The next FDA commissioner needs to address health inequalities and barriers to care


As a practicing obstetrician and gynecologist and an advocate for improving access to reproductive and sexual health and resources, I have seen firsthand how our health systems all too often fail those with the greatest barriers to accessing health care and services.

The Biden government has a unique opportunity to appoint a Commissioner for the Food and Drug Administration (FDA) who boldly addresses systemic biases and obstacles in health care, advocates evidence-based science, and promotes health equity. The next FDA commissioner will play a critical role in setting the direction of our country’s health care. Administration must take into account the needs of people and communities and their opportunities to access health care. The pandemic has shown the importance of having leaders who are science-driven and committed to justice. however, these principles are also important in ameliorating long-standing, recalcitrant health inequalities.

Despite the changes made by the Affordable Care Act and advances in contraception technology Access to contraception remains a major challenge for far too many Americans. The FDA commissioner will have the opportunity to make a huge leap forward in women’s health and access to contraception by ensuring that birth control methods that have been proven to meet the same requirements as other over-the-counter drugs are available over the counter. It has been 60 years since the FDA approved contraception for everyone, but people continue to face medically unnecessary prescribing barriers. The ability to use birth control pills without a prescription would provide a safe and inexpensive method of birth control.

It is also important that the FDA commissioner commit to an evidence-based and timely review of the proposed switch from prescription to over-the-counter (OTC). For years, medical associations and doctors across the country have urged the FDA to investigate the possibility of OTC access to the pill. In fact, the American College of Obstetricians and Gynecologists has officially approved such access for all ages.

In addition, every candidate for FDA commissioner must have a clear understanding of the inequalities in our health care system and how they affect the reproductive health of people of color, people struggling to survive, and people from rural areas. In fact, people with limited resources receiving medical care through Medicaid are more likely Have gaps in access to contraception. Black women and girls are also less likely to have gaps in access to contraception regardless of their income. It is critical that the Commissioner understand the role of the FDA in addressing these inequalities.

In addition, women of childbearing potential have been excluded or underrepresented in clinical trials for studies of conditions such as diabetes and heart disease in the past – and that exclusion was even worse in women of color. The lack of inclusion is reflected in incomplete data sets that prevent some people from making informed decisions about their health care. Therefore, each potential candidate must have a plan on how the FDA can improve and modernize clinical trials and ensure the equitable inclusion of people of color and reproductive capabilities.

A potential candidate needs to trust that people will make their own decisions about their reproductive health – 70 percent of women of childbearing age prefer access to the pill on the store shelf. It is long time for the FDA to take the lead and remove unnecessary barriers. We look forward to working with a Commissioner who is ready to face the challenges of all people – especially those who have been inadequately cared for by our health system for far too long.

Raegan McDonald-Mosley, MD, MPH, FACOG, is CEO of decision-making power, Chief physician of the Initiative to prevent access, and a practicing obstetrician-gynecologist. Follow her on Twitter @DrRaegan.

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