The Register Citizen (Torrington, CT)
Reproductive rights battle hits next level
The leak of the draft Supreme Court opinion overturning the landmark abortion rights case, Roe v. Wade, sparked a flurry of protests around the country. The news raised concerns that other federal protections will be rolled back, including the right to birth control. In response to this federal volatility, a number of states have acted to protect access to abortion, and to reproductive health care more generally. Laudably, Gov. Ned Lamont led the nation in signing legislation protecting and expanding access to abortion in Connecticut, but the state should go further, by taking urgent action to expand access to contraception.
As health care professionals, we believe it is imperative that Connecticut allow pharmacists to prescribe hormonal birth control directly to patients. Connecticut lags behind many peer states in its failure to take this step. To date, 17 states and the District of Columbia allow pharmacistprescribed contraception, and 29 similar state bills have been introduced this year. Both neighboring Rhode Island and Massachusetts are considering similar proposals this legislative cycle, with significant support from community advocates.
Even though birth control pills have been legal for decades, many women face problems obtaining them. This issue is particularly acute in Connecticut. According to data released by Power to Decide, an advocacy organization, an estimated 180,000 lower-income women in our state live in “contraceptive deserts,” facing significant barriers to contraceptive access. Nationally, 30 percent of surveyed women who tried to obtain a prescription for birth control reported difficulties. Two of the most frequently cited barriers were not having a doctor and trouble getting an appointment. One of us, a gynecology resident, recently saw a patient who became pregnant while waiting months for a birth control appointment. Allowing pharmacists to prescribe birth control would dramatically decrease these delays in care and promote equitable access.
Over half of women who did not want to become pregnant reported it would be a “big personal advantage” to have pharmacist-prescribed birth control, and 41 percent of those not using contraceptives said they would start if available from pharmacists. Physicians, too, are broadly supportive of increasing access to contraceptives at the pharmacy level, with the American College of Obstetricians and Gynecologists and American Academy of Family Physicians releasing opinions going a step further, supporting over-the-counter access even without a pharmacist’s prescription.
This broad support is due, in part, to evidence demonstrating the safety of over-the-counter and pharmacist-prescribed contraception. Evidence of the general safety of oral contraceptives is overwhelming, and they are taken by 14 percent of women aged 15-49. However, hormonal contraception, like any drug, carries risks. Of particular concern for combined birth control pills — those with both estrogen and progestin — is the risk for blood clots, a rare complication that is more likely in women with identifiable underlying health conditions.
In Oregon, where pharmacist prescribed birth control is already legal, a study showed that pharmacists are comparable to physicians in their ability to identify these health problems. Several additional studies demonstrate that patients themselves are capable of self-screening their eligibility for hormonal contraceptives, leading to ACOG’s recommendation that hormonal contraception ultimately be available over-thecounter and without age restrictions. Connecticut now has a pressing opportunity to adopt the “intermediate step” in ACOG’s recommendation — allowing pharmacists to prescribe contraception.
With the overturning of Roe v. Wade imminent, and the threat of further reduced federal protections, legislators must act swiftly to protect reproductive freedom in Connecticut. This not only includes ensuring continued access to abortion, but expanding access to contraception, as well. Allowing pharmacists to prescribe contraceptives is a key step in such an expansion, by reducing the significant delays and costs involved in seeing a physician, in addition to reducing the current strain on the health care system. Existing protections must also be shorn up, and support given to federal reform where possible. Connecticut is a national leader in protecting access to health care, and should continue to lead by urgently expanding access to contraception for all who need it.
Dr. Blake Shultz is a fellow at the Solomon Center for Health Law and Policy at Yale Law School and an incoming emergency medicine resident at MGH/Brigham Hospitals. He is a recent graduate of Yale School of Medicine and Yale Law School, as well as Cornell University. Dr. Sara Tannenbaum is a senior resident OBGYN physician at Brigham and Women's Hospital. She is a graduate of Harvard University and Yale School of Medicine.