‘The pill’ faces an uncertain future in a post-Roe world

·Senior Editor
·7-min read

“The 360” shows you diverse perspectives on the day’s top stories and debates.

What’s happening

After the Supreme Court’s decision to overturn Roe v. Wade and end constitutional protections for abortions, major questions have been raised about the future of birth control in the United States.

The Democrat-led House of Representatives on Thursday passed the Right to Contraception Act, a bill that would enshrine access contraception into federal law. That right already exists, thanks to a pair of Supreme Court decisions passed more than 50 years ago, but some legal experts say the court’s willingness to overturn Roe may be a signal that other rights established using similar legal principles are also at risk. Although it passed by a comfortable margin in the House, the bill faces uncertain odds in the evenly divided Senate.

While Democrats in Congress are looking to secure the status quo on birth control, the Food and Drug Administration is considering a proposal that could make it significantly easier to access contraception. Earlier this month, a French pharmaceutical company submitted an application for the first-ever over-the-counter birth control pill that would be available without a prescription.

About 65% of women of age 15 to 49 in the U.S. rely on some form of birth control — a broad category that includes a variety of methods to prevent pregnancy. The most popular nonsurgical choice is oral contraceptives, commonly known as “the pill.” The first oral contraceptive was approved for use in 1960. Within a few years, use of the pill took off, so much so that its arrival on the market is considered by some historians to be one of the major social pivot points of the 20th century. As of 2018, more than 10 million women were taking one of the many oral contraceptives on the market. Millions more have relied on alternate methods like patches, shots, implants and intrauterine devices that deliver steady doses of the same hormones contained in the pills.

Why there’s debate

Although the court’s decision throwing out Roe didn’t directly influence laws around contraception, there’s ample debate about what the ruling could mean for the future of the pill and other similar birth control methods.

Many legal analysts on the left say there’s reason to believe that the Supreme Court will target the precedents guaranteeing the right to contraception now that Roe has been overturned. But others, including most conservatives, say these fears are unfounded. And even if the justices did reverse those cases, it would still require states to ban contraception — something they argue there’s very little appetite for, even in the reddest parts of the country. This debate will become moot, of course, if the Right to Contraception Act becomes law.

Reproductive rights activists say that, even though it may remain legal, it may become effectively inaccessible to a lot of women in the U.S. Millions live in what are known as contraception deserts, areas where there aren’t enough doctors and clinics to meet the contraceptive needs of the local population. The problem could become even more severe in the near future, experts say, as clinics that provide abortions — which frequently provide a range of other family planning services — are forced to close in states that ban or severely limit abortions.

There’s some hope, though, that many of these access issues could be alleviated if the FDA decides to approve at least some form of the pill for over-the-counter sale. Advocates say that dropping the prescription requirement would not only relieve burdens that often prevent women from consistently being able to access birth control. Some are also optimistic that the end of Roe may encourage more men to take ownership of contraceptive planning and may even speed up progress on the decades-long quest for a male birth control pill.

What’s next

Senate Majority Leader Chuck Schumer, D-N.Y., hasn’t set a timetable to bring the Right to Contraception Act up for a vote, and it’s unclear whether the legislation can garner enough Republican votes to overcome a likely GOP filibuster.

The FDA is expected to make a decision on whether to approve over-the-counter birth control pills some time next year.

Perspectives

Contraception will inevitably become a target for the far-right

“A radical minority of Americans want to make an example of women who have sex outside marriage, women who compete with men in the workplace, women who are independent and who cannot be controlled. That’s part of why birth control is likely their next target.” — Mara Gay, New York Times

Conservative politicians have no interest in limiting access to contraception

“A handful of legislators across the country might not support birth control, but they’re a fringe in America's politics. However, many pro-lifers support expanded birth control access because they think it’s an effective way to prevent unintended pregnancies that lead to abortions.” — Tom Joyce, Washington Post

The issue of contraception is far from settled in the courts

“Thomas may be alone now, but who knows who will be willing to join him down the road? His envelope-pushing is more than doctrinal provocation — it has real-world consequences. It invites conservative activists to bring such challenges. … What starts as an extreme, outlier view can migrate into the conservative mainstream.” — Ruth Marcus, Washington Post

Over-the-counter contraception could be a game changer for many

“A doctor's visit to obtain a prescription can be a hurdle to using birth control pills. Getting to clinic locations may be inconvenient, especially for those without transportation or too young to drive. Appointments may not be readily available. Being able to buy birth control pills as easily as ibuprofen or aspirin would reduce the number of steps needed to get them into the hands of those who need them.” — Editorial, Star Tribune

Other popular forms of contraception are more vulnerable than the pill

"Even the craziest anti-abortion states like South Dakota and Missouri, I don't think they're banning contraception across the board. But could they have banned Plan B, or they're gonna ban IUDs? I could see that.” — David S. Cohen, constitutional law expert, to Salon

Laws concerning birth control access need to be fundamentally rewritten

“When the birth control pill hit the market in the 1960s, it was revolutionary. … Sixty years later, the science behind the pill has evolved. It’s not your mama’s pill, but you still have to get it the same way your mama, and perhaps even your grandma, did. It’s long past time for that to change.” — Raegan McDonald-Mosley, The Hill

More needs to be done to relieve the cost burden of birth control

“It is past time to implement reasonable measures to make birth control more obtainable, convenient, and affordable — or even free — for all. That was needed before the [Roe] decision, and is even more important now.” — Halle Tecco, Stat

The government shouldn’t be using taxpayer dollars to fund birth control

“The main [argument] for continuing to subsidize Planned Parenthood with hundreds of millions of taxpayer dollars every year is to help women obtain birth control. … We have no constitutional obligation to provide our neighbors — men or women — with contraception.” — David Harsanyi, National Review

Anti-abortion laws also hurt access to birth control

“In many states, anti-abortion politics can limit patients’ access to contraception, especially low-income women who rely on publicly funded clinics. That could be even more true as some abortion clinics around the country start to close following the Supreme Court’s ruling last month overturning the constitutional right to abortion. For many people worried about an unplanned pregnancy, all of the tools that they might use to prevent one — from birth control to abortion — are out of reach simply because of where they live.” — Monica Potts, FiveThirtyEight

Men must take on more of the family-planning burden

“There’s no easy way to shift at least some of the contraceptive burden onto men. There will be moments, like the overturning of Roe v. Wade, that prompt introspection and, for some, action. And forthcoming technologies, like male birth control pills and injections, could provide more flexible contraception options for men. But simply making vasectomies more accessible and less expensive could shift some of the burden soon, at the moment when it is most needed.” — Kenny Torrella, Vox

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