In what was her final dissent, the late Justice Ruth Bader Ginsburg fiercely advocated for workers to have their birth control covered by insurance regardless of their employers’ beliefs. In the decision, the Supreme Court ruled 7-2 in the midst of the COVID-19 pandemic to uphold the Trump administration’s rules that allow companies to deny insurance coverage of birth control to employees.
As Justice Ginsburg knew, birth control is essential to people’s well-being and economic security, and especially at this immensely unstable time, everyone — whoever they are, wherever they live and however much money they make — must be able to access it in the way that works best for them.
When the pandemic first swept the nation earlier this year, we did not know how long it would last, or how the economy, our communities and our health care system would be devastated. COVID-19 has spotlighted our country’s racism and racial inequities; the brunt of it has fallen upon Black people, Indigenous people, and people of color, from the highest rates of infections and deaths, to the bulk of job losses, to the most barriers to reach essential health care, especially reproductive health care like contraception.
Even prior to the pandemic, systemic racism was at the root of the barriers people face in accessing birth control, meaning that like access to health care broadly, access to birth control is more challenging for Black people, people of color, Indigenous people, young people and people struggling to make ends meet. Now, amid unemployment and lockdowns, the pandemic has worsened these barriers, making it even harder if not impossible for many people to get the contraceptive method of their choice.
Racism is embedded in every part of our health care system — starting with where care is provided, who gets insurance coverage, and which patients are listened to and taken seriously. This has only worsened amid the pandemic: People of color account for a disproportionate number of hospitalizations and deaths from COVID-19.
The communities most deeply affected by the virus — Native Americans, Black people and Latinx people — also carry the generational weight of some of the most egregious sins committed in the name of medical research and contraceptive development. Throughout history, Black and Brown women have been exploited and experimented on without their consent in the name of advancing reproductive health care. Today, women of color continue to face the greatest barriers when it comes to the ability to control their bodies, lives and futures.
Meeting this moment demands radical changes in how we as a country ensure all of us can get essential care amid the uncertainties of a public health and economic crisis that continues to impact people’s family planning decisions. Leading medical organizations have been calling for birth control pills to become available over the counter for years, citing their strong safety record and people’s ability to identify what contraceptive method they need.
It’s time we listen to them. We need over-the-counter birth control that is accessible to people of all ages, affordable and covered by insurance.
This World Contraception Day, it’s painfully clear the current model for how people are required to obtain birth control pills never worked for everyone — all the more so during a pandemic that has overwhelmed the medical system, placed difficult restrictions on travel and required us to limit interactions with other people.
Research shows nearly one in three U.S. women who have ever tried to fill a birth control prescription ran into a roadblock, and it’s worse for people of color, young people, people in rural communities, immigrants and those struggling financially. There are financial and time costs associated with nearly every step of getting a prescription — from the cost of the clinic visit, to transportation, to missing work or school, to arranging child care — none of which is medically necessary. Birth control pills are safe for over-the-counter sale and people are able to determine whether the pill is right for them using a simple checklist. The prescription requirement is simply an unnecessary barrier.
We need contraceptive options that work for everyone, whether prescribed by a health care provider, in person or through an app; or available right on the shelf, to ensure no one who needs care is left behind. Leaving no one behind also means we must pay attention to affordability and ensure that any over-the-counter pill is covered by insurance.
Making the birth control pill available over the counter would be a groundbreaking step and give people greater ability to make decisions and have autonomy over their bodies. But this is only part of the equation. Especially now, during a pandemic that has resulted in millions of job losses and gaps in insurance coverage, affordability is crucial to access.
There is a tremendous amount of work to be done to overcome inequities in access to health care and to address the barriers starkly revealed by this public health and economic crisis — which are not new and have been baked into our health care system for centuries.
It is critical in this moment that we protect and expand people’s ability to control their lives and shape their futures and heed the advice of medical experts. Making birth control available over-the-counter is just one step of many we must take to meet everyone’s need for access to contraception and ensure everyone can make their own reproductive decisions and have the freedom to thrive.