One year after FDA approves over-the-counter birth control pill, advocates push for more access

Sriha Srinivasan remembers how surprised her mom was two years ago when she learned that birth control pills weren’t sold in stores without a prescription in the United States.

“My parents are immigrants from India, and it’s been over the counter there since my mom can remember,” said Srinivasan, a recent graduate of University of California Los Angeles.

More than 100 countries were already selling birth control without a prescription before the U.S. Food and Drug Administration — one year ago as of Thursday — approved Opill. Though the hormonal, over-the-counter birth control pill was approved in May 2023, it didn’t reach online retailers or the shelves of major drug stores across the country until a couple of months ago.

Opill is a progestin-only birth control pill, which is slightly different from the typical prescription of a progestin and estrogen combination pill. Dr. Kristin Lyerly, an OB-GYN in Green Bay, Wisconsin, said that means the oral contraceptive is still very safe and 98% effective, but the user has to be more diligent about making sure it’s taken at the same time every day. If the time window is missed by three hours or more, there is a higher chance of unintended pregnancy, so she recommends that people use a backup form of protection for the next 48 hours while they get back on schedule.

Srinivasan, 21, gets health care coverage through her parents’ private insurance, but she said when she called clinics to see if she could get a birth control prescription last year, the first appointment that was available was six months out.

She happened to be working with Free the Pill, a group of reproductive health advocates and health care providers, on getting Opill approved by the FDA, so she decided to hold off.

“Almost out of spite, I was like, ‘I’m going to wait and get this over the counter.’”

On March 22, just after Opill hit the U.S. market, Srinivasan drove with a friend to a nearby Walgreens to buy their first packs, which cost about $20 each. The two recorded a TikTok of themselves taking their first doses.

“It was a very joyous and empowering moment to be able to take that for the first time,” Srinivasan said.

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Dr. Daniel Grossman, director of the Advancing New Standards in Reproductive Health program at the University of California San Francisco, has been at the forefront of the effort to get FDA approval for an over-the-counter birth control pill since 2004, and is part of the steering committee of Free the Pill. His research efforts included a study showing that women who had direct access to the pill in areas like Texas border towns where people could cross into Mexico to get it directly stayed on it longer than those who needed a prescription. His research also found that people generally didn’t support age restrictions, and the FDA approval for Opill does not have an age restriction.

Grossman said more access to contraception is important for overall reproductive health, but it’s especially important in the wake of the Dobbs decision in 2022 that overturned Roe v. Wade and led 14 states to enact near-total abortion bans.

“Improved access to contraception isn’t going to solve the crisis of abortion access that we’re currently facing, but that said, in this moment — when people in half of the states have very limited options for abortion care and there are growing threats on access to contraception — I think it’s important that we do everything we can to expand access to all methods of birth control where that’s possible,” Grossman said.

Aside from a few expected and manageable side effects, including headaches and light bleeding, Srinivasan said she’s had a good experience with the pills and their availability so far. But there’s room for improvement, she said, and Free the Pill is advocating for more cost assistance support and coverage from national private insurance companies.

Free the Pill launched an online petition this week to pressure President Joe Biden and his administration to require insurance plans to include coverage for Opill. It had 35,000 signatures as of Thursday afternoon.

Srinivasan said she tried to apply for assistance but wasn’t able to because she has insurance, and only those without any form of private or public insurance can apply. Qualifying applicants also have to have a household income at or below 200% of the federal poverty line, which is $15,060 for a single person. A 2022 survey from Advocates for Youth found that 1 in 3 of those surveyed cited affordability as one of the biggest barriers to accessing contraception.

“At a $20 price point, it’s something I can afford because I have a job and I live in California, where the minimum wage is over $17 an hour, but it’s definitely not something my peers in other states can afford that easily,” Srinivasan said. “I hope they adjust that, because it’s definitely not reaching the people that it should be reaching right now.”