• <div class="header-image" style="background-image: url(/live/image/gid/4/3040_V7N1_header.rev.1549561230.jpg);"/><div class="header-background-color"/>

The Over-the-Counter Birth Control Debate

March 31, 2016
Early this year, new laws in Oregon and California have enabled women to get hormonal contraceptives–such as the pill, patches and rings–directly from the pharmacy, with several other states planning to follow. What are the details and implications of these new laws? How have politicians and medical experts responded? Wonk Tank’s Health, Education and Welfare team will address these questions in our report this week on over-the-counter birth control.



Since the FDA approved the use of the pill and other hormonal contraceptives in 1960, women’s access to such hormonal contraception has faced several barriers. Currently, in addition to “Zygote Personhood Bills”[1] and other congressional measures to make birth control less accessible, the traditional path to obtaining hormonal birth control involves going to an appointment at a clinic or doctor’s office, getting a physical examination, and then taking the prescription to a pharmacy. Several medical and political groups, such as the American College of Obstetricians and Gynecologists, have argued against this current method of obtaining birth control and have endorsed full over-the-counter access.[2]


On January 1 of this year, women in Oregon are now able to get the birth control pill, patch or ring without a trip to the gynecologist, although not completely over-the-counter either. In this law, women over 18 can visit their pharmacies to get a prescription directly from their pharmacist after a short screening process that consists of a 20-question self-assessment. Pharmacists also have to complete a training protocol in order to issue prescriptions. Moreover, prescriptions can include up to a year’s worth of the pill, a significantly longer time than most prescriptions from doctors.[3] In California, a similar practice has begun to occur early this month, although with no age restriction. The law in California also requires pharmacists to take women’s blood pressure. Plans to implement similar practices have arisen in the states of Washington, Hawaii, Arizona and Alaska.[4]


Under the Affordable Care Act, all prescription hormonal birth control will be covered by insurance, albeit with a possible additional cost of $25 for the pharmacist’s services. Both the law in California and in Oregon has received bipartisan support, with the political purpose of reducing rates of unintended pregnancy and abortion. Rep. Knute Buehler, a Republican who sponsored Oregon’s law, explained his decision to the New York Times by stating that it will “have repercussions for decreasing poverty because one of the key things for women in poverty is unintended pregnancy.”[5]




In other states, like North Carolina and Colorado, the debate on over-the-counter birth control has taken a strange twist, with a group of Republicans pushing the option while Democrats resist.[6] Politicians who oppose these bills have insisted that there is no guarantee of over-the-counter birth control being covered by insurance, the absence of which would widen economic disparities among women. Even Planned Parenthood, which has a typically positive view of options that provide access to women’s health services, has taken contradictory action.[7] Although the organization opposes mandatory office visits for birth control, they’ve released ads targeting the Republican candidates who support over-the-counter birth control, accusing them of driving up healthcare costs for women. Other critics point out that birth control methods available over-the-counter would be the less effective options, with less variety for women.[8]


Meanwhile, Republicans argue that their plan–unlike the Democrats’–encourages the manufacture of over-the-counter birth control and eliminates restrictions on contraceptives mandated by the Affordable Care Act.[9] But the same politicians support doing away with the Affordable Care Act entirely, which would leave women’s access to contraceptives incredibly vulnerable, especially for the poor.


The partisan conflict over birth control has been subsumed into rhetoric that places Democrats and Republicans on clearly opposite sides of women’s health issues. But the underlying problem is a less politicized question: that of screening guidelines.[10] In 2012, recommendations for cervical cancer screening were shifted from once per year to once every three years, drastically lowering the rate at which women see their gynecologists and making visits for birth control prescriptions less likely. That decision was a product of public health experts’ attempts to match concerns of overspending with medically-informed estimates of proper screening times. Studies found that there was little difference in outcomes between women screened every two years and women screened every three years, but a significant difference in cost.[11] Interestingly, the group which instituted the new screening guidelines (the American College of Obstetricians and Gynecologists) has come out in support of over-the-counter birth control.


The Potential Economic Consequences


Offering women the opportunity to purchase the pill without requiring a doctor’s prescription, not only breaks down another barrier for a woman to control her own sexual reproduction and protects young (teenage) girls from having unintended (teen) pregnancy, but it also has the potential to be a cost-savings solution for the public sector.  


Reproductive health researchers from the University of California, San Francisco released a study that estimates how making oral contraceptives available over-the-counter may affect 1) contraceptive use, 2) unintended pregnancies, and 3) associated contraceptive and pregnancy costs among low-income women.[12]  Based on previous data, the researchers estimated two possible scenarios to compare (e.g. low over-the-counter use v. high over-the-counter use) amongst the proportion of low-income women likely to switch to an over-the-counter pill.  From there, the researchers predicted the rate at which these over-the-counter pills would be readily adopted by these women considering the costs per pill pack.  Finally, the researchers estimated the cost-savings of each scenario by comparing the total public sector cost of providing over-the-counter pills and medical care for unintended pregnancy.[13]


From this study, the researchers found that about 21% of low-income women at risk for unintended pregnancy are very likely to use birth control pills if they were available to them without a prescription (over-the-counter).[14]  However, the use of such over-the-counter pills varies, depending on the cost of the pill pack.  

Source: Foster et al.Source: Foster et al.

Represented in the figure above is a scenario in which the researchers assumed that with no out-of-pocket costs for the over-the counter pill, an additional 11-21% of low-income women will use the pill, resulting in a 20-36% decrease in the number of women using no method or a method less effective than the pill, and a 7-25% decrease in the number of unintended pregnancies, depending on the level of use and any effect on contraceptive failure rates. [15] Thus, the researchers concluded from these findings that if such out-of-pocket costs for the pill are low, over-the-counter access to birth control could have a significant effect on the use of effective contraceptives and potentially reduce the number of unintended pregnancies.  By having low-cost over-the-counter birth control available so that all women could access it, the researchers argue that there could be savings on public expenditures that were allocated to public health plans that focus on pregnancy and contraceptive health care services.  




The issue of women’s reproductive health, and the autonomy women have to decide what to do with their bodies, will always be a contentious issue, particularly when religious (political) issues come into play.  However, removing the prescription barrier to the birth control pill comes at a low or zero out-of-pocket cost and its benefits of potentially increasing the use of effective contraception methods and reducing unintended pregnancy as well as healthcare costs making the case that this policy should be enacted at the federal level.  Maybe after more research is undertaken after a few years of the policy’s implementation in Oregon and California, policymakers will have a better idea on the effectiveness of this policy on not only women’s health, but also its potential economic

  [1] Baumann, Nick. 2016. “Congressional GOP Pushes Zygote Personhood Bills”. Mother Jones. http://www.motherjones.com/politics/2011/11/mississippi-personhood-zygote-federal-law.


  [2]“Over-The-Counter Access To Oral Contraceptives - ACOG”. 2016. Acog.Org. http://www.acog.org/Resources-And-Publications/Committee-Opinions/Committee-on-Gynecologic-Practice/Over-the-Counter-Access-to-Oral-Contraceptives.


  [3]Belluck, Pam. 2016. “Birth Control without Seeing a Doctor: Oregon Now, More States Later.” The New York Times. http://www.nytimes.com/interactive/2016/01/04/health/birth-control-oregon-contraception.html?_r=0


  [4]Karlamangla, Soumya. 2016. “Birth control pills without prescriptions, coming soon to California under new law.” Los Angelos Times. http://www.latimes.com/health/la-me-birth-control-pharmacies-20160214-story.html.


  [5]Caplan-Bricker, Nora. 2015. “Women Want Over-the-Counter Birth Control: California and Oregon are listening.” Slate Magazine. http://www.slate.com/articles/double_x/doublex/2015/11/over_the_counter_birth_control_in_california_and_oregon.html.


  [6]Libby, Sara. 2014. “The Weird Bipartisan Consensus On Over-The-Counter Birth Control”. The Atlantic. http://www.theatlantic.com/politics/archive/2014/09/birth-control-consensus/380584/.


  [7]Hohmann, James. 2016. “Planned Parenthood’s Ad Buy”. POLITICO. http://www.politico.com/story/2014/09/planned-parenthoods-colo-nc-ad-buy-110891.


  [8]“Should Birth Control Be Over The Counter?”. 2014. Women’s Health. http://www.womenshealthmag.com/health/over-the-counter-birth-control.


  [9]“Colorado Discovers A Way To Reduce Abortion”. 2016. The Huffington Post. http://www.huffingtonpost.com/2015/07/06/birth-control-abortion_n_7738894.html.


  [10]Alter, Charlotte. 2015. “Why Over-The-Counter Birth Control Is Stalled”.TIME.Com. http://time.com/4132835/why-over-the-counter-birth-control-is-stalled/.


  [11] “New Guidelines Put Pap Smear Screening Test For Cervical Cancer At Every 3-5 Years”. 2016. Cleveland.Com. http://www.cleveland.com/healthfit/index.ssf/2012/10/new_guidelines_put_cervical_ca.html.


  [12]Foster, Diana G., M. Antonia Biggs, Kathryn A. Phillips, Kate Grindlay, and Daniel Grossman. 2015. “Potential Public Sector Cost-Savings From Over-The-Counter Access To Oral Contraceptives”. Contraception91 (5): 373-379. doi:10.1016/j.contraception.2015.01.010.


  [13] Ibid.




Student Blog Disclaimer
  • The views expressed on the Student Blog are the author’s opinions and don’t necessarily represent the Penn Wharton Public Policy Initiative’s strategies, recommendations, or opinions.



  • <h3>NOAA National Climatic Data Center</h3><p><img width="200" height="198" alt="" src="/live/image/gid/4/width/200/height/198/483_noaa_logo.rev.1407788692.jpg" class="lw_image lw_image483 lw_align_left" srcset="/live/image/scale/2x/gid/4/width/200/height/198/483_noaa_logo.rev.1407788692.jpg 2x, /live/image/scale/3x/gid/4/width/200/height/198/483_noaa_logo.rev.1407788692.jpg 3x" data-max-w="954" data-max-h="945"/>NOAA’s National Climatic Data Center (NCDC) is responsible for preserving, monitoring, assessing, and providing public access to the Nation’s treasure of <strong>climate and historical weather data and information</strong>.</p><p> Quick link to home page: <a href="http://www.ncdc.noaa.gov/" target="_blank">http://www.ncdc.noaa.gov/</a></p><p> Quick link to NCDC’s climate and weather datasets, products, and various web pages and resources: <a href="http://www.ncdc.noaa.gov/data-access/quick-links" target="_blank">http://www.ncdc.noaa.gov/data-access/quick-links</a></p><p> Quick link to Text & Map Search: <a href="http://www.ncdc.noaa.gov/cdo-web/" target="_blank">http://www.ncdc.noaa.gov/cdo-web/</a></p><p>See all <a href="/data-resources/">data and resources</a> »</p>
  • <h3>The Penn World Table</h3><p> The Penn World Table provides purchasing power parity and national income accounts converted to international prices for 189 countries/territories for some or all of the years 1950-2010.</p><p><a href="https://pwt.sas.upenn.edu/php_site/pwt71/pwt71_form.php" target="_blank">Quick link.</a> </p><p>See all <a href="/data-resources/">data and resources</a> »</p>
  • <h3>MapStats</h3><p> A feature of FedStats, MapStats allows users to search for <strong>state, county, city, congressional district, or Federal judicial district data</strong> (demographic, economic, and geographic).</p><p> Quick link: <a href="http://www.fedstats.gov/mapstats/" target="_blank">http://www.fedstats.gov/mapstats/</a></p><p>See all <a href="/data-resources/">data and resources</a> »</p>
  • <h3>Congressional Budget Office</h3><p><img width="180" height="180" alt="" src="/live/image/gid/4/width/180/height/180/380_cbo-logo.rev.1406822035.jpg" class="lw_image lw_image380 lw_align_right" data-max-w="180" data-max-h="180"/>Since its founding in 1974, the Congressional Budget Office (CBO) has produced independent analyses of budgetary and economic issues to support the Congressional budget process.</p><p> The agency is strictly nonpartisan and conducts objective, impartial analysis, which is evident in each of the dozens of reports and hundreds of cost estimates that its economists and policy analysts produce each year. CBO does not make policy recommendations, and each report and cost estimate discloses the agency’s assumptions and methodologies. <strong>CBO provides budgetary and economic information in a variety of ways and at various points in the legislative process.</strong> Products include baseline budget projections and economic forecasts, analysis of the President’s budget, cost estimates, analysis of federal mandates, working papers, and more.</p><p> Quick link to Products page: <a href="http://www.cbo.gov/about/our-products" target="_blank">http://www.cbo.gov/about/our-products</a></p><p> Quick link to Topics: <a href="http://www.cbo.gov/topics" target="_blank">http://www.cbo.gov/topics</a></p><p>See all <a href="/data-resources/">data and resources</a> »</p>
  • <h3>Internal Revenue Service: Tax Statistics</h3><p><img width="155" height="200" alt="" src="/live/image/gid/4/width/155/height/200/486_irs_logo.rev.1407789424.jpg" class="lw_image lw_image486 lw_align_left" srcset="/live/image/scale/2x/gid/4/width/155/height/200/486_irs_logo.rev.1407789424.jpg 2x" data-max-w="463" data-max-h="596"/>Find statistics on business tax, individual tax, charitable and exempt organizations, IRS operations and budget, and income (SOI), as well as statistics by form, products, publications, papers, and other IRS data.</p><p> Quick link to <strong>Tax Statistics, where you will find a wide range of tables, articles, and data</strong> that describe and measure elements of the U.S. tax system: <a href="http://www.irs.gov/uac/Tax-Stats-2" target="_blank">http://www.irs.gov/uac/Tax-Stats-2</a></p><p>See all <a href="/data-resources/">data and resources</a> »</p>
  • <h3>National Center for Education Statistics</h3><p><strong><img width="400" height="80" alt="" src="/live/image/gid/4/width/400/height/80/479_nces.rev.1407787656.jpg" class="lw_image lw_image479 lw_align_right" data-max-w="400" data-max-h="80"/>The National Center for Education Statistics (NCES) is the primary federal entity for collecting and analyzing data related to education in the U.S. and other nations.</strong> NCES is located within the U.S. Department of Education and the Institute of Education Sciences. NCES has an extensive Statistical Standards Program that consults and advises on methodological and statistical aspects involved in the design, collection, and analysis of data collections in the Center. To learn more about the NCES, <a href="http://nces.ed.gov/about/" target="_blank">click here</a>.</p><p> Quick link to NCES Data Tools: <a href="http://nces.ed.gov/datatools/index.asp?DataToolSectionID=4" target="_blank">http://nces.ed.gov/datatools/index.asp?DataToolSectionID=4</a></p><p> Quick link to Quick Tables and Figures: <a href="http://nces.ed.gov/quicktables/" target="_blank">http://nces.ed.gov/quicktables/</a></p><p> Quick link to NCES Fast Facts (Note: The primary purpose of the Fast Facts website is to provide users with concise information on a range of educational issues, from early childhood to adult learning.): <a href="http://nces.ed.gov/fastfacts/" target="_blank">http://nces.ed.gov/fastfacts/#</a></p><p>See all <a href="/data-resources/">data and resources</a> »</p>
  • <h3>The World Bank Data (U.S.)</h3><p><img width="130" height="118" alt="" src="/live/image/gid/4/width/130/height/118/484_world-bank-logo.rev.1407788945.jpg" class="lw_image lw_image484 lw_align_left" srcset="/live/image/scale/2x/gid/4/width/130/height/118/484_world-bank-logo.rev.1407788945.jpg 2x, /live/image/scale/3x/gid/4/width/130/height/118/484_world-bank-logo.rev.1407788945.jpg 3x" data-max-w="1406" data-max-h="1275"/>The <strong>World Bank</strong> provides World Development Indicators, Surveys, and data on Finances and Climate Change.</p><p> Quick link: <a href="http://data.worldbank.org/country/united-states" target="_blank">http://data.worldbank.org/country/united-states</a></p><p>See all <a href="/data-resources/">data and resources</a> »</p>
  • <h3>National Bureau of Economic Research (Public Use Data Archive)</h3><p><img width="180" height="43" alt="" src="/live/image/gid/4/width/180/height/43/478_nber.rev.1407530465.jpg" class="lw_image lw_image478 lw_align_right" data-max-w="329" data-max-h="79"/>Founded in 1920, the <strong>National Bureau of Economic Research</strong> is a private, nonprofit, nonpartisan research organization dedicated to promoting a greater understanding of how the economy works. The NBER is committed to undertaking and disseminating unbiased economic research among public policymakers, business professionals, and the academic community.</p><p> Quick Link to <strong>Public Use Data Archive</strong>: <a href="http://www.nber.org/data/" target="_blank">http://www.nber.org/data/</a></p><p>See all <a href="/data-resources/">data and resources</a> »</p>
  • <h3>HUD State of the Cities Data Systems</h3><p><strong><img width="200" height="200" alt="" src="/live/image/gid/4/width/200/height/200/482_hud_logo.rev.1407788472.jpg" class="lw_image lw_image482 lw_align_left" srcset="/live/image/scale/2x/gid/4/width/200/height/200/482_hud_logo.rev.1407788472.jpg 2x, /live/image/scale/3x/gid/4/width/200/height/200/482_hud_logo.rev.1407788472.jpg 3x" data-max-w="612" data-max-h="613"/>The SOCDS provides data for individual Metropolitan Areas, Central Cities, and Suburbs.</strong> It is a portal for non-national data made available through a number of outside institutions (e.g. Census, BLS, FBI and others).</p><p> Quick link: <a href="http://www.huduser.org/portal/datasets/socds.html" target="_blank">http://www.huduser.org/portal/datasets/socds.html</a></p><p>See all <a href="/data-resources/">data and resources</a> »</p>
  • <h3>Federal Reserve Economic Data (FRED®)</h3><p><strong><img width="180" height="79" alt="" src="/live/image/gid/4/width/180/height/79/481_fred-logo.rev.1407788243.jpg" class="lw_image lw_image481 lw_align_right" data-max-w="222" data-max-h="97"/>An online database consisting of more than 72,000 economic data time series from 54 national, international, public, and private sources.</strong> FRED®, created and maintained by Research Department at the Federal Reserve Bank of St. Louis, goes far beyond simply providing data: It combines data with a powerful mix of tools that help the user understand, interact with, display, and disseminate the data.</p><p> Quick link to data page: <a href="http://research.stlouisfed.org/fred2/tags/series" target="_blank">http://research.stlouisfed.org/fred2/tags/series</a></p><p>See all <a href="/data-resources/">data and resources</a> »</p>
  • <h3>Federal Aviation Administration: Accident & Incident Data</h3><p><img width="100" height="100" alt="" src="/live/image/gid/4/width/100/height/100/80_faa-logo.rev.1402681347.jpg" class="lw_image lw_image80 lw_align_left" srcset="/live/image/scale/2x/gid/4/width/100/height/100/80_faa-logo.rev.1402681347.jpg 2x, /live/image/scale/3x/gid/4/width/100/height/100/80_faa-logo.rev.1402681347.jpg 3x" data-max-w="550" data-max-h="550"/>The NTSB issues an accident report following each investigation. These reports are available online for reports issued since 1996, with older reports coming online soon. The reports listing is sortable by the event date, report date, city, and state.</p><p> Quick link: <a href="http://www.faa.gov/data_research/accident_incident/" target="_blank">http://www.faa.gov/data_research/accident_incident/</a></p><p>See all <a href="/data-resources/">data and resources</a> »</p>
  • <h3>USDA Nutrition Assistance Data</h3><p><img width="180" height="124" alt="" src="/live/image/gid/4/width/180/height/124/485_usda_logo.rev.1407789238.jpg" class="lw_image lw_image485 lw_align_right" srcset="/live/image/scale/2x/gid/4/width/180/height/124/485_usda_logo.rev.1407789238.jpg 2x, /live/image/scale/3x/gid/4/width/180/height/124/485_usda_logo.rev.1407789238.jpg 3x" data-max-w="1233" data-max-h="850"/>Data and research regarding the following <strong>USDA Nutrition Assistance</strong> programs are available through this site:</p><ul><li>Supplemental Nutrition Assistance Program (SNAP) </li><li>Food Distribution Programs </li><li>School Meals </li><li>Women, Infants and Children </li></ul><p> Quick link: <a href="http://www.fns.usda.gov/data-and-statistics" target="_blank">http://www.fns.usda.gov/data-and-statistics</a></p><p>See all <a href="/data-resources/">data and resources</a> »</p>