What Happened When We Tried to Get Over-the-Counter Birth Control in California

It's been over two weeks since California enacted regulations allowing women to purchase hormonal birth control at the pharmacy without a doctor's prescription. But good luck actually finding a pharmacy that's ready to give it to you.

Calls to over a dozen San Francisco Bay Area, Los Angeles, and San Diego branches of CVS, Rite Aid, and Walgreens yielded zero pharmacies ready to comply with the nearly three-year-old law, which passed in 2013 but was stuck in regulation limbo until April 8, 2016.

Several of the pharmacists I spoke to said they'd heard of the law but had no idea when they'd receive training allowing them to implement it. A spokesperson for Kaiser Permanente, one of the largest health care providers in the state, said they were still waiting for the California board of pharmacy to create regulation—this regulation was actually released to pharmacists and the public two weeks ago. A Walgreens representative said simply that they "do not offer oral contraceptives without a doctor's prescription" and have no current plans to do so.

There's no guarantee your local California pharmacy will ever get with the program—pharmacies are not required to participate. A CVS spokesperson said the company has begun a pilot program at a few select CVS pharmacies to measure demand for over-the-counter birth control and determine how it will fit into "existing pharmacy workflow," but didn't say where those pharmacies were located.

Under the law, woman are now allowed to obtain the pill, the patch, the vaginal ring, and Depo-Provera injection birth control at a pharmacy after completing a 20-question self-screening survey and consulting with a pharmacist, a process estimated to take about 15 minutes. To participate, pharmacists must undergo some additional training, which can be completed through a two-hour online course.

Still, while implementation of the law might be hitting some roadblocks, most women's health advocates believe the reform is a step in the right direction. A 2013 study revealed that over two-thirds of US women support birth control being available completely over the counter. This is unlikely to happen anytime soon, as it would require FDA over-the-counter approval of each individual brand. California is now the state second state after Oregon where women can receive hormonal birth control without a trip to the doctor; Washington passed similar legislation expected to take effect in June, and a comparable measure was recently introduced in the Tennessee state legislature.

Jon Roth, CEO of the California Pharmacists Association, said he expects the majority of the 6,500 California pharmacies in his organization to begin offering the service over the next month.

"The community pharmacy is really the neighborhood face of health care, so we see this as an exceptional opportunity for women to reduce any sort of barrier that they might have had, increasing the convenience in receiving their birth control options," said Roth.

Virginia Herold, executive officer of the California Board of Pharmacy, the organization responsible for the regulation, had a less optimistic estimate, expecting the service to become more widely available in four to six months.

"Most pharmacies are just in the process of stepping up so they'll be able to meet the demand," said Herold. "We wanted the regulation to go into effect as soon as possible."

While California is one of the best states for reproductive rights (over 99 percent of women have an abortion provider in their county, for example, compared to 4 percent in Wyoming), access is still an obstacle. According to Lawrence Swiader of the National Campaign to Prevent Teen and Unplanned Pregnancy, "there are still entire zip codes in California without a clinic within an hour's drive."

"There's demand out there for this, and there's a behavioral issue at hand, too," said Swiader. "We know that if people don't have easy access, they are not likely to find the method that's right for them. They're not going to use the method they've chosen as well as they could."

But some reproductive rights advocates have concerns about women's health care moving from the doctor's office to the local pharmacy chain. Adam Sonfield, a senior public policy associate at the Guttmacher Institute, a reproductive rights think tank, worries that confidentiality may be compromised in a busy pharmacy setting, and that the law might leave women vulnerable to judgment by customers or pharmacists themselves.

"You've seen women being publicly shamed for asking about emergency contraception," said Sonfield. "There have been a few instances of pharmacists treating women really poorly. If you have pharmacists who don't want to be involved in these activities, that's something you need to address."

There's also the chance that making only certain types of contraception available in a pharmacy will steer women away from long-term, reversible methods, such as the IUD, which have become increasingly popular.

"There's the broader issue around choice of methods and making sure that women learn about all the different choices that are out there," said Sonfield. "Knocking down barriers is fantastic, but we want to make sure we're not creating new ones."

And finally, there's worry that the convenience of pharmacy access might dissuade some women from going to their physician for pap smears and STD screenings, an argument Roth likens to holding a woman's birth control "hostage to her getting the other services."

"We don't see those as related," Roth said. "Our members will be encouraging women to continue to seek their primary care providers for those very important screenings."

Dr. Alison Block, a family medicine physician in northern California and a member of Physicians for Reproductive Health, agrees, describing the law as a way to give women the control and autonomy they deserve.

"My main philosophy as someone who provides reproductive health care is to trust women to make their own decisions," she said. "The idea that they have to conversation with a doctor to decide which method is best for them seems overly paternalistic and unnecessary."