After much opposition from anti-abortion politicians, the Senate confirmed Dr. Robert Califf as commissioner of the Food and Drug Administration after a tight 50-46 vote on Feb. 15. Califf also served as commissioner during the Obama administration and faced criticism over his record handling the opioid crisis. One year after the position was left vacant, and at a time when the stakes for abortion care could not be higher, reproductive rights advocates are calling on Califf to follow the science and advance public health for reproductive health and justice issues.
In December, the FDA announced they would permanently allow the abortion pill to be available by mail order—a reprieve from the abortion care crisis playing out in the Supreme Court. Califf was not involved with that decision, but he defended it during his December confirmation hearing, agreeing with the agency’s decision to make rules grounded in scientific evidence regarding the pills’ safety.
“After reviewing decades of research showing medication abortion is safe and effective, the FDA recently took a significant step to permanently lift some of its unnecessary restrictions so that more people, especially people of color working to make ends meet, can get care,” said Destiny Lopez, co-president of All* Above All said. “This is just one piece of the puzzle to ensure that our communities can get their medication abortion care in the way that makes sense for them.”
Despite the FDA’s decision to lift the in-person dispensing requirements on medication abortion in December, people in 19 states still face barriers to medication abortion due to bans on telehealth for abortion. In its new Action Plan for Abortion Justice, All* Above All calls for an end to these restrictions so that abortion care is available and affordable.
“These bans push care out of reach for people who are already marginalized by our health care system—especially Black and brown women who are working to make ends meet, those who live in rural areas, and those without a nearby health care provider,” Lopez said. “There is no medical or scientific reason for these bans—they are purely political.”
While the FDA does not control state-level decisions, Califf will lead the agency as it reviews an application for an over-the-counter birth control pill this year from HRA Pharma, which has been in the works since 2016. Advocates from the Free the Pill campaign say the progestin contraceptive pill meets the FDA’s over-the-counter requirements. The FDA requires that the pills are not toxic in the event of an overdose, that they are not addictive, that the instructions are simple without a doctor’s explanation, that a person can take the pill safely without a provider’s screening, and that people can determine if the pill is appropriate for them.
“This would be a groundbreaking expansion for access to making birth control pills available over-the-counter,” said Victoria Nichols, project director at Free the Pill. “It can help bridge the gap in access and give people greater control over their reproductive health.”
Despite more than 60 years of proven safety and effectiveness, people still face barriers to getting birth control. The pill can cost up to $50 a month, and if an exam is needed from a doctor to prescribe it, that could cost up to $250 more. Additional barriers include taking time off work or school, finding and affording child care, transportation to a health care provider and the pharmacy, and lack of insurance coverage. An over-the-counter birth control pill presents an opportunity to expand contraceptive access to communities that face these hurdles.
“These barriers fall harder on people of color, Indigenous people, young people, immigrants, LGBTQ+ people, folks who are working to make ends meet,” Nichols said. “These are barriers that are deeply rooted in systemic racism and other forms of discrimination and oppression.”
A 2015 study found that at low and no out-of-pocket cost, a large population of women in the U.S. might likely use an over-the-counter progestin-only pill. A low retail price and insurance coverage are necessary to provide equitable access to this method for low-income populations across the country, fill current gaps in contraceptive access, and potentially decrease unintended pregnancy. Nichols notes that broader access to contraception is not a substitute for abortion care, but it is not an “either-or situation” and similar barriers fall harder on people of color, immigrants, and the LGBTQ+ community.
“The decision about whether and when or how to become a parent is one of the most important decisions someone can make in their life,” Nichols said. “People should have access to birth control and people should have access to abortion, prenatal care, and parenting support so that they can make the best decisions for themselves in their lives and their families.”
Nichols says that access to abortion care helps to ensure that people are healthy and thriving, and access to over-the-counter birth control pills would give people greater control over their reproductive health and lives at a time when access to abortion hangs in the balance. But, even if barriers to birth control are removed, abortion care would still be necessary and “an integral part of the full spectrum of health care.” The application process could take up to six months for the FDA to review.
“We are at a pivotal moment for abortion access in this country,” Lopez said. “With Texas’ abortion ban in place for nearly six months and the Supreme Court weighing a Mississippi case that could decimate access nationwide, we need everyone—from our public health officials to policymakers—to follow the science which makes clear that medication abortion is safe and effective, and ensure that care is available to anyone who needs it.”