I'm an Ob-gyn — Here's What I Think About the Possibility of OTC Birth Control Pills

Expanding access to reproductive health care has never been more important.

Birth Control
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In case you missed it, the U.S. Food and Drug Administration (FDA) just received its first application from a company, HRA Pharma, to sell its birth control pill (Opill) over the counter without a prescription. In some other countries, it's actually common to find birth control pills available for purchase without having to see a physician first. In fact, about 100 countries don't require a prescription for oral contraceptives, according to a global review published in the journal Contraception. So why has it taken so long for the U.S. to consider this option?

Making birth control available over the counter allows people to get highly effective birth control and start it immediately without waiting for an appointment with a medical provider. Given that approximately half of all pregnancies in the U.S. are unintended, the increased availability of over-the-counter options for birth control will allow people to have more control over how they build their families. (Related: What to Know About Getting Abortion Pills In the Mail)

The main concern for limiting the availability of over-the-counter birth control pills is that they pose a rare, yet life-threatening complication of blood clots. Those who get life-threatening blood clots from birth control pills account for up to nine in 10,000 users and usually, an underlying condition accounts for the cause of the blood clot. Although this health complication is serious, for context, statistically speaking, someone has a higher risk of a life-threatening blood clot during pregnancy. (See: 6 Medical Reasons Someone May Need to Have an Abortion)

Much like the emergency contraceptive option, Plan B, which the FDA made accessible over the counter for people of all ages in 2013, Opill is a progestin-only medication, which carries a lower risk of blood clots than other forms of birth control pills. Other forms of birth control pills that contain a combination of estrogen and progestins carry a higher risk of forming life-threatening blood clots due to the addition of estrogen.

Heather Irobunda MD, FACOG

Given that approximately half of all pregnancies in the U.S. are unintended, the increased availability of over-the-counter options for birth control will allow people to have more control over how they build their families.

— Heather Irobunda MD, FACOG

There are also concerns that people won't be able to understand the instructions for how to use birth control pills provided with the medication without a prescription. However, HRA Pharma has conducted years worth of research that shows consumers can understand the instructions and information that comes with their medication. Additionally, research has found that providing oral contraception users with more pill packs and removing the element of requiring a prescription leads to an increased continuation of use. This correlates with my experience caring for patients looking for an easy, effective way to prevent pregnancy. Making a variety of birth control options more accessible helps people take better control of their reproductive health.

The American College of Obstetricians and Gynecologists (ACOG) and reproductive health advocates have been long-time champions of making birth control pills easily accessible. The ACOG not only supports this current application by HRA Pharma for its over-the-counter progestin-only birth control pill to be approved by the FDA, but it also backs further expansion of access to birth control pills, citing overwhelming data demonstrating the benefits of doing so. These benefits include great ease of obtaining birth control pills and fewer unplanned pregnancies. It can already be so difficult to juggle the responsibilities of jobs, school, and home life, so making it easier to get birth control allows people to have more control over their bodies and their reproductive health.

In the wake of the Supreme Court's decision to overturn Roe v. Wade, the 1973 case that constitutionally protected the right to abortions, all avenues must be explored when expanding access to reproductive health care. However, HRA Pharma's application to sell its birth control pills without a prescription was unrelated to the recent Supreme Court decision, according to the Associated Press.

Nevertheless, having birth control pills available over the counter in states with restrictive abortion laws will allow those who don't want to have children to have an additional tool for pregnancy prevention. Communities that have large numbers of people who are uninsured and underinsured will benefit from the increased availability of over-the-counter birth control because it allows people access to these medications without making a medical appointment. Hopefully, in addition to making this medication available without a prescription, it will also be covered by insurance carriers to remove yet another barrier to accessing this care. (Related: Experts Unpack the Ripple Effects Overturning Roe v. Wade Will Have On Black and Brown Communities)

Overall, this application is an important step forward in the fight for accessible reproductive health care. More access to birth control provides better prevention of unintended pregnancies and may help many avoid the need for abortion care in parts of the country where access to it is scarce.

Dr. Heather Irobunda is a board-certified obstetrician-gynecologist currently practicing at NYC Health and Hospitals. After receiving her bachelor's degree, and completing a post-baccalaureate program, she earned her doctorate of medicine in 2011. She went on to serve as an active-duty Army ob-gyn while completing her residency in obstetrics and gynecology at the Walter Reed National Military Medical Center. Now, with more than a decade of experience in the medical field, her work is dedicated to empowering women to make informed decisions about their health. Follow her on Instagram @drheatherirobundamd.

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