Improving Reproductive Health through Over-the-Counter Birth Control Pills

The possibility of being able to purchase birth control pills over the counter took a significant step forward on May 10 as two advisory committees to the U.S. Food and Drug Administration voted unanimously to make a progestin-only pill called Opill available without a prescription. Opill gained FDA approval for prescription use in the United States in 1973 and the switch from prescription to over-the-counter status involves reviewing data that the drug can be used safely and effectively without the oversight of a physician.

If the FDA approves the recommendation this summer, Opill would become the most effective birth control method on store shelves, surpassing existing options such as condoms and sponges, and would remove barriers that can make it challenging for many people to obtain this birth control option. The American College of Obstetricians and Gynecologists, the American Medical Association, and the American Academy of Family Physicians also support an over-the-counter birth control pill.

The possibility of a birth control pill becoming more easily available comes at a time when the United States is facing a maternal mortality crisis, abortion bans, and possible restrictions on an FDA-approved abortion medication. Over-the-counter access to the pill could have a significant impact on reproductive health and autonomy, especially for adults and adolescents facing barriers to accessing different birth control methods.

To gain insights into the potential impact of over-the-counter access to hormonal birth control, scientists interviewed two sexual and reproductive health equity researchers. One researcher noted that transportation to health care appointments, a lack of insurance coverage, and the absence of federally mandated, comprehensive sex education are some of the barriers that adults and adolescents face in terms of accessing different birth control methods. The other researcher emphasized the importance of providing people the opportunity to be unpregnant, particularly considering the additional crises facing reproductive autonomy. If the FDA approves over-the-counter access to Opill, it could extend options to people who otherwise may not have access to a method of birth control that works for them, changing their lives.

SN: What do we know about the historical impact of prescription birth control?

Gómez: The availability of hormonal birth control has been transformative for, historically, cis gender women’s participation in the world, in the workforce, in their ability to engage in education. Being able to control your fertility is such an important part about being able to control your destiny. There are many things that can affect our ability to live the lives that we want, but if you are a person who can become pregnant, [it’s] really important to have the option of deciding if, when and how you want to become pregnant or remain pregnant.

SN: When choosing a birth control method, what does it mean to take a person-centered contraceptive care approach?

Gómez: A person-centered approach, if we’re talking about contraceptive access, means … actually support[ing] the person in making the decision that’s best for them versus what someone else thinks they should be doing. There’s a long history of birth control abuse and coercion in the United States, from forced sterilization to aggressive promotion of certain methods toward Black communities and people who are poor. Even though there are different levels of effectiveness of different types of methods, that doesn’t make one more medically appropriate.

For some people, they don’t like something that they can’t stop using without going to see a health care provider [such as an implant or other long-acting reversible contraception]. You may feel that you’re losing bodily autonomy through using a method that you can’t stop using on your own. That’s a very real concern for some people, and it’s definitely grounded in some of the historical abuses and racism and ongoing experiences of low-quality care that some people, too many people, experience.

Logan: [A person-centered approach] is being OK with people saying, “no,  I don’t want to use that method,” and saying, “that’s fine,” as opposed to [providers] feeling like it’s their job to convince people to get on a method or to use a particular method. [It’s] showing people that you care about them using what feels right and best for them. We’re aligning people’s preferences with methods that are available.

SN: Does the possible over-the-counter availability of hormonal birth control assist with this approach?

Logan: Yes. It gives people the power that they need without these constraints that are really only hurdles. This is in no way to replace routine preventative care. It is to reduce barriers to methods that we know are safe and effective that people can use independently. I think the health care system is already very strained. Is it a good thing that we’re moving some services that we know to be safe and effective outside of the health care system? I would say yes.

Gómez: [Easier access] can make a huge difference for people. Being able to start using [a birth control pill] without seeing a provider, that removes many layers of barriers. All of those can reduce people’s ability to use it at all or to use it continuously. Not everyone wants to use the pill, [but for those who do] having over-the-counter access is really going to help people.

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