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Key points
- Important sexual health products are finally more easily available, but are still underused.
- A powerful coalition has limited access to contraception.
- Teens and poor people are hurt most by limitations on contraceptive access.
This summer, the FDA approved the first contraceptive pill for over-the-counter (OTC), non-prescription sale.
The move has the support of the American Medical Association and the American College of Obstetricians and Gynecologists, as well as more than half the U.S. population. It will make using the Pill easier to get and use, especially for women of color and teens.
Half of America's 6,000,000 pregnancies each year are unintended—by far the highest rate in the rich world. Each year, 1 out of 20 women of reproductive age has an unintended pregnancy. Many women have little or no intercourse, so the effective ratio is even higher.
And who’s more likely to get pregnant “by accident”? Poor women and women who don’t finish high school or college. And unintended pregnancy is a key transmitter of generational poverty. For example, the children of teen or unmarried parents often become teen or unmarried parents themselves.
But it’s not just teens. Half of the pregnancies to women over 35 and three-quarters of the pregnancies of women over age 40 are unintended.
A Major Impact? Maybe Not
However, although making the Pill OTC has enormous symbolic importance, I’m not sure this will have a major impact in actually reducing unintended pregnancy. After all, condoms have been available on drugstore shelves for decades, along with spermicidal foam. Buying them can’t be more embarrassing than buying tampons or hemorrhoid creams.
County health departments and Planned Parenthood have also been offering free or low-cost diaphragms, IUDs, and condoms, as well as the Pill, in private, anonymous settings for decades. Granted, these programs are underfunded and can’t do enough outreach. But they’re also dramatically underused.
More recently, emergency contraception and abortion-by-medication have been easily available to everyone. For years I have urged men and women to buy and keep these products at home, because each one relies on timely use. Sadly, neither have been flying off store shelves (although there’s often a brief run on abortion pills when a state criminalizes their use).
Empowerment as Contraceptive
Each new contraceptive advance is used mostly by people who believe in their own empowerment. Michael Carrera, a leading sex educator, has often said that “A belief in the future is the best contraceptive." That is, giving people hope that they can shape their own destiny is crucial to a person’s decision to use birth control. Why else go through the logistical, financial, emotional, and relationship hassle?
And that’s what many poor people lack: a belief that the world will let them shape their life’s destiny.
Exploiting this fact is the conservative, sex-averse movement that continues to discourage the use of birth control—and any other technology or law that makes sex safer, more comfortable, or more enjoyable. These people lobby against giving teens the HPV vaccine, against dispensing contraception in high schools, against condom machines in airports and bars, and against accurate school sex education.
Since most Americans begin their partnered sex lives as unmarried people, most people who use contraception start when they’re unmarried. And that troubles some policymakers and activists.
Those who war against sex do not want young people to develop the contraceptive habit or mindset. And they’re incredibly effective—not at preventing young people from having intercourse, but at discouraging them from using birth control. For millions, that limited mindset continues into adulthood—and leads to millions of unintended pregnancies every year.
So yes, let’s make the Pill as easily available as possible. And let’s encourage men and women to use these miraculous products, along with every other form of contraception.
