The next FDA commissioner must let science and equity lead

Two landmark policies that determine people’s health and reproductive autonomy—making birth control pills available over the counter and eliminating medically unnecessary restrictions on medication abortion care—could be finalized by the Food and Drug Administration in the coming months.  The new FDA commissioner, who is expected to be nominated by President Biden soon, will have the crucially important task of ensuring that these policies are guided by science and equity, not by politics.

First, the birth control pill is in the final stages of the FDA’s review process to become an over-the-counter drug available without a prescription. This would mean that oral contraceptive pills would be available on the store shelf, right next to condoms and other forms of contraception—as is already the case in over one hundred other countries.

If science and commonsense prevails over politics and stigma, over-the-counter birth control pills will be covered by insurance and available to all who seek them. The pill has a decades-long safety record, and many of our nation’s preeminent medical societies—including the American College of Obstetricians and Gynecologists, the American Medical Association, and the American Academy of Family Physicians—have endorsed making the pill available over the counter. A recent Kaiser Family Foundation survey found that 70 percent of women of reproductive age support this change. It’s time this safe, routine health care is made available to all who need it.

Historically, systemic inequities have pushed reproductive health care out of reach for people of color and people with lower incomes. Increased access to contraception is a long overdue advancement for reproductive justice that would help give people of all races and incomes the ability to choose when to start a family and manage their health. To meaningfully advance health equity, over-the-counter birth control must be affordable and accessible for communities that have historically faced barriers to access.

Second, for too long, the FDA has required that mifepristone—one of the two drugs used in medication abortion—be dispensed to patients in person. Medically unnecessary restrictions like the in-person dispensing requirement interfere with this essential health care. They also create barriers to access for people who need to take time off of work, obtain childcare, or travel to obtain the drug in person—all of which require financial privilege. These barriers push care further out of reach and exacerbate longstanding health inequities. 

Following a letter I sent with Rep. Ayanna Pressley (D-Mass.) and the Democratic congresswomen of the Oversight Committee, the FDA suspended the in-person dispensing requirement for the duration of the coronavirus public health emergency.  And in May, the FDA announced a full, evidence-based review of the restrictions on mifepristone. FDA’s own analysis has already shown that lifting the in-person dispensing requirement for mifepristone during the coronavirus pandemic did not increase serious safety concerns. The next FDA commissioner should lift medically unnecessary restrictions on medication abortion care as part of the agency’s mission to make health care access more equitable. 

The FDA has not always met its obligation to advance equitable health policy. For example, access to emergency contraception was significantly delayed when politicians interfered with FDA recommendations. And for years, women of reproductive age were often excluded from clinical trials, resulting in poor access to safe and effective drugs and devices. 

Expanding access to contraception and early abortion care would empower millions of people to plan their future and manage their health on their own terms. The next FDA commissioner must insulate the agency’s policymaking from political interference and let science and equity lead.  Access to health care should be based on science—not politics.

Rep. Carolyn B. Maloney is the Chairwoman of the Committee on Oversight and Reform and represents the 12th District of New York in the U.S. House of Representatives.