Findings

Congress finds as follows: (1) Family planning is basic health care. Access to contraception helps people determine if and when to become pregnant. Contraception is also a cornerstone of reproductive autonomy and can help people fulfill their educational, professional, and social aspirations. (2) As a result of the enactment of the Patient Protection and Affordable Care Act (Public Law 111–148), approximately 151,600,000 individuals in the United States were enrolled in private health insurance plans in the United States in 2020, including 58,000,000 women between the ages of 19 and 64 who had coverage of contraceptive methods approved, cleared, or authorized by the Food and Drug Administration without cost-sharing under such plans. (3) The Patient Protection and Affordable Care Act saved women $1,400,000,000 on birth control pills alone in 2013. (4) According to the Centers for Disease Control and Prevention, nearly 2/3 of women between the ages of 15 and 49 are currently using a contraceptive method, and among sexually active women who were not seeking pregnancy, nearly 9 in 10 have used contraception. (5) Although the Centers for Disease Control and Prevention included family planning in its published list of the Ten Great Public Health Achievements in the 20th Century, people in the United States face a myriad of barriers in accessing birth control, including cost, geography, immigration status, language access, discrimination, and stigma. These contraceptive barriers are rooted in systemic inequities, structural racism, and other forms of oppression in our health care system and society. (6) In 2019, approximately 2,293,000 pregnancies, nearly 42 percent of all pregnancies, in the United States were unintended. (7) Systemic racism and discrimination, as well as lack of access to comprehensive sex education, exacerbates severe health inequities and creates additional barriers to accessing contraception; for example, due to high uninsured rates and barriers, Hispanic women with low-incomes experience a significantly higher rate of unintended pregnancy (58 percent) compared to their White counterparts (33 percent). In a 2023 study exploring challenges accessing contraceptive care among people who identified as Asian-American, Native Hawaiian, or Pacific Islander, Black or African-American, Indigenous, or Latina/Latinx, 45 percent of respondents reported experiencing at least one challenge accessing contraception in the past year. (8) In addition to preventing pregnancy, contraceptives are used for a range of medical purposes, such as treating abnormal uterine bleeding, irregular menstrual cycles, and endometriosis, as well as for people managing other chronic conditions, which are generally higher in communities of color due to systemic discrimination. (9) The Food and Drug Administration has approved, cleared, or authorized multiple emergency contraceptive methods as safe and effective in preventing unintended pregnancy and has approved over-the-counter access to some forms of emergency contraception for all individuals, regardless of age. If taken soon after unprotected sex or primary contraceptive failure, emergency contraception can significantly reduce a person’s chance of unintended pregnancy. Additionally, in 2023, the Food and Drug Administration approved the first over-the-counter daily birth control pill which will give people of all ages greater access to birth control options without a prescription. (10) Contraception is a protected fundamental right in the United States and access to contraception should not be impeded by one individual’s personal beliefs. Providers, including pharmacists, play a key role in providing contraceptive services and important information about prescription and over-the-counter birth control options to people across the country. It is critical that contraceptive care is provided to people of all ages in a supportive way that is culturally appropriate and delivered without stigma, bias, or delay. (11) Reports of pharmacists refusing to fill prescriptions for contraceptives, including emergency contraceptives, or provide emergency contraception over-the-counter have surfaced in States across the Nation, including Alabama, Arizona, California, the District of Columbia, Georgia, Illinois, Louisiana, Massachusetts, Michigan, Minnesota, Missouri, Montana, New Hampshire, New Mexico, New York, North Carolina, Ohio, Oklahoma, Oregon, Rhode Island, Tennessee, Texas, Washington, West Virginia, and Wisconsin. (12) Since the Supreme Court decision in Dobbs v. Jackson Women’s Health Organization (142 S. Ct. 2228 (2022)), there have been increased reports of people being denied birth control at pharmacies. (13) In 2022, the Department of Health and Human Services issued guidance clarifying that refusing to dispense birth control can be sex discrimination under section 1557 of the Patient Protection and Affordable Care Act (42 U.S.C. 18116).