I'm a gynecologist - here's what I think about the possibility of OTC birth control pills

I'm a gynecologist - here's what I think about the possibility of OTC birth control pills

In case you missed it, the US 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 is even common to buy birth control pills without having to see a doctor first. In fact, about 100 countries do not require a prescription for oral contraceptives, according to a global review published in the journal Contraception. So why did it take so long for the US to consider this option?

Over-the-counter contraception allows people to obtain highly effective contraception and start using it immediately without having to wait for an appointment with a medical provider. Given that about half of all pregnancies in the U.S. are unintended, the increasing availability of over-the-counter birth control options 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 represent a rare but 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 medical condition is responsible for the cause of the blood clot. Although this health complication is serious, someone is statistically at higher risk of a life-threatening blood clot during pregnancy. (See: 6 Medical Reasons Why Someone Needs to Have an Abortion)

Similar to the emergency contraceptive option Plan B, which the FDA made available over the counter to people of all ages in 2013, Opill is a progestin-only drug that poses 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 about half of all pregnancies in the U.S. are unintended, the increasing availability of over-the-counter birth control options will allow people to have more control over how they build their families.

—Heather Irobunda MD, FACOG

There are also concerns that people may not understand the instructions for using birth control pills that come with the medication without a prescription. However, HRA Pharma has conducted years of research showing that consumers can understand the instructions and information that come with their medications. Additionally, research has found that providing more pill packs to oral contraceptive users and eliminating the element of requiring a prescription results in increased continued use. This correlates with my experience caring for patients who are looking for a simple and effective method of pregnancy prevention. 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 long advocated for making birth control pills easily accessible. In addition to supporting this current application by HRA Pharma for approval of their over-the-counter progestin-containing birth control pill, the ACOG supports further expanding access to birth control pills, citing overwhelming data supporting the benefits thereof. These benefits include ease of obtaining birth control pills and fewer unplanned pregnancies. Balancing the responsibilities of work, school, and home life can be so difficult. So if it's easier to get contraceptives, people can have more control over their bodies and their reproductive health.

After the Supreme Court's decision, Roe v. Wade to overturn the 1973 case that constitutionally protected the right to abortion, all options must be explored to expand access to reproductive health care. However, according to the Associated Press, HRA Pharma's request to sell its birth control pills without a prescription was unrelated to the recent Supreme Court decision.

Nonetheless, in states with restrictive abortion laws, the over-the-counter birth control pill will provide an additional tool for pregnancy prevention for those who do not want to have children. Communities with large numbers of people who are uninsured or underinsured will benefit from the increased availability of over-the-counter birth control because it allows people to access these medications without having to make a doctor's appointment. Hopefully, this medication will not only be made available without a prescription but also covered by insurance carriers, removing 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 healthcare. Greater access to birth control provides better prevention of unwanted pregnancies and can 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 and gynecologist currently practicing at NYC Health and Hospitals. After receiving her bachelor's degree and completing a post-baccalaureate program, she earned her Doctor of Medicine degree in 2011. She then served on active duty as an Army gynecologist while completing her residency in obstetrics and gynecology at 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.