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Contraceptive Accessibility

March 8, 2022
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WRITTEN BY Dr. Jill Barnas

Executive Summary

Several types of drugs and devices, available both over-the-counter (OTC) and by prescription, exist to prevent implantation and fertilization of an egg, and reduce the chance for unwanted pregnancies. In general, contraceptives, or birth control, delay ovulation and prevent the fertilization of an egg before pregnancy is established. Prescription contraceptives are the most popular form of birth control. A variety of social determinants of health, such as poverty, lack of insurance, or accessible health care, can create barriers to contraceptive access. To increase access to prescription contraceptives, states have proposed legislation to permit pharmacists to provide oral contraceptives without a doctor’s prescription.


  • Most classes of contraceptives work similarly by disrupting or delaying the release of an unfertilized egg from an ovary during the fertile window, which prevents fertilization.
  • Emergency contraception (Plan B and Ella) is a one-time use, higher dose of basic hormonal birth control that prevents pregnancy by the disruption of  ovulation after unprotected sexual intercourse. These drugs prevent fertilization of an egg.
  • In the United States, it is estimated that approximately 27% of women in their reproductive years live in a “contraceptive desert,” meaning they lack access to all forms of birth control.
  • Eighteen states, including Washington D.C., have passed various laws permitting pharmacists to distribute hormonal birth control without a collaborative physician agreement. 


  • The percentage of women residing in contraceptive deserts within Missouri is unknown.
  • While more states are increasing accessibility to various birth control methods, research surrounding best practice for who provides the prescription (physician-prescribed vs. pharmacy-prescribed) and the OTC status are still ongoing. 
    • Currently, no states have permitted prescription contraceptives to be accessed without a physician or pharmacist prescription.


This Note has been updated. See the previous version here (published in November 2021).

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