequency with which women encounter barriers to accessing essential medical care is due in part to barriers related to cost, insurance, and transportation. As a result of these barriers, vulnerable populations – including individuals of low socioeconomic status, uninsured or underinsured persons, or geographically-isolated individuals – can quickly find themselves unable to obtain contraceptives.
A common argument against over-the-counter access to oral contraceptives is that there are certain conditions that make the use of hormonal contraceptives unsafe. In accordance with good clinical practice, patients should be screened for contraindications to some hormonal contraceptives that could cause rare, but dangerous side effects. Studies demonstrate that patients are as, if not more, effective at self-screening compared to physicians (Xu et. al., 2014). Screening for contraindications is based only on the patient’s history and does not require a pelvic or breast exam, sexually transmitted infection screening, or a pap test.
The benefits of birth control extend beyond contraception. The recent declines in adolescent pregnancy and abortion rates in the United States have not occurred in isolation, but have been attributed to increased contraceptive use, particularly the birth control pill (Lindberg et al., 2016). In addition to being an effective method of preventing pregnancy, the pill can be used to treat heavy and irregular periods, cramps or pain, and acne (Allen, 2020). Contraceptives have been shown to improve birth outcomes, reduce the risk of ovarian and uterine cancer, and support women’s educational attainment and professional advancement (Guttmacher Institute, 2013).
Oral contraceptives are popular, safe and effective, but accessing them is not always convenient. Making birth control pills available via standing prescription would eliminate the barrier of having to see a doctor to get a prescription. Though I believe that birth control should ultimately be available over the counter, SB1082’s proposal to provide a standing order prescription for Arizona women is an important first step.
SB1082 already passed out of the Senate Health Committee February 17 and awaits a vote of the full Senate. It received strong bipartisan support last year, as evidenced by its unanimous passage by the Senate on February 20, 2020. The bill should have been passed as swiftly by the House but was not voted upon due to the Covid shutdown. The bill should be among the priorities for this session as it would remove one of the barriers that prevent women from having reliable access to contraception.
Megan Sluga is a medical student at the University of Arizona.