Opinion | Make birth control available over the counter already

Decades of research have demonstrated the safety, effectiveness and ease of use of birth control pills. The FDA first approved oral contraceptives in 1960. Opill itself was approved under a different name 50 years ago, in 1973. By 2005, more than 500 million women globally were estimated to be using hormonal contraceptives. Today, about 1 in 4 American women between ages 15 and 44 who use birth control choose oral contraceptives as their method of choice.

Serious side effects are extremely uncommon. With perfect use, meaning if the individual takes the medication every day around the same time, oral contraceptives are 99 percent effective at preventing pregnancy. With typical use, they are 93 percent effective — still more effective than typical use of other nonprescription methods such as condoms, spermicide and fertility tracking.

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.

Nearly half of all pregnancies in the United States are unintended. Compared with planned pregnancies, unintended ones are associated with worse health outcomes for both the baby and the mother. Adolescent mothers have a particularly high rate of unplanned pregnancies and pregnancy complications, and teen pregnancy is associated with lower educational attainment and generational poverty. Though teen birthrates have been dropping in recent years, about 30 percent of first births still occur among teenagers.

Despite the evidence and public health justification in favor of Opill’s over-the-counter application, its approval is far from certain. At the recent advisory meeting, FDA officials raised three major concerns, none of which I believe are reasons to hold up this approval.

First, they expressed worry that women wouldn’t understand that Opill shouldn’t be used by patients with a history of breast cancer or who are taking drugs that have medication interactions. But studies have found that women are capable of self-screening for eligibility. Moreover, many medications available without a prescription have serious contraindications. Aspirin and ibuprofen shouldn’t be taken by patients with gastrointestinal bleeding. Tylenol and Benadryl have many drug interactions and can lead to death when taken in large quantities. Yet the FDA allows these medications to be on drugstore shelves with appropriate warning labels, as it should with Opill.

Second, officials noted that the effectiveness of the pill depends on patient adherence. But again, women are capable of following basic instructions. In the manufacturer’s study of 883 women, 92 percent took Opill every day. The compliance rate was similar in teens and those with low health literacy. The most common reason cited for missing the pill was running out of them, a problem that would be reduced if there weren’t a prescription requirement.

Third, some detractors point to the rising rates of advanced cervical cancer and sexually transmitted infections such as chlamydia, gonorrhea and syphilis. If women had to get a Pap smear and receive instruction on safe sex methods before being prescribed the oral contraceptive, wouldn’t that increase cancer detection and STI screening?

These critics are right to raise awareness of the disturbing trends in women’s health. But withholding birth control to coerce women to access health care is not the right solution.

There is no medical rationale to do so. The American College of Obstetricians and Gynecologists explicitly states that “pelvic and breast examinations, cervical cancer screening, and sexually transmitted infection screening are not required before initiating hormonal contraception and should not be used as reasons to deny access to hormonal contraception.” The organization supports making the pill available over the counter, as do the American Medical Association and American Academy of Family Physicians.

Moreover, tying birth control pills to preventive care assumes that all patients who want to see a doctor can. That’s not the case. More than 19 million reproductive-age women live in contraceptive deserts. Nearly 8 million women in this age group are uninsured. Those concerned about women’s health should work to increase primary care and preventive services rather than add barriers to contraceptive access.

Here’s one more crucial data point: A survey by KFF in 2022 found that 77 percent of reproductive-age women support over-the-counter birth control pills. Women clearly want to be trusted with their own reproductive health decisions. The FDA should listen to women and heed the guidance of the medical community and the unanimous recommendation of its own advisory committee.