Over the Counter Birth Control Pills & Disability Justice

In March, an over-the-counter birth control pill finally became available in the US. This new advancement will improve access to birth control for marginalized people, including low-income people, people of color, and Disabled people.

Over 100 other countries also offer over-the-counter birth control pills, and this type of pill was approved over 50 years ago, with decades of experience proving its safety and efficacy. So while this may seem like a relatively small advancement in reproductive justice, it is important to celebrate the small wins. In collaboration with URGE (Unite for Reproductive and Gender Equity), I wanted to explore the ways the option of an over-the-counter birth control pill can reduce barriers to contraceptive access for Disabled folks.

What is reproductive justice?

The term for the concept of reproductive justice was coined by a group Black women in 1994 as an alternative to the reproductive rights movement, recognizing that the reproductive rights movement frequently excluded the needs of marginalized women and trans people while favoring the experiences of white middle-class and upper-middle-class women. Reproductive justice combines elements of reproductive rights and social justice. The organization SisterSong defines reproductive justice as “the human right to maintain personal bodily autonomy, have children, not have children, and parent the children we have in safe and sustainable communities.”

These changes are similar to the transformations the disability activism community has experienced in the shift from disability rights to disability justice. Disability justice was coined by performance troupe Sins Invalid in 2005. Disability justice is a specifically anticapitalist and anticolonial framework that seeks to recognize those who were “invisibilized” by the original disability rights movement – “[those] who lived at intersecting junctures of oppression – disabled people of color, immigrants with disabilities, queers with disabilities, trans and gender non-conforming people with disabilities, people with disabilities who are houseless, people with disabilities who are incarcerated, people with disabilities who have had their ancestral lands stolen, amongst others.”

Both the reproductive justice and disability justice movements emphasize the importance of intersectionality and bodily autonomy.

Why is reproductive justice important for the Disability community?

Disabled people still face significant stigmas regarding sexual and reproductive health. Disabled people face reproductive-health-related ableism from many different angles, from healthcare providers making assumptions about whether Disabled people are sexually active, to intellectually and developmentally disabled people being overprescribed birth control or even forcibly sterilized, to people with chronic illnesses like endometriosis, polycystic ovarian syndrome, and hormonal disorders not being able to access healthcare that would ease their symptoms.

For as many access issues Disabled people have in reproductive healthcare, we have as many variations in the ways we fight it. Disabled activist Laurie Bertram Roberts created the organization Yellowhammer Fund to help people in the deep South access abortions. Recent Guggenheim Fellow Jessica Blinkhorn’s performance art has explored themes of sexuality and dominance through a disability lens. And a recently opened sexual wellness store in Atlanta, Kiss and Ride, highlights access for queer Disabled folks.

What barriers to accessing birth control has the Disability community faced?

The Autistic Self-Advocacy Network, in collaboration with the National Partnership for Women & Families, wrote an excellent paper explaining the many barriers Disabled people face while trying to access contraceptives, and I recommend checking it out if you want to learn more.

• Lack of contraceptive coverage for Medicare recipients

While Medicare is typically thought of as only being for people over 65, the government health insurance also covers people of all ages with qualifying disabilities. Unfortunately, Medicare does not require contraceptives to be covered if they are being prescribed to prevent pregnancy, and does not cover all forms of contraceptives. Medicare enrollees had at times been forced to pay out-of-pocket for contraceptives, and Medicare Advantage enrollees had higher incidences of IUDs and tubal ligations compared to reproductive-aged people covered by traditional Medicare.

 A 2019 study found that 14.3% of people enrolled in traditional Medicare and 16.3% people enrolled in Medicare Advantage had an insurance claim for contraception in 2019. In comparison, 25% of people enrolled in Medicaid, which is required to cover all types of contraceptives, had an insurance claim for contraception in 2019.

• No insurance coverage at all

Many Americans, including Disabled people, are uninsured, making the out-of-pocket cost of contraceptives prohibitive. While the over-the-counter birth control is still expensive at $19.99 for a one-month supply, not needing a prescription does eliminate the cost of a prescribing appointment which would have previously been necessary.

• Stigma and lack of medical education by providers

Healthcare providers frequently fail Disabled people by assuming, subconsciously or not, that Disabled people are not interested in or capable of sex and that they have no reproductive justice needs. Healthcare providers may prescribe types of contraceptives that conflict with the patient’s access needs, comfort levels, or are not what the Disabled patient truly wants. Providers may not share the full spectrum of contraceptive options available. Intellectually and developmentally disabled people receive less sexual and reproductive health education overall, including about consent.

• Non-contraceptive reasons birth control is used

Birth control is frequently used to treat uncomfortable or debilitating symptoms in chronically ill menstruating people, including heavy periods, endometriosis, chronic anemia, hormonal imbalances and uterine or ovarian cysts. An over-the-counter birth control pill increases access for this part of the community.

• Medical burnout

Caring for yourself as a Disabled or chronically ill person is hard, and it can be difficult to want to schedule another doctor’s appointment on top of other appointments and care tasks. An over-the-counter option for oral birth control can help reduce this feeling of burnout for some Disabled folks, as well as cutting down on medical costs like transportation and a copay.

Despite this win, we should keep fighting for reproductive justice and better improvements to this access, such as lowering the price and requiring insurance coverage. By continuing to pressure pharmaceutical companies, retailers, and policymakers, we can ensure that this new availability of an over-the-counter birth control pill increases reproductive justice for all Americans, including the Disability community.