The women never received any monetary compensation for their participation, and when the FDA eventually approved the first “lifestyle drug” on the market, the cost was prohibitive to many of the same women who were on the front lines of testing.

“In Puerto Rico, a range of elected officials were opposed because they objected to the idea that Puerto Rican women were being tested for a drug ultimately designed for affluent women living on the mainland,” Marsh said. “A major newspaper accused the researchers of conducting a population-control campaign, and some local doctors told their patients not to participate in the trials.”

While the United States has made sweeping advances in access to birth control, many socioeconomic influences, such as income, location, and education, continue to shape contraceptive decisions and access. While policies like the Affordable Care Act help many insured individuals obtain birth control for free, they do little to assist those without health insurance, who may need to spend thousands of dollars each year out of pocket to prevent pregnancy.

“Institutional barriers to equitable access to care still exist in the United States, even as we have made strides in expanding access to care,” Marsh said. “The Affordable Care Act has dramatically expanded access, but it does not insure everyone. About 27 million people, or 8.4 percent of the population, do not have health insurance.”

Marsh noted that many poor communities still lack equitable access to reproductive health care. An estimated 19 million women of reproductive age are living in contraceptive deserts, which the reproductive rights organization Power to Decide defines as areas with fewer than one health center for every 1,000 women in need of publicly funded contraception. For women living in these areas without access to transportation (or internet access needed for telehealth), the pill may still be out of reach.

Over-the-counter birth control access would be a historic advancement in reproductive healthcare, but it would not undo the country’s legacy of mistreatment. To bridge this gap and effectively get birth control into the hands of all communities, Marsh said, will require a multipronged approach that creates new points of access for underserved communities (for example, distribution in non-traditional settings like barbershops). Transparent patient-provider communication that acknowledges past mistreatment is also a key priority.

“We need to treat this as a community issue, with trusted community members talking to their neighbors and members of community organizations about the pill’s availability,” Marsh said.