On July 13, the Food and Drug Administration (FDA) approved Opill, a daily progestin-only contraceptive pill, for over-the-counter use. (It is currently available by prescription.) This historic advancement makes Opill the first birth control pill available over the counter in the U.S., greatly improving access for many people.
“The science is clear that an over-the-counter progestin-only pill is safe and effective and can advance public health and health equity, especially among communities who face the most barriers in our healthcare system,” Kelly Blanchard, president of Ibis Reproductive Health, which runs the Free the Pill coalition, previously said in a statement. Reproductive health experts say the communities that will be most affected by this change include young women like teenagers, and people who don't have the time or money to obtain a prescription.
Opill's manufacturer says the pill will be available in stores and online retailers by early 2024. Many advocates say the move can’t come too soon. Particularly since, in the wake of Roe v. Wade being overturned last June, many reproductive health clinics have shut down, making it even harder to access contraceptives.
As someone who has personally struggled with obtaining birth control pills, this move feels personal. The need to see my doctor every six weeks in order to renew my birth control, as dictated by ridiculous insurance policies, has caused me to miss work on multiple occasions. Then, more often than not, I've found myself trapped in pharmacy queues that stretch to infinity, just to snag a measly 28-day pack of birth control pills. That's not to mention the intense battles of wits with insurance reps over annoying copays for those doctor's visits.
Preventing an unintended pregnancy shouldn't feel like a dizzying process that results in tears. And yet, the entire thing often feels like an awful, never-ending comedy show (or low-budget horror film, depending on your preference) that usually leaves me questioning the absurdity of it all.
The benefit of "the pill" is its 99-percent effectiveness in preventing unintended pregnancies (when used correctly). Making birth control more accessible not only allows individuals to make informed decisions about their reproductive health but it also allows them flexibility when it comes to family planning. This, in turn, can reduce the number of unplanned pregnancies and help individuals and couples better align their childbearing goals with their personal circumstances.
However, so many people face enormous barriers when it comes to contraception access. In a 2022 survey conducted by Advocates for Youth, 88 percent of young adults struggled to access birth control, while 55 percent experienced such significant barriers—whether due to finances, prescription requirements, lack of insurance, limited access to healthcare providers, or age and consent restrictions—that they were unable to begin taking birth control on their preferred timeline.
And the consequences are distressing. Among those who reported being unable to get on birth control, a notable 58 percent had a pregnancy scare, 20 percent experienced an unwanted pregnancy, and 16 percent ended a pregnancy with an abortion.
Meanwhile, more than 19 million Americans with uteruses who are of reproductive age live in “contraceptive desserts,” according to data from Power to Decide, an organization that promotes sexual health and well-being. Shockingly, approximately 1.2 million of these individuals find themselves in counties “without a single health center offering the full range of [contraception] methods.”
Yet simply bringing the pill over the counter is not enough to truly increase access. Victoria Nichols, MPH, Free the Pill project director, says that in order to maximize the positive impact of transitioning to OTC birth control, it’s crucial to address potential obstacles concerning insurance coverage, like coverage exemptions and cost-sharing requirements that can result in high co-pays, deductibles, or coinsurance.
“Policymakers must ensure that legislative barriers related to insurance coverage don’t push the pill out of reach for the people who stand to benefit the most from the switch, particularly Indigenous communities, people of color, and those working to make ends meet,” Nichols says.
The New York Times reports that Opill's manufacturer has not yet shared how much a 28-day pack will cost, but released a statement that the company is committed to accessibility, and has spoken of plans to make the medication available at no cost to certain populations.
Last year, Democratic lawmakers in Congress introduced the Affordability is Access Act, a proposal that aims to guarantee insurance companies fully cover the expenses associated with FDA-approved over-the-counter oral contraceptives.
“Legislators at the state level can also take action now to promote health equity, human rights, public health and contraceptive equity by requiring that insurers cover OTC birth control methods without a prescription, as eight states have already done,” Nichols says. “Any over-the-counter birth control pill must be covered by insurance and sold at an affordable price.”
The approval of oral contraceptives by the FDA dates back to 1960, marking a significant milestone in contraception history. (In fact, Opill was first approved under a different name 50 years ago.) By 2005, it was estimated that over 500 million women worldwide relied on hormonal contraceptives. Today, approximately 1 in 4 Americans who ovulate and use birth control opt for oral contraceptives.
Yet, despite the large percentage who take “the pill,” the ability to obtain it has remained challenging. Bringing oral contraceptives over-the-counter eases the long-time obstacles. By providing the means to prevent unintended pregnancies, birth control access not only offers reproductive control but also supports women's health, promotes gender equality, and contributes to overall well-being. It is a vital component of comprehensive healthcare that allows individuals to shape their lives according to their own aspirations and goals.
That sounds remarkable to me.
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