Will over-the-counter birth control be a game changer for reproductive health?

“The 360” shows you diverse perspectives on the day’s top stories and debates.

What’s happening

The Food and Drug Administration approved the first over-the-counter oral contraceptive last week, a step that will soon make one of the most popular forms of birth control available without a prescription for the first time in the United States.

Opill, a birth control pill that was initially approved for prescription use 50 years ago, is expected to be available over the counter starting early next year. In making its decision, the FDA found that Opill can be used “safely and effectively” without direct guidance from a doctor, and the benefits of nonprescription access outweigh any potential risks.

Since first being made available in 1960, birth control pills have proved to be among the most effective forms of contraception and carry a low rate of serious side effects, especially when compared with the risks associated with pregnancy. More than 100 countries currently allow birth control pills to be purchased without a prescription.

Unlike the majority of oral contraceptives on the market, which contain both estrogen and progestin, Opill is a low-dose “minipill” that contains only progestin. Minipills are considered to be slightly less effective at preventing pregnancy than more popular combination pills but are seen as having a somewhat lower risk profile.

Why there’s debate

The American Medical Association released a statement calling the approval of over-the-counter birth control “a monumental step in providing broader access to safe and effective reproductive health care” in a nation where nearly half of all pregnancies are unplanned. The AMA, along with several other prominent medical groups, argue that removing the “barriers” to accessing contraception will empower more Americans to make their own family-planning decisions at a time when strict new restrictions are being imposed on reproductive care in Republican-led states.

But others say there are reasons to be skeptical that the change will really make much of a difference. To start, Opill is just one of the many oral contraceptives on the market, and it’s in a formulation that the majority of women don’t use. It’s also unclear how much Opill will cost and whether it will be covered by most insurance plans. Some research shows that even an expense of $20 a month could be too much for some people to consistently afford.

Some conservatives also believe that nonprescription birth control is a mistake. A coalition of Catholic groups said they “strenuously oppose” the policy in a letter to the FDA last year, arguing that patients will face elevated risks of complications if they don’t have a doctor’s guidance. Others said they were against over-the-counter birth control based on the heavily disputed belief that increased availability of contraception will encourage risky sexual behavior, particularly among teenagers.

What’s next

Opill will likely remain the only nonprescription birth control pill on the market for a while. At least one other drug company has said it intends to pursue nonprescription approval, this time for a combination pill, but still plans to conduct further trials before submitting an application to the FDA.

Perspectives

Over-the-counter contraceptives could make a life-and-death difference in post-Roe America

“Increasing access to a highly effective contraceptive method is a public health necessity. This urgency has been heightened with the onslaught of restrictions limiting abortion care.” — Leana Wen, Washington Post

Cost will determine how much of an impact the change will have

“It’s great that it’s going to be over the counter, but that doesn’t mean that everyone’s going to be able to afford it. … For someone who has limited income, it may be hard to purchase an over-the-counter medication.” — Carolyn Sufrin, Johns Hopkins School of Medicine associate professor, Futurity

It’s risky to allow people to make major reproductive health decisions without a doctor’s input

“Does the FDA really expect young girls and women using OTC oral contraceptives to potentially self-monitor multiple kinds of cancers, STDs, psychiatric changes and other serious adverse effects? Requiring professional medical screenings, follow-up visits, education, tests and examinations are not barriers to good health in women and girls, but the best protection.” — David Gortler, Newsweek

Those with the least power will see the greatest benefit

“Despite the popularity and the decades of safe use and research contraception, many people still face barriers to birth control. And we know that these barriers fall the hardest on young people and Black, indigenous, and people of color.” — Sarah Baum, senior research scientist at Ibis Reproductive Health, The Root

Opill can provide a convenient backup when contraceptive care gets disrupted

“Adding Opill to the contraceptive toolkit relieves some of the stress surrounding contraception. It means not having to scramble for or cram in a last-minute doctor’s appointment to secure pills before traveling. It means not risking an unwanted pregnancy if you run out before a refill, lose a pack or there’s a delay when changing providers.” — Adrianna Rodriguez, USA Today

Conservative backlash could mean many Americans can’t access nonprescription birth control

“I expect there will be people who are opposed to this precisely because it enables minors to obtain [birth control] without a prescription or without parents’ knowledge. I could certainly imagine that in certain states — in the name of parents rights, being anti-woke — trying to say that the state is going to prohibit the sale of the drug to minors.” — Wendy Parmet, co-director of the Center for Health Policy and Law at Northeastern University

A single pill going over the counter won’t change much

“The FDA took a mini step in the right direction by allowing women over-the-counter access to one mini pill. But Americans should not be satisfied until all forms of hormonal contraception are set free from the government's yoke.” — Jeffrey A. Singer, Reason