Student Health Center Pharmacy

I initially felt relieved when I heard that birth control would be available in North Carolina without a prescription. I thought, "Great! I won't have to endure the stink eye adults give me when I sit in my OBGYN's waiting room!" While access to birth control without the need for a prescription may sound ideal, there are more caveats to this law than one might think.

The law was passed by the North Carolina General Assembly with overwhelming bipartisan support and went into effect in February of this year. It states that people in North Carolina are no longer required to have a doctor's prescription to obtain hormonal birth control. North Carolina is one of over 15 states to enact a law for over-the-counter access to birth control. Contraceptive pills and patches are now available for purchase at pharmacies and drugstores following a brief assessment prepared by the CDC and administered by a qualified pharmacist.

The main goal of the bill is accessibility. In rural populations especially, pharmacies are more common than doctor's offices. North Carolina Health News explained that the pandemic "reinforced the effectiveness of a pharmacy-centered distribution model after the governor gave pharmacists the authority to administer COVID-19 vaccines."

On the topic of accessibility, we have seen many states move to outlaw or tighten laws surrounding abortion. According to the Guttmacher Institute, 54% of pregnancies in 2010 were unplanned. Of these pregnancies, 58% were carried to term, and 27% were terminated by abortion. The remaining 15% resulted in miscarriage. Access to prescription-less birth control lowers abortion rates. This is vital as the Supreme Court could potentially limit reproductive rights challenged by Roe v. Wade.

The primary concern with the law is that contraceptives will remain unaffordable for young, uninsured and low-income communities. In 2010, the Affordable Care Act (ACA) required insurance companies to cover the cost of birth control, but for uninsured people, the out-of-pocket costs can climb up to $600 annually. The U.S. Census recorded that 8.6% of people were uninsured during 2020. A PBS article on the topic shared that only nine states with similar laws state that insurance is required to cover the cost of contraceptives, regardless of whether the buyer is insured. This provision prevents the law from being performative because it does not cover the cost for those that need it most, such as low-income communities of color.

As the law stands now in North Carolina, it is expanding the reproductive health options for the wealthier class, not for the population as a whole. The CDC found that in 2019, 65.3% of women aged 15-49 used a method of contraception. Almost all women will use a form of contraception in their life. An important thing to note is that birth control is not solely for pregnancy prevention. Many people take contraceptives to ward off debilitating cramps and back pain, a heavy flow, or other symptoms such as migraines and depression resulting from menstruation.

As convenient as this law may sound, I worry that it removes the need for a doctor's visit. When you take any method of birth control, you are altering your body's normal hormonal status, which is a very delicate thing. It is often necessary to try different dosages before finding the one that works for the patient.

When starting birth control, Planned Parenthood says that it's common to experience a myriad of side effects. These vary in severity and can include "spotting or bleeding between periods…sore breasts, nausea, or headaches." Complications due to using birth control are uncommon but can include "heart attack, stroke, blood clots, and liver tumors" and can even lead to death in rare cases.

A quick consultation with your local pharmacist does not guarantee this level of attention, especially if they have customers waiting in line to fill prescriptions. Many countries around the world use pharmacists to get a diagnosis of symptoms. In the U.S., we are accustomed to relaying this information to our primary care doctor, who then refers us to a specialist. If we're going to rely on pharmacists as a first stop for treatment, we need to ensure that they can give customers their undivided attention. Customers must also be aware that pharmacists have these capabilities; access to any health care service is only as good as the information provided.

This law is good in theory, but its execution could use some tweaking. As similar laws extend to more states in the U.S., they should include a provision that requires insurance to cover the cost for insured and uninsured people. This law is a step in the right direction, but it should not be our endgame.

As the U.S. tightens its restrictions on abortion access, safe access to contraceptives will become increasingly important. When we pass laws like this, we need to ensure that we are looking out for all communities that could benefit, such as youth, people of color and those with low-income.