by Lynn Loacker
Managing Director, Project W
The personal computer. The smartphone. The Pill?
When we think of technological innovations that have fueled massive economic and social change, we think of technology like the PC or the iPhone. But the birth control pill?
The impact of the development and distribution of a small round pill delivering micrograms of estrogen and progestin cannot be overstated. In 1999 and the run up to the millennium, The Economist called the Pill the greatest advance in science and technology in the 20th century – "one invention that historians a thousand years in the future will look back on and say, 'That defined the 20th century.'"
By untethering sex and procreation, the Pill transformed the cultural and societal norms that defined the lives of women. The Pill became available in the 1960s but, because of state law prohibitions, was generally not available to unmarried minors. By the mid-1970s, however, unmarried women between the ages of 18 and 21 were able to legally access oral contraceptives. And that is when the Pill began to fuel what is nothing short of an economic revolution.
In February 2020, the Joint Economic Committee of the United States Congress published an updated report compiling extensive research that demonstrates how accessible and reliable birth control has advanced women's economic empowerment. Among other things:
- College enrollment was 20% higher for women who had legal access to birth control than for those who did not.
- After birth control became legal and accessible, the percentage of women in first-year law and business school classes increased from less than 5% in the 1960s to more than 57% and 39% by 1980 for law and business schools, respectively.
- Access to birth control pills is likely responsible for roughly one-third of the total wage gains women have made since the 1960s.
- It has been estimated that, since the 1960s, access to the Pill at a younger age resulted in an 8% hourly wage premium by age 50.
- By significantly reducing the likelihood of a first birth before age 22, access to the Pill before age 21 increased the number of women in the workforce and raised the number of annual hours worked.
And the economic benefits were not limited to women; the economy, in general, broadly benefitted with more women in the workforce and more hours worked. One study published in 2014 estimated that GDP would have been roughly 12% lower in 2012 without the significant increase in working hours contributed by women.
If the introduction of the Pill unleashed significant economic gains by women, imagine the economic consequences (not to mention the social and human consequences) if the Pill could be obtained without requiring a visit to the doctor or the pharmacy. That kind of access would make the Pill widely available to even more women, particularly women in rural areas and marginalized communities.
That's where the Pill 2.0 comes in. And where the next wave of innovators is aiming to democratize access to one of the most powerful tools of women's economic empowerment.
All you need is the internet and a mailbox
Dr. Sophia Yen spent years of additional training in adolescent medicine so she "could specialize in sex, drugs, and rock and roll." Those years of training led her to become an evangelist for the Pill as the key to women's empowerment. Dr. Yen sees birth control as enabling more women to finish high school and college, to earn advanced degrees, and to pursue careers that place them in the C-suite and boardroom, all of which lead to greater economic equity and financial security.
The research demonstrates that the Pill has played an outsized role in women's economic empowerment over the past 50 years. However, according to Dr. Yen, while 10.7 million women in the United States currently use the Pill, the patch, or the vaginal ring, it is estimated that 70% more pre-menopausal women would use the Pill or another birth control option if they were "easily available." So, eliminate the current barriers to access -- the need to go to the doctor to get a prescription or to make the trip to the pharmacy every month – and more women will benefit from the economic power of the Pill.
That's where Pandia Health comes in. It took a doctor, a woman, and a user of the Pill to see that need for greater and easier accessibility. Through Pandia Health, Dr. Yen and her team aim to enable any woman with access to the internet and a mailbox to get the Pill at a low cost. Dr. Yen's original plan was simply to facilitate the delivery of birth control for her customers – upload a doctor's prescription, bill the insurance carrier, and deliver packets every month until directed to stop. Even without insurance coverage, Pandia Health has made the cost reasonable – anywhere from $7 to $15 per pill pack for most pills.
However, when Pandia Health ran ads for free birth control delivery, 60% of the women who responded didn't have a prescription. So Pandia Health took the step of adopting the protocol approved by the California Medical Board, the California Pharmacy Board, and the American College of Obstetricians and Gynecology of California that permitted pharmacists to write prescriptions for the Pill. Then they added another layer of control by incorporating a review by doctors on their staff and by requiring self-reported blood pressure test results before issuing a prescription. Now, Pandia Health does it all: writes a prescription, advises on the best birth control option for an individual, and delivers a pack every month, 3 months, 6 months, or year, depending on applicable insurance coverage and state regulations.
Understanding that access entails more than simply putting the Pill in your medicine cabinet, Pandia Health's subscription model affords women access to expert birth control doctors who can find the right solution for them with the fewest side effects and who are available for unlimited follow-up questions. And Pandia Health also established the Pandia Health Birth Control Fund to help defray the cost of birth control for the 1 in 10 women who are uninsured.
As easy as buying toothpaste
Another route to democratizing access to the Pill is taking it over the counter. Over 100 countries permit the dispensing of oral contraceptives over the counter without a prescription. But not the United States, where the Food and Drug Administration has yet to approve the switch from prescription to OTC.
As outlined in a paper published by the American College of Obstetricians and Gynecologists, the FDA review for a prescription to OTC switch involves three steps: (1) a label comprehension study to assess whether literate or low-literate users can understand a drug product label, (2) a self-selection study to assess whether consumers can make appropriate self-selection decisions based on the information in the label, and (3) an actual use study to simulate real world use by consumers. However, as described in a recent New York Times article, the FDA is seemingly dragging its feet in moving that process forward when it comes to the Pill.
Although two companies – Cadence Health and HRA Pharma – have been in pre-application discussions with the FDA for several years, neither has filed an application for approval of the switch of its pill from prescription to OTC. And in addition to the slow pace of the FDA process, there are increasing headwinds from anti-abortion groups and from some users of the Pill themselves raising concerns about access to the Pill without a doctor's consultation.
While the availability of the Pill over the counter is apparently still years away, the need for accessible birth control has never been more urgent. A study just published by a group of researchers at the CUNY Graduate School of Public Health & Health Policy found that during the first wave of COVID-19 nearly 40% of the women they surveyed reported delays in obtaining contraception, particularly in obtaining new prescriptions for the pill, patch, or ring. And, in a lighter vein, Amy Schumer also recently called attention to the lack of easily accessible birth control.
Dr. Sophia Yen, Pandia Health
The introduction and availability of the Pill in the 1970s and the 1980s saw a surge in economic empowerment for women and enabled women to earn college and graduate degrees and to advance their careers, thereby increasing their earning power and financial security. However, women in rural areas or marginalized communities still have little or no easy access to oral contraceptives and have not enjoyed the benefits more privileged women have.
As Representative Barbara Lee said on Twitter, "[a]ccess to over-the-counter birth control is a racial equity issue, a gender equity issue, and an economic equity issue." Whether over the counter or in your mailbox, democratizing access is key to ensuring that all women benefit from the power of the Pill.
Learn more about Dr. Yen and her work at Pandia Health - YouTube and Pandia Health's other social media:
Follow the prescription to OTC effort by groups like the Contraceptive Access Initiative and the OCs OTC Working Group.