I’ve been a practicing OB/GYN for nearly 15 years, long enough to see patient after patient struggle through the web of systemic barriers that make accessing healthcare needlessly difficult. At my practice in Baltimore, in a state that is a national trailblazer in providing comprehensive and affordable reproductive healthcare, I still hear every day from women who struggle to get the care they need. My patients have told me stories about having to take three buses to get to an appointment, only to be turned away, if they are late. Some patients don’t have the right type of insurance coverage or have no insurance, pushing needed health services or medication financially out of reach. Others can’t take time off work or afford transportation or childcare in order to go to their doctor.
Reproductive healthcare is not a luxury, and for Black women specifically, being in full control of our reproductive decisions can quite literally be a matter of life and death. Data from the CDC show Black women are three to four times more likely to die during childbirth than White women. These statistics remain consistent even when adjusting for factors like age, education, and economic status. There is a growing consensus that the stress of prejudice and racism endured by Black women increases the likelihood of preterm birth and other health consequences.
Racial and ethnic disparities in unintended pregnancy also persist. Black women are significantly more likely to have an unintended pregnancy when compared to all women of reproductive age, and the percentage of people who decide to end an unintended pregnancy, instead of give birth, is highest among Black women. Black women at risk of unintended pregnancy are also less likely to use any method of contraception, particularly young Black women. Researchers propose these disparities are a consequence of implicit and explicit racism when interacting with the medical system, lack of quality information about effective family planning methods, and inability to access or afford reproductive healthcare.
What I see in these statistics — and what I hear from my patients — is that the current systems for providing birth control are not meeting Black women’s needs.
We need to think bigger about how to overcome these barriers and provide convenient contraceptive options directly in people’s communities. From birth control delivery apps, to pharmacist prescribing programs, healthcare innovators are bringing us closer to a world where the tools to prevent pregnancy are at your fingertips. In my view, an over-the-counter birth control pill is the obvious next step and would be a game changer for giving people the option of getting safe birth control when and where they want it.
Women's health providers are working in tandem with researchers to hone best practices for providing birth control pills—for example, no longer are blood pressure checks or pap smears required prior to prescribing the pill for healthy patients. People are already empowered to provide self-care with over-the-counter medications, and there is no reason a birth control pill should be different. Studies show that individuals themselves can determine whether birth control pills are right for them and if there are any health conditions that might make taking birth control pills less safe or less effective.
While having a yearly genecology exam is important for other health reasons, it is not necessary to start birth control pills. Yet, I’m not concerned about my patients disappearing. In a recent survey, the vast majority of women interested in taking an over-the-counter birth control pill reported they would continue to visit their healthcare provider to obtain gynecological screenings, like pap smears. We don’t have to hold patients hostage to their prescriptions for birth control pills in order to get them into the office for other services. We need to work to make all reproductive healthcare more accessible for people where and when they need it.
Of course, over-the-counter birth control pills won’t singlehandedly fix the legacy left by discriminatory healthcare programs and the reproductive coercion experienced by Black women, but it can bring us closer to a future where every person has the resources they need to make decisions about their own bodies and lives with dignity.