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Health & Social Policy National Op-Ed

Popping the Pill: Why Birth Control Should Be Available Over-the-Counter

By Shelby Frye

In 2020, the birth control pill celebrated the 60th anniversary of its approval from the Food and Drug Administration. Six decades after this stamp of  approval, the pill remains one of the most popular contraceptive options in the United States. There are two types of birth control pills- the combined oral contraceptive (COC), and the progestin-only pill (POP). Despite their popularity, birth control pills are inaccessible to many people because it requires a prescription. Because the pill is not available over-the-counter (OTC), many people, especially those with low incomes or no insurance, have reduced choice in their own health decisions and are at higher risk for unintended pregnancy. And while the United States has been dragging its feet over this issue, over 100 countries in the world have granted OTC status to birth control pills. 

What’s more, birth control pills already clearly meet the FDA requirements for OTC status are already clearly met for birth control pills: the benefits of the drugs outweigh the risks, the potential for misuse is low, the condition can be self-diagnosed, and directions for use are clear. In fact, progestin-only emergency contraception is already available OTC in the United States, with no age restriction. 

One of the main arguments against allowing birth control pills to be sold OTC is that they are potentially dangerous and require a doctor’s oversight before they should be used. However, it is well-documented that the birth control pill is very safe, with the Centers for Disease Control and Prevention citing few medical conditions that would prevent someone from taking it.  Research supports the lack of contraindications—medical conditions that may make a certain treatment harmful— of the birth control pill as well as the accuracy of self-screening those contraindications. The probability of contraceptive users overlooking a contraindication is low, casting further doubt on the necessity of seeing a doctor before obtaining birth control. 

Requiring a doctor’s prescription to access the pill may deter those seeking birth control due to the high cost of a doctor’s visit, difficulty getting off of work or a lack of transportation. This places a unique burden on people of color, the uninsured and the poor, as well as young, single people because they are less likely to have the resources to get a prescription. The unnecessary obstacle may force the person seeking the pill to turn to other, less safe birth control options. Pharmacies typically have more convenient hours than doctor’s offices, and they tend to be more common, allowing easier access to contraceptives for most people if the pill were available OTC.  

By making birth control pills more accessible via OTC access, unintended pregnancies may be reduced in vulnerable communities. In the U.S., unintended pregnancies account for approximately half of all pregnancies. Moreover, unintended pregnancies are nearly five times as likely among those with low incomes compared to higher earners, and rates are also higher for people of color and young people as compared to white, older people.

Teen pregnancies are especially high in communities of color, highlighting the need to ensure OTC access with no age restriction. In 2019, the teen birth rate for people of color was over 2x as high as the birth rate for white teens. The CDC  states that access to contraceptives, among other reproductive health services, will improve health outcomes and equity among adolescents. Ultimately, approving OTC status for birth control pills will allow folks to control their pregnancies and give them greater autonomy in planning their own families. 

After all this evidence, then, what is the holdup?  Let’s face it: politics. Although there is some bipartisan support for OTC birth control access (most surprisingly, from Representative Alexandria Ocasio-Cortez and Senator Ted Cruz), the two parties cannot agree on what that access should look like. Some Republicans want to see an age restriction on OTC birth control, and some Democratic lawmakers worry that insurance companies will choose not to cover birth control if it becomes available OTC, placing an even bigger financial burden on contraceptive seekers. Of course, all of this seems to sit perfectly within a culture of paternalism, in which we don’t trust women to make their own decisions about their own bodies, even taking a pill that is arguably safer than Tylenol. Congress has a job: to put politics aside, look at the overwhelming evidence, and pass legislation revoking the FDA’s birth control prescription requirement. If they do, millions of people, and society, stands to gain.

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