We have made significant strides in recent years in reducing the number of unplanned pregnancies. Since 1983, the rate of unplanned pregnancy in the United States has dropped by around 40 percent. The decline in the teen pregnancy rate over the same time period has been even more dramatic, dropping around 84 percent.
The decision to become a parent is personal. When individuals have control over these decisions, it has profound implications for their health and financial well-being, and broader implications for our whole society. Unplanned pregnancies are associated with poorer maternal and infant health outcomes, and costlier medical bills.
Improved access to hormonal contraceptives, commonly called “the pill,” “the patch” or “the ring,” accounts for much of this change, allowing individuals to have more control over their bodies, decision making and planning for their future.
Improved access to contraception needs to be celebrated. But it’s currently being threatened, both by shortages of primary care providers, and direct attacks on reproductive rights. There also remain alarming racial disparities in access to contraceptives, with people of color having less access than their white peers.
According to a 2021 survey from the JAMA Network, about 45 percent of women experienced at least one barrier to reproductive health care services in 2021, up 10 percent from 2017. The most commonly cited reason was difficulty finding a health care provider.
Fortunately, there’s a solution. Bills (2023-S 0103, 2023-H 5282) sponsored by Senator Meghan Kallman of Pawtucket and Representative Camille Vella-Wilkinson of Warwick, would allow licensed pharmacists to prescribe and dispense FDA-approved hormonal contraceptives. Pharmacists receive extensive education on hormonal contraception during training. With this proposal, they will screen patients for potential safety risk factors using the same tool used by other prescribing clinicians, and help connect patients to reproductive health providers when needed.
It is no secret that Rhode Island has an alarming shortage of primary care doctors. Pharmacists are accessible, well-trained, and in every community throughout our state. With this bill, they will help bridge the gap, and ensure access to birth control for all Rhode Islanders.
Rhode Island would not be alone in these efforts. In 2016, Oregon became the first state to allow pharmacists to prescribe FDA-approved hormonal birth control medications. A study published in the journal Obstetrics and Gynecology found that, in the first two years of the program, the bill prevented 50 unplanned pregnancies. This is a significant benefit to the individuals who have greater control over whether and when to have children, but it also saved taxpayers $1.6 million in public costs.
In the years since, nearly half of US states joined Oregon, including New York, Connecticut and New Hampshire. The evidence has been overwhelming: the programs are safe for patients, save taxpayers money, and increase access to birth control.
A key component of Senator Kallman’s bill requires insurers to cover prescriptions and related counseling, even if the pharmacist is out of network. This is vital because, in Rhode Island, pharmacists are currently not contracted with insurers as individual providers. Those managing patients in clinics and hospitals are not tied to a pharmacy and are thus out of network. Without payment, pharmacies would lack resources to train staff and expand access to patients.
Despite recent gains, we must continue to make contraception readily available, especially when provider shortages and political demagoguery threaten to limit access. Birth control is safe and effective. We should trust the medical expertise of pharmacists to help ensure everyone who needs it has access.
Meghan Kallman is a Democrat representing District 15 (Pawtucket, Providence) in the state Senate. Nicole Jellinek is the chair of The Rhode Island Coalition for Reproductive Freedom.
Beth Cronin, MD, is the Rhode Island section chair of the American College of Obstetricians and Gynecologists. Chris Federico, PharmD, is the president-elect of the Rhode Island Pharmacists Association.