Opinion | It’s Time for Birth Control Pills to Move Over the Counter

As an adolescent medicine physician, I see patients through their early reproductive lives, providing them with full spectrum care and support to address their reproductive and sexual health needs. Most of the patients I care for will spend more than 30 years trying to avoid becoming pregnant, so ensuring access to birth control is a central part of my job.

But even with all the birth control options that medical professionals can prescribe, almost half of pregnancies in the U.S. are unintended and there is no denying that people need better access to the contraception that is right for them. I was happy to hear that the FDA is reviewing an application to switch a daily birth control pill to over-the-counter availability. Removing the prescription requirement would be a historic advancement in contraceptive care and one whose time has truly come.

For years, major medical and advocacy groups, including the American College of Obstetricians and Gynecologists, the American Medical Association, the American Academy of Family Physicians, and Physicians for Reproductive Health have supported moving birth control pills over the counter because they are safe, effective, and have tremendous benefits for public health.

The application the FDA will review for over-the-counter use is a progestin-only daily pill (also known as a “minipill”). The FDA first approved progestin-only pills for prescription use in 1973 and since then, they have since been used by millions in the U.S. We have decades of evidence showing that they are up to 99% effective at preventing pregnancy when taken correctly and safe for use by almost anyone who wants to prevent pregnancy, including people who can’t or don’t want to use estrogen.

But the requirement to get a prescription means that the birth control pill isn’t an option for some people. Barriers include finding a healthcare provider and an available appointment. Making it to that appointment can require taking time off work or school, and finding childcare. In fact, one in three cis-gender women in the U.S. who have ever tried to get or refill a prescription for the pill, patch, or ring reported difficulties doing so. People need to be able to access the birth control that is the best fit for their life and circumstances without navigating a maze of barriers to care. This isn’t simply just a frustration or inconvenience, it can have a tremendous impact on people’s lives and health. This is only more true with the end of Roe.

There has always been a need for better access to birth control, but it goes without saying that against the current climate of increasing restrictions on abortion care, people are seeking many options to prevent unwanted or unplanned pregnancy. In my practice, I have seen an increase in young people coming to me to discuss their options; these are all people who have access to insurance and therefore, are more likely to be able to afford the visit needed to get a prescription. But as someone who cares deeply about health equity and access for everyone, I am also thinking about the people in my community who I don’t see. People who aren’t able to see a healthcare provider should be able to get effective birth control pills right off the shelf.

When the FDA first approved the birth control pill, it empowered people to take control of their futures and to make the best decisions for themselves. FDA approval of over-the-counter access will remove one of the barriers that stands in the way of all people accessing this safe and effective method. There is no better time than now to make this happen.

Melissa Dundas, MD, is an adolescent medicine physician in New York and a fellow with Physicians for Reproductive Health.