Unless you’ve been living under a rock, you likely know that women’s health and reproductive rights have dominated national debates. While always important issues, the U.S. Supreme Court’s recent decision to overturn Roe. v. Wade has ensured that they will continue to take center stage in political campaigns for years to come.
Time will tell how debates over abortion in particular will ultimately be resolved, but there are some small concrete steps that state and federal governments can take to alleviate healthcare burdens facing women. It begins with embracing freer markets, and there may be hope on the horizon as states reduce barriers to birth control and the Food and Drug Administration (FDA) mulls making some hormonal contraception available over the counter.
In Georgia, if women want to obtain birth control, they must visit a doctor, submit to a blood pressure test and self-report their medical history to check for possible contraindications. Once they’ve jumped through these hoops, then a physician may provide them with a birth control prescription, which a pharmacist will eventually fill, but there are obvious problems with this model.
Doctors’ visits can be expensive, and physicians—particularly obstetrician-gynecologists (OB-GYNs)—aren’t always easily accessible, especially in rural Georgia. In fact, the Peach State has one of the country’s worst physician-to-patient ratios, and as of 2018, nine counties didn’t have a single medical doctor and roughly half of Georgia’s counties were without an OB-GYN. This puts basic healthcare out of the reach of many Georgians, and the results are as predictable as they are disappointing.
Around 60 percent of Georgia pregnancies are unplanned—far outpacing the national average—and taxpayers foot the bill for roughly 80 percent of these pregnancies. In 2010, this cost the state of Georgia around $230 million and the federal government over $680 million. More than a decade later, these costs have almost certainly surged even higher thanks to Georgia’s explosive growth and inflation.
Over the past several years, states have increasingly rejected Georgia’s current birth control access model. To date, 24 states, including Tennessee, North Carolina, South Carolina and Arkansas, now allow pharmacists to prescribe birth control directly to women, and why not? Pharmacists are capable of conducting the same tests to check for contraindications, and they can do so effectively and safely.
Despite this, the Georgia legislature has resisted this policy even though expanded access to contraception is badly needed. It would make women’s healthcare more accessible and affordable and likely reduce the taxpayer exposure related to unplanned pregnancies. It’s unclear whether the U.S. Supreme Court’s decision regarding Roe will spur the Georgia General Assembly to act, but there is reason for very cautious optimism, considering that the federal government could improve the situation.
While states have the power to enact the pharmacy access birth control paradigm, only the federal government can make hormonal contraception available over the counter, which could become a reality. “The Food and Drug Administration has received its first application for a birth control pill sold over the counter,” writes the New York Times. The company, HRA Pharma, claimed the honor of submitting the first ever application, but their timing has nothing to do with the Roe decision. It is “a really sad coincidence,” according to an HRA Pharma spokesperson.
Nevertheless, other companies look to join them. Cadence Health, for example, is in talks with the FDA and hopes to submit an application later this year to obtain approval to sell their hormonal contraceptive pills without the need for physician or pharmacy approval.
If the FDA approves these applications, then that would bring the United States more in line with much of the globe. As it stands, some 100 countries permit women to purchase birth control over the counter, but without political pressure, don’t expect the FDA to move fast. Their approval process takes, on average, around 12 years. However, as we saw with the COVID-19 vaccines, policymakers can speed up the painfully slow process.
While I have no doubt that experts will debate whether birth control ought to be available over the counter or accessible through a pharmacist, a couple things seem absolutely certain: Expanded access to hormonal contraception is absolutely vital, and we already know plenty about birth control to make informed decisions. After all, the pill was first introduced when Harry Truman was president, but many decades later, Georgia policymakers still ensure that it remains out of reach for many women—leaving everyday Georgians to deal with the consequences.
Marc Hyden is the director of state government affairs at the R Street Institute. You can follow him on Twitter at @marc_hyden.