U.S. Advocates Fight to ‘Free the Pill’

Update June 23, 2022: The American Medical Association (AMA) passed a resolution on June 15 in support of removing the prescription requirement to birth control pills. The AMA also encouraged the FDA to approve over-the-counter access to oral contraceptives without an age restriction.

Birth control pills are already available over-the-counter in most of Central and South America, Asia and Africa. Over-the-counter availability in the U.K. is adding to the momentum toward OTC access in the U.S. (Wikimedia Commons)

The United Kingdom recently allowed sale of birth control pills without a doctor’s prescription for the first time since the medication’s approval in that country 60 years ago. Meanwhile, the U.S. Federal Drug Administration (FDA) still requires Americans to go to their doctors to get a prescription and then go to a pharmacy to obtain birth control pills.

“We’ve been saying for years that it’s past time to have an over-the-counter pill in the U.S.,” said Britt Wahlin, vice president for development and public affairs for Ibis Reproductive Health, a leading advocate for sexual and reproductive health. “The U.K. is yet another reason that the U.S. needs to get in line with the rest of the world in terms of over-the-counter access to oral contraceptives.”

In early July, the U.K. approved a reclassification of two progestogen-only “mini-pills”: Hana made by global pharmaceutical company HRA Pharma, and Lovima made by the British pharmaceutical company Maxwellia founded by Anna Maxwell in 2013. Both these pills contain 75 micrograms of desogestrel and are 99 percent effective if used properly. 

These pills are now available in the U.K. without a prescription after consultation with a pharmacist. Advocates say this will expand access, especially for people who face barriers to making an appointment to see a doctor or family planning clinic to get a prescription.

Birth control pills are already available over-the-counter in most of Central and South America, Asia and Africa. Over-the-counter availability in the U.K. is adding to the momentum toward OTC access in the U.S., said Wahlin, by “normalizing this idea for people … that this isn’t revolutionary. This is happening in other places—in 100 other countries. The U.K. is just the latest to take this on.” 

Meanwhile in the U.S., while 12 states and the District of Columbia have special rules allowing some pharmacists to prescribe birth control in limited circumstances, most states require anyone seeking birth control to visit a health care provider to get a prescription and then go to a pharmacy to pick up their birth control pills. 

“This isn’t revolutionary. This is happening in other places—in 100 other countries. The U.K. is just the latest to take this on.” 

These requirements create barriers, particularly for lower-income and young people, who may not have health insurance or money to pay for doctor visits. Immigrant women report cultural and linguistic barriers to accessing quality, comprehensive reproductive health services, making prescription access to birth control pills particularly challenging. COVID-19 has only exacerbated these barriers.

Increasing Access and Affordability

Ibis has been working in partnership for several years with the pharmaceutical company HRA Pharma to bring an over-the-counter birth control pill to the U.S. Earlier this year, HRA Pharma announced a plan to develop an OTC contraceptive progesterone pill called OPILL to be available by 2023. Another company—Cadence Health—is reportedly also working on over-the-counter approval for their combination pill Zena

Wahlin is optimistic that over-the-counter birth control pills will be available in the U.S. within the next couple of years.

“Birth control pills are safe and effective. They’ve been studied extensively for the last six decades,” said Wahlin. “We believe that they are safe enough for over-the-counter sale … even safer than some of the products that are currently available.” Research shows that birth control pills are safer than many drugs already available over-the-counter, including Ibuprofen, Tylenol, Sudafed and Benadryl. 

The American College of Obstetricians and Gynecologists and the American Academy of Family Physicians support over-the-counter availability of hormonal contraception without age restrictions. The American Medical Association has encouraged pill manufacturers to apply to the FDA for over-the-counter status for contraceptive pills. 

A Planned Parenthood Rally in New York City in February 2011. (Women’s eNews / Flickr)

In addition to over-the-counter status for birth control pills, Ibis is advocating for insurance coverage of over-the-counter birth control pills when they become available and that there are no age restrictions on access. 

“It’s not enough that we have an over-the-counter pill. It’s also critical that we make sure that once it is available over-the-counter that people can really access it, especially people for whom contraception has been harder to access—communities of color, young people, immigrants and people working to make ends meet.”

Only nine states currently require insurance coverage of over-the-counter contraception without requiring a prescription for that coverage. Wahlin notes that the National Health Law Program has a model law that includes a guarantee of health insurance coverage for over-the-counter access to birth control pills. The AMA supports full insurance coverage of over-the-counter contraceptives without patient cost-sharing “because contraception is essential preventative health care.”

In the U.K., advocates are still fighting for insurance coverage of birth control pills dispensed by pharmacists. The pills cost about $10 a month. People with U.K.’s National Health Service insurance still have to get a prescription from a health care provider to get free birth control pills. U.K. advocates are calling on the government to make the pills free in community pharmacies and to make a wider range of brands available, including combined pills.

Free the Pill Campaign

Ibis is part of the Oral Contraceptives Over-the-Counter Working Group—a coalition of over 100 national, state and local reproductive health, rights and justice organizations working to increase access to birth control through a Free the Pill campaign to raise awareness about the issue and mobilize people to act.

The working group’s statement of purpose focuses in particular on how the prescription requirement for hormonal contraception is a barrier for some people, including those who lack health insurance as well as those who are insured but face other obstacles such as difficulties getting to a health facility or expenses related to taking time off from work for a clinic visit. 

Other organizations have created their own statements, such as The National Congress of American Indians that has passed a resolution supporting over-the-counter access to birth control pills that are affordable, covered by insurance and available to people of all ages within Indian Health Service facilities.

Ibis has partnered with Advocates for Youth to create a #FreeThePill Youth Council made up of youth activists from across the country who are working in their communities to bring birth control over-the-counter, covered by insurance with no age-restriction. They offer a #FreeThePill Virtual Store, where you can look around a pharmacy set in the future (2031), move through the store and explore your options for buying birth control. While you’re there, you can listen to Free the Pill Radio and hear a birth control anthem.

Advocates for Youth has published a sign-on letter from young Americans urging President Joseph Biden and Vice President Kamala Harris to #FreeThePill by making it “available over-the-counter, covered by insurance, and free of age restrictions.” 

“Bringing the birth control pill over-the-counter would enable more people to use the pill consistently and correctly, thereby helping to prevent unintended pregnancies in the US and allowing young people the ability to live their lives on their own terms,” said the letter. “Young people are tired of jumping through hoops to access the contraception they need, and the science shows that the pill is safe and effective and current barriers point to the need to move it over-the-counter.”

In the mid-20th century, advocates fought for years to create the birth control pill and win FDA approval in 1960. Then advocates fought for years to make emergency contraception (Plan B) available over-the-counter in the U.S., finally succeeding in 2013. Today, advocates for over-the-counter birth control pills are optimistic they will succeed too. 

“Other countries are doing this,” said Wahlin. “I hope that it’s a signal that this is going to be a reality soon in the United States.”

To join the fight for great access to birth control, go to freethepill.org and follow the latest news on Twitter at #FreeThePill and @freethepill.

In the latest episode of the Ms. podcast “On the Issues With Michele Goodwin”—Sex Ed 101: The Talk You Wish You Got From Your Parents (with Kelly Davis, Dr. Fatu Forna, Mary Emily O’Hara and Jennifer Weiss-Wolf)—we talk about sex, periods, non-binary health care, maternal health, and what don’t we know or ignore about our own bodies.

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Carrie N. Baker, J.D., Ph.D., is the Sylvia Dlugasch Bauman professor of American Studies and the chair of the Program for the Study of Women and Gender at Smith College. She is a contributing editor at Ms. magazine. You can contact Dr. Baker at cbaker@msmagazine.com or follow her on Twitter @CarrieNBaker.