Even as the Supreme Court prepares to consider yet another divisive case involving access to contraception, public health advocates hope these arrangements could spread across the country, as states grappling with persistently high rates of unintended pregnancy seek to increase access to birth control with measures that so far have been unavailable under federal law.
Most Western countries require a doctor's prescription for hormonal contraceptives such as pills, patches and rings, but starting sometime in the next few months, women in California and Oregon will be able to obtain these types of birth control by getting a prescription directly from the pharmacist who dispenses them, a more convenient and potentially less expensive option than going to the doctor.
Pharmacists will be authorized to prescribe contraceptives after a quick screening process in which women fill out a questionnaire about their health and medical histories. The contraceptives will be covered by insurance, as they are now.
The laws are the latest effort to make birth control more accessible, a long-standing goal of medical professionals and policymakers. But unlike other recent debates over contraception - including the firestorm over the Obama administration's requirement under the Affordable Care Act that all health plans pay for contraceptives - these legislative efforts have been largely free of political rancor.
"I feel strongly that this is what's best for women's health in the 21st century, and I also feel it will have repercussions for decreasing poverty because one of the key things for women in poverty is unintended pregnancy," said state Rep. Knute Buehler, a Republican who sponsored Oregon's law.
About half of the 6.6 million pregnancies annually in the United States are unintended, a higher proportion than in Europe.
Reproductive health groups and medical associations increasingly say the ultimate goal should be to make contraceptives available without a prescription, and some worry that the push for pharmacist-prescribed contraceptives could thwart that. The American Congress of Obstetricians and Gynecologists is one of the few groups to express opposition to these laws, arguing that hormonal contraceptives should be available solely over the counter.
"My basic tenet is there should be nobody between the patient and the pill," said Dr. Mark DeFrancesco, the president of the organization. "I'm afraid we're going to create a new model that becomes a barrier between that and over the counter. I worry that it's going to derail the over-the-counter movement."
But supporters of over-the-counter contraceptives acknowledge that getting Food and Drug Administration approval could take a long time because the agency often requires additional studies.
Cost is another possible drawback of over-the-counter sales. The Affordable Care Act does not explicitly require plans to cover over-the-counter medications, so women might wind up paying hundreds of dollars a year for over-the-counter birth control instead of obtaining it free with a prescription.
A bill introduced in Congress in May by Republican senators would help expedite the process in which contraceptive manufacturers apply to the FDA for over-the-counter approval, but some Democrats and women's groups say it might ultimately reduce birth control use because it does not specify insurance coverage for over-the-counter methods. In response, Democrats have introduced a bill stipulating that contraceptives would remain covered if they were to become available without a prescription.
In the absence of federal action, states are stepping in.
Jill Vincik, a high school teacher who recently moved to Bend, Ore., said that being able to get her birth control pills without a doctor's appointment would make life easier.
"I would certainly take advantage of it," said Vincik, 37, a single mother, who noted that she had a gynecological exam before moving and had not yet found a gynecologist in Oregon. "I shouldn't be in a position to have to go to a doctor when my pills run out. I'm not going to do another Pap smear; I just did one."
Advocates of this approach, including pharmacists' organizations, plan to lobby for it across the country.
" I think it can spread pretty quickly," said Buehler, the Oregon legislator, who is also an orthopedist.
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