US Plays Catchup on Women’s Health with OTC Birth Control

Dozens of countries already allow access to oral contraception without a prescription

(Bloomberg) — The approval of the first over-the-counter birth control product is a small step forward for women’s reproductive health in the US, after a year marked by the burden of new abortion restrictions and a recent jump in the maternal mortality rate.  

The US Food and Drug Administration’s Thursday approval of Perrigo Co.’s Opill, an oral contraceptive that’s been available for years but will soon be sold without a prescription, brings the US in line with dozens of countries globally that already allow patients to access the pills over the counter.

In a 2012 analysis of 147 countries, oral contraceptives were informally available without prescription in 38% of countries, legally available without a prescription or screening in 24%, and available only by prescription in 31%. “In many countries, [oral contraceptives] are already available in commercial outlets without prescription, either as a recognized [over-the-counter] drug or informally in practice,” researchers wrote in the study.

Much of Asia, including India and South Korea, and Latin America, including Mexico, allow access to birth control over the counter, according to Free the Pill, a coalition advocating for increased access to contraception. The UK in 2021 began allowing over-the-counter pharmacy sales of two progestin-only pills.

The decision is seen as a crucial step toward giving women more autonomy over their family planning, which decades of research show improves their economic and health outcomes. An estimated 36 million women aged 15 to 49 now live in states that have banned or are likely to ban abortion, and the availability of mifepristone, one of two drugs commonly used to end pregnancies, is under threat due to a lawsuit attempting to revoke the FDA’s approval. Politicians on both sides of the aisle have come out in support of birth control without a prescription; the most vocal opposition comes from some religious and anti-abortion groups that claim the drug’s availability would lead to an increase in unprotected sex.

The pill won’t be available immediately, with Perrigo saying consumers should be able to buy it over-the-counter starting in early 2024, and it isn’t suitable for everyone to take. The company hasn’t yet detailed how much the drug will cost, though it has said it’s dedicated to making the pill affordable. 

Read more:  What to Know About Opill, the Birth Control Pill Cleared for OTC

Since Roe v. Wade was overturned in June 2022, large swaths of the country have banned most abortions, increasing travel times and costs for patients seeking care. 

With the Supreme Court decision, the US joined a small club of countries that have clamped down on abortion laws. Since 1994, over 60 nations have liberalized their abortion laws. Only very few, including the US, El Salvador, Nicaragua and Poland, have removed legal grounds for terminations, according to the Center for Reproductive Rights, which advocates for abortion rights. 

Four methods of preventing pregnancy have more than 100 million users globally: female sterilization, male condoms, intrauterine devices and the pill, according to a 2019 report from the United Nations.

In the US, at least four states—Colorado, South Carolina, Utah and West Virginia—allow pharmacists to refuse to prescribe contraceptives. Nine states have adopted restrictions on emergency contraception.

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