We can’t discuss reproductive health without also considering reproductive freedom. Although great strides have been made over the past 50 years to provide women with access to birth control, safe and legal abortion, prenatal services, safe childbirth, and fertility services, lately, it feels like the clock is spinning backward at warp speed.
Around the country, laws around women’s bodies are changing, often at the expense of health and, in many cases, the cost is life itself. While the Biden administration is committed to protecting reproductive rights, not all federal and state agencies are in agreement.
According to Planned Parenthood, after the Supreme Court overturned Roe v. Wade in June 2022, one in three women now live in states where abortion is not accessible. Less than two years after women lost their constitutional right to abortion, 21 states banned or severely restricted abortion. Three additional states blocked bans, but the future is uncertain.
Our next presidential election is months away, and it’s an understatement to say abortion is a divisive issue. Politically driven attacks against women and their right to control their bodies are hot-button issues (among many) that are about to catch fire. Former President Trump thinks abortion should be left to individual states, while the Biden administration continue to fight for reproductive freedom for all women, regardless of where they live.
In New York, abortion has been legal since 1970, and, according to the state government website, “Because the right is codified in New York State law, federal decisions to limit access to abortion will not impact New York State.” This reproductive freedom benefits not only New Yorkers, but anyone from outside the state who needs abortion care. Both medical abortion and in-clinic abortion are available in New York State up to and including 24 weeks of pregnancy, and after 24 weeks, abortion is available if a woman’s health or pregnancy is at risk.
Hochul is part of the Reproductive Freedom Alliance, “a nonpartisan coalition of 23 governors committed to protecting and expanding reproductive freedom,” and in January, she announced $100 million in new funding to support abortion providers and reproductive health care. New York’s commitment to reproductive freedom includes a $35 million investment to support abortion providers across the state and purchasing a five-year supply of the abortion pill misoprostol. Hochul is also signing laws that protect patients and providers, which includes bolstering access to abortion care through telehealth services.
In addition, Hochul joined New York State Health Commissioner Dr. James McDonald on March 19 to sign a standing order authorizing pharmacists to dispense three types of hormonal contraceptive medication—an oral hormonal pill, a hormonal vaginal ring, and a hormonal contraceptive patch—without a prescription. According to reporting from Gothamist, when the order was signed, Dr. McDonald said, “Health department data shows 85 percent of pharmacies plan to take advantage of the order, but it will take some time for them to complete the required training.”
The program seems to be getting off to a slow start in the Hudson Valley. I called Dedrick’s Pharmacy in New Paltz and was told, “It’s not in effect yet for us. We don’t have it set up so far. It’s a brand-new ruling.” I brought up the order and the information on the state website, but the pharmacist said, “It’s all up in the air. We don’t even know what we’re doing yet.” Nekos-Dedrick’s Pharmacy in Kingston declind to answer, telling me: “We’re super short-staffed and super busy.”
On April 23, over a month after the order was signed, I spoke with Rebecca Kelly, a pharmacist who owns Kelly’s Pharmacy, which has locations in West Coxsackie, Greenville, and Delmar. Kelly told me that her stores aren’t offering it yet but that pharmacists can actually write a prescription for birth control (not true) and that she didn’t think the order had “come out” yet (it had). Kelly also told me that “it’s not something we’ll carry on the over-the-counter shelves because it requires medical oversight.” I asked Kelly about Opill, the first nonprescription daily oral contraceptive that can be bought off the shelf that the FDA approved last July. “I have no idea what that is,” Kelly said.
“While increasing access to birth control is not a solution to the ongoing attacks on abortion access and other forms of sexual and reproductive health care, it is a critical part of protecting our reproductive freedom.” —Wendy Stark, president and CEO of Planned Parenthood of Greater New York
The pharmacist at Vogel Pharmacy in Wappingers Falls seemed slightly more apprised of the situation when he said, “I do not have any at the moment.” When I asked if he already carried it but just didn’t have any in stock, he told me, “I know they were putting something out, but I didn’t know it came out yet.” He told me he’d look into it and I should call back.
I tried College Parkside Pharmacy in Albany, where Hochul and Dr. McDonald signed the order. I figured they’d have it, but they did not. “You have to try one of the bigger retail places,” the clerk told me. “We’re too small.”
I finally succeeded in finding Opill at Walgreens on Holland Avenue in Albany and at Walgreens in Hudson. CVS in Hudson also carries Opill, but CVS in Rhinebeck told me, “Our location isn’t carrying that yet.” Satisfied that over-the-counter birth control is at least available in the Hudson Valley—albeit not without a prohibitively long drive for some people—I stopped making phone calls to pharmacies and turned my focus to getting additional information from county and state offices as well as from medical professionals.
No Comment
I contacted Northern Dutchess Hospital in Rhinebeck and Westchester Medical Center in Valhalla, but neither could find an OB-GYN to comment.
I then reached out to the Family Planning office at the Greene County Public Health Department. Although the receptionist I spoke to was friendly and told me someone would get back to me with comments on birth control access and reproductive freedom, I never heard from her again.
I had higher expectations for Ulster County, which has almost five times the Greene County population. I called the county office and was connected with Amberly Jane Campbell, assistant deputy county executive. Campbell is the Ulster County communications chief and she told me she could get a statement from Jen Metzger, Ulster County Executive. I wanted to hear from a health professional, not a politician, and as a former journalist, Campbell understood and told me she’d get back to me. A week later, she responded, “We conferred with a few different doctors and tried to get someone who would be willing to go on the record, but we were unable to find anyone.”
Blanket Prescription
With the local hospitals and county offices not willing to comment, I reached out to the New York State Department of Health. Danielle R. De Souza, M.Sc., senior public information officer, cleared up some of the confusion, specifically that the standing orders for contraception and over-the-counter products like the FDA-approved Opill are not the same.
“The standing order is functionally a blanket prescription for all New Yorkers and those visiting New York from out of state that has been written and signed by State Health Commissioner James McDonald, a licensed physician, which is what allows individuals who meet appropriate screening criteria to obtain a hormonal contraception without first visiting a prescribing clinician,” De Souza said. While the oral pill, the hormonal vaginal ring, and the hormonal patch will be available without an individual prescription (because of the blanket prescription from Dr. McDonald), they do require a consultation with a pharmacist and are not available over-the-counter.
Opill is truly over-the-counter. It will be in the family planning aisle and can be picked up and paid for just like condoms. The price will vary, but it should be around $20 to $25 a month. Opill is federally approved, and all 50 states can sell it, though pharmacies aren’t required to carry it.
“Participating pharmacists dispensing these medications are required to provide the individual with a self-screening patient intake form,” De Souza says. “If the pharmacist deems the selected medication appropriate, they will provide counseling including direction for self-administered usage, potential risks associated with medications, and risk for HIV and other sexually transmitted infections.”
A Huge Plus
What does over-the-counter birth control mean for reproductive freedom? Well, it’s complicated. “While increasing access to birth control is not a solution to the ongoing attacks on abortion access and other forms of sexual and reproductive health care, it is a critical part of protecting our reproductive freedom,” says Wendy Stark, president and CEO of Planned Parenthood of Greater New York.
Georgie Kovacs is a biopharma strategist who founded Fempower Health, an organization that educates and empowers women to find answers and solutions to their healthcare needs. “From a reproductive rights perspective, the availability of over-the-counter birth control is an incredible step forward, allowing more individuals to exercise their right to choose when and if to have children, without the barrier of a prescription,” Kovacs says.
Kovacs lives in the Westchester village of Irvington and was happy to discover that her local CVS carries Opill for about $20. Because Opill is as easily accessible as any other over-the-counter product—and there’s no age restriction—one group who may benefit is teenage girls seeking a birth control method to use in place of, or in conjunction with, condoms.
(One problem: insurance doesn’t cover products bought over the counter, which means cost may be a challenge for some. Even for those with insurance, other issues include finding healthcare providers who are taking new patients and then, if they are, waiting several months to get an appointment.)
“Another huge plus of the new order is that pharmacists can dispense up to 12 months of supply [at one time], and a larger dispensed supply has been shown to improve contraceptive continuation,” says Paula M. Castano, MD, MPH, associate professor of obstetrics and gynecology, chief, Division of Family Planning and Preventive Services and medical director of Outpatient Services, Columbia University Irving Medical Center/New York-Presbyterian Hospital. “Some states and plans include over-the-counter coverage,” Dr. Castano says, adding that Opill is offering discounts with more packs purchased and they have an assistance program.
“This is a game-changer for communities impacted by systemic health inequities,” says Mary Jane Minkin, MD, OBGYN and clinical professor at the Yale University School of Medicine. “In the best of all possible worlds, all women would have an outstanding women’s health care provider, but unfortunately, many do not. Having safe, reliable contraception available is vital, especially in this day and age.”
This article appears in June 2024.
