Benefits Of Low Estrogen Birth Control Pills – , the dire state of reproductive health in the United States—including access to contraception—moved to the forefront of public consciousness. Expanding access to the full range of contraceptive options would not negate the need for abortion care services, but contraceptive care is a key access point to ensure women can plan their pregnancies and to improve access to comprehensive reproductive health and rights. This includes expanding access to hormonal contraceptives, which are the most common form of reversible contraception in the United States.

The most common reason for using contraceptives is to prevent pregnancy, but many women also use hormonal birth control pills to treat other health conditions – such as irregular periods, menstrual pain and acne – further emphasizing the importance of access to contraceptives. Unfortunately, many women and other people who use contraception—some studies estimate as many as one-third of adult women—report that they have barriers when seeking contraception. These barriers include, but are not limited to, financial concerns and inaccessibility; lack of transportation; living in a rural area or underserved community; cultural and linguistic differences in relation to their providers; and more. In addition, 19 million women of reproductive age live in contraceptive deserts, which are counties where the number of health centers offering a full range of methods is insufficient to meet the needs of the number of women in the county who are eligible for publicly funded contraception. Furthermore, Black women and other women of color face increased barriers when seeking contraceptive care—especially Black women, who have faced decades of misinformation and coercive and unethical practices regarding contraceptive access.Twitter Contraceptive care is a key access point to ensure that women can plan their pregnancies and to improve access to comprehensive reproductive health and rights.

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, advocates’ long-standing efforts to expand access to contraception by securing over-the-counter approval have gained renewed attention. Last July, HRA Pharma took one small step in that direction when it filed a first-of-its-kind application with the US Food and Drug Administration (FDA), seeking approval to sell its Opill over-the-counter. Opill is a progestin-only daily contraceptive pill that has been used by prescription for 50 years and – because it does not contain estrogen – carries a lower risk of blood clotting than other hormonal pills. If approved, it would be the first over-the-counter hormonal contraceptive pill in the United States. Another pill company — Cadence Health — is reportedly close to filing for approval of its combined progestin-estrogen birth control pill. For more information on the types of oral contraceptive pills, see the text box below.

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The FDA OTC approval process is lengthy and takes about 10 months. As a result, the general public is unlikely to see any developments until mid-to-late 2023. Regardless, the public should be aware of the impact these apps may have on access to contraception.

There are three types of oral contraceptive pills: combined, progestin-only, and extended-release and continuous-use pills. The types of pills available are described below along with examples, how they work, and a typical daily regimen for users.

As noted above, the oral contraceptive pill is the most common form of reversible contraception in the United States. Data from the 2017–2019 National Survey of Family Growth shows that 65 percent of women ages 15 to 49 use contraception. The most commonly used contraceptive methods were “female sterilization (18.1 percent), oral contraceptive pills (14 percent), long-acting reversible contraceptives (10.4 percent) and external condoms (8.4 percent).” These numbers vary among racial groups, with current use “higher among non-Hispanic white women (17.8%) than among Hispanic (7.9%) and non-Hispanic black women (8.1%).” Use also varies by age group, with younger women using contraceptives more often than older women. The National Survey of Family Growth provides a comprehensive overview of contraceptive use in the United States.

Women’s health advocacy groups and major medical organizations have supported the fight to make oral contraceptive pills available over the counter for years. In fact, nearly three dozen medical organizations—including the American Medical Association, the American College of Obstetricians and Gynecologists (ACOG), and the American Academy of Family Physicians—signed a statement in support of age-free contraception. Additionally, in March, 59 pro-choice members of the US House of Representatives wrote to FDA Commissioner Robert Califf urging the agency to approve the pill for OTC consumption.

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Importantly, research shows that women of reproductive age overwhelmingly favor making birth control available over the counter. A 2011 survey of a nationally representative sample of American women ages 18 to 44 (n=2,046) found that among all respondents, 62 percent said they “strongly or somewhat favored” making oral contraceptives available without a prescription . In addition, a 2015 online survey of interest in progestin-only contraception found that 39 percent of adult women and 29 percent of teenagers said they would likely use the pill, especially if it was covered by insurance. Furthermore, a majority of voters support “making birth control pills available over the counter,” and two-thirds of voters believe the FDA should “prioritize the sale of over-the-counter birth control pills.”

As mentioned above, the FDA process is designed to demonstrate that consumers can accurately understand and follow OTC labels. According to ACOG, “the drug’s potential toxicity and whether the drug can benefit consumers without compromising their safety” are the main factors FDA considers to make drugs available over the counter. Labels and instructions must be understandable without the presence of a healthcare professional. The packaging must also state the benefits and risks to the user’s health. Leading medical organizations have reaffirmed that a prescription is not clinically necessary to access the pill. It is non-toxic, non-addictive and has no risk of overdose, meeting FDA criteria for OTC access. In fact, other OTC medications to relieve cold, flu, and allergy symptoms carry greater risks.

Consumers have been using the pill safely for 60 years. And years of research have shown that women can accurately understand the labels and eligibility criteria for using oral contraceptive pills. One study found that self-checking of oral contraceptive contraindications using a medical checklist was relatively accurate, with about 7 percent of women in the sample mistakenly thinking they were eligible for use. This is similar to the accuracy rate of health professional-led assessments and screenings. The authors concluded that an OTC supply of oral contraceptives is likely to be safe, especially for younger women and with blood pressure monitoring. Additionally, a 2019 systematic review of the literature found that not only are women overwhelmingly able to accurately assess their suitability and contraindications for use, but also found that access to OTC can encourage continued use and minimize disruptions in care .

When it comes to reproductive access, the United States lags behind the rest of the world. OTC birth control pills are available in more than 100 countries, mostly in Latin America, Africa and Europe. A 2013 study of data from 147 countries found that oral contraceptives were informally available without a prescription in 38 percent of countries; legally available without a prescription (no medical examination required) in 24 percent of countries; legally available without a prescription (screening required) in 8 percent of countries; and available only by prescription in 31 percent of countries. The United States is one of the few countries that still does not have at least one OTC birth control pill option. US policymakers can look to other countries’ models for implementation to help strengthen and improve approaches.

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A 2012 study found that relatively few women who use contraceptives use the progestin-only pill option. However, since this option generally presents lower risks and fewer contraindications for consumers, it may be a good first attempt to make OTC available. Perhaps just as importantly, making Opill available OTC can act as a springboard to make other options available.

Cost is also a major factor: more consumers are interested and willing to use progestin-only contraception if there is little or no out-of-pocket cost. Policymakers should keep this fact in mind and work to keep costs low, including ensuring that OTC birth control methods can be covered by insurance.

The supply of oral contraceptive pills over the counter is one important strategy for increasing the bodily and reproductive autonomy of women and all people who can become pregnant. This is especially important for people who currently face myriad barriers when trying to access care, especially in times of new threats to gender equality and reproductive health. Although FDA approval would not completely resolve these disparities, providing access to low-cost, over-the-counter contraceptives would mark a significant step forward for access.

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