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Birth control should NOT require a prescription. 
Around 1/3 of hormonal contraceptive users say they’ve had gaps in pregnancy prevention or self-discontinued their medication solely due to issues with prescription access.
https://www.liebertpub.com/doi/abs/10.1089/jwh.2015.5312
https://www.liebertpub.com/doi/abs/10.1089/jwh.2015.5312
Concerns about risks are well-meaning, but rooted in a dark history of over-reaches in controlling reproductive healthcare.
These concerns rely on assumptions that patients cannot self-screen. BUT the science has consistently shown patients determine safe eligibility for use based on screening questions AS WELL (and sometimes MORE accurately) than physicians.
Even if we ignored that data, progesterone-only pills have very few contraindications. For combined pills, nearly every risk associated with their use would be increased 2-10x in a pregnancy.
But, we don’t even have to ignore that data. We know that our patients are capable of accurately self-screening. They just need the tools.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2615461/Provide
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2615461/Provide
Provide the tools = EMPOWER our patients. 
Improve contraceptive access = DECREASE unintended pregnancy.
Decrease unintended pregnancy = SO. MANY. BENEFITS. (Psychological, social, economic, medical, monetary.)
Improve contraceptive access = DECREASE unintended pregnancy.
Decrease unintended pregnancy = SO. MANY. BENEFITS. (Psychological, social, economic, medical, monetary.)
“But nobody will get their pap smears anymore.” 
This theoretical go-to argument is worth discussing, mostly because it’s largely unsupported by available evidence. https://www.contraceptionjournal.org/article/S0010-7824(12)00105-9/fulltext
This theoretical go-to argument is worth discussing, mostly because it’s largely unsupported by available evidence. https://www.contraceptionjournal.org/article/S0010-7824(12)00105-9/fulltext
Consider that most of those who have access to care, but choose not to use prescription contraceptives, still obtain preventative screenings.
Regardless, it is unethical to hold contraception hostage in exchange for health screening. 
For preventative health screening our patients need ACCESS & AFFORDABILITY.
They need reliable & understandable information on when & where to obtain screening.
They do NOT need an unintended pregnancy or hostage prescription.
They need reliable & understandable information on when & where to obtain screening.
They do NOT need an unintended pregnancy or hostage prescription.
In conclusion, available evidence supports the desire, need, and relative safety of over-the-counter hormonal contraceptive access. Nobody should control your reproductive health except you. 
ACOG Committee Opinion: https://www.acog.org/en/Clinical/Clinical%20Guidance/Committee%20Opinion/Articles/2019/10/Over-the-Counter%20Access%20to%20Hormonal%20Contraception
