Approximately 89% of people in the U.S. live near a pharmacy. Yet, not all Americans have the same access to contraceptives at their local pharmacy. Tara Mancini, director of public policy at Power to Decide, shared that statistic and more about “contraceptive deserts” in the session “Pharmacists’ Role in Contraceptive Care” at the APHA 2023 Annual Meeting and Expo. Power to Decide is a nonprofit, nonpartisan organization that works to advance sexual and reproductive well-being.

According to Mancini, more than 19 million women with low incomes live in contraceptive deserts. Of those 19 million women in need of contraception, 1.2 million live in counties without access to a single health center that provides the full range of birth control methods.A Black woman pharmacist is leaning on a pharmacy counter and smiling at the white woman leaning on the counter next to her.

However, there is an increasing interest by states to expand the authority of pharmacists to directly prescribe and dispense hormonal birth control — whether it’s a pill, patch or insertable ring — eliminating the need for people to go to a doctor for a birth control prescription.

Twenty-seven states and Washington, D.C., have given pharmacists prescriptive authority. Among them, Connecticut, Indiana, Massachusetts, Maine, New Jersey, New York and Rhode Island passed the legislation granting that authority to pharmacists in 2023. 

Mancini noted that state policies can be different in a few ways. Some states require insurance. Some states permit pharmacies to dispense a 12-month supply of birth control at one time. Twelve states have an age restriction or require identification for someone to receive their birth control prescription, and seven states placed restrictions on which methods of birth control are available at pharmacies. 

Julia Strasser, assistant research professor of health policy and management at the George Washington University Milken Institute School of Public Health, analyzed prescription data in 13 states where pharmacists have the authority to prescribe contraceptives. In her research, Strasser found that in 2021, 2,947 pharmacists prescribed contraceptives, with significant variation between states. Montana had two pharmacists prescribing birth control, while California had 1,776. States with the highest proportion of pharmacists were Oregon (13.4%), followed by California (11.3%) and Colorado (10.3%). The remaining 10 states had fewer than 10% of pharmacists in the state prescribing.

“It’s a rapidly changing policy area, and some states are still working on creating or implementing policy,” Strasser said. “We need to think about how pharmacists can get the training and support they need to offer contraception.”

Maria Rodriguez, professor of obstetrics and gynecology at Oregon Health & Science University and medical director for Oregon’s Reproductive Health Program, said Oregon was one of the earliest states to adopt a policy on pharmacists offering birth control. When Oregon’s policy began in 2016, it only covered birth control pills and patches. In 2017, the policy expanded to cover the insertable ring and the long-term injection, commonly referred to as “the shot.”

Oregon requires pharmacists to complete a training program, provide a self-screening tool to the person, refer them to a clinician and provide a record to them. In Oregon, pharmacists are prohibited from requiring people to schedule an appointment to receive birth control, as well as from prescribing contraception to individuals who have not had a clinical visit within the past three years. 

Rodriguez found that most people seeking birth control from their pharmacy are uninsured, under age 24 and live in a rural area — all factors that can limit a person’s access to contraception.

“The public health side of things is expanding access to birth control, especially for populations who face barriers to birth control,” Rodriguez said. 

Photo by SDI Productions, courtesy iStockphoto.