A year later, some see over-the-counter birth control pill as big step forward in U.S.

A year after the nation's first nonprescription daily birth control pill debuted for sale, reproductive health advocates said its impact has been felt especially by young women who now can easily obtain such contraception on store shelves and online without fear and shame that can accompany such choices.

Opill, manufactured by Perrigo Company, is a hormonal birth control medication the U.S. Food and Drug Administration approved in July 2023 to be sold over the counter before the rollout to consumers last March.

The company didn't release specific sales data but said Monday in a statement that sales of Opill "have grown on a weekly basis" and there is "an approximate 50% repeat rate" for purchases and use.

Opill is made of progestin, and according to the FDA, is a medication that has been considered safe for more than 50 years, with clinical trials showing it is 98% effective when taken daily at the same time. The agency didn't immediately respond Monday to an inquiry asking about Opill's impact in the last year.

The FDA has said while Opill's effectiveness is lower in real-life settings due to human error, it is believed to be more effective than other nonprescription contraceptive methods, such as condoms, spermicide and sponges.

Victoria Nichols, project director at Free the Pill coalition, which includes more than 200 reproductive health, rights and justice groups, said the FDA’s approval to allow Opill to be sold over the counter was a "historic achievement" that has expanded "critical" reproductive health access in the past year.

The United States joined 100 other nations that currently make birth control pills available without the need for a prescription, Nichols said. The Free the Pill coalition, operated by Ibis Reproductive Health, is an international nonprofit that was instrumental in pushing for federal authorization.

"This is a massive step forward," Nichols said of the impact a year later.

Expanding access to reproductive options is critical at a time when states are restricting abortions, some reproductive health advocates and medical experts said. In 2022, the U.S. Supreme Court overturned constitutional abortion protection established in its landmark Roe v. Wade 1973 decision. 

Twelve states have a total ban on abortion in place, according to Guttmacher Institute, a nonprofit research and policy organization focused on advancing sexual and reproductive health and rights.

More access to birth control also is important at a time when immigrant populations may be avoiding medical care due to fears of deportation or arrest, some of the experts said.

'Contraceptive deserts'

Angela Maske, strategic projects manager at Washington, D.C.-based Advocates for Youth, a nonprofit, said young people face numerous challenges accessing birth control. 

Hurdles include being scared to tell their family they are sexually active, along with the inability to schedule medical appointments due to being uninsured or intimidated. Other issues include being unable to take time off from work or school to get to doctor appointments and having no easy way to get there, according to Maske and other reproductive health and justice groups. They said the OTC pill's availability has helped lift some of those barriers.

Rochelle Rodney, co-executive director of New York Birth Control Access Project, said young people throughout New York and across the country historically have dealt with "stigma and shame" when it comes to their sexual health. Young people, she said, now are relieved to have the ease and convenience of either ordering birth control pills online or privately grabbing them off a store shelf.

"They've been raving about not having to set an appointment with a doctor and go through tons of conversations and counseling when they have already decided that they wanted to try it or they have already been on contraceptive pills," Rodney said in an interview.

Some experts said the pill's expanded availability also benefits other women, like those who have low income or lack health insurance. 

Across the country, more than 19 million women of reproductive age live in "contraceptive deserts," meaning they "lack reasonable access in their county to a health center that offers the full range of contraceptive methods," according to a 2023 report by Power to Decide, a nonprofit that advocates for reproductive health. The report also found more than 1.2 million women in New York State live in counties that lack the full range of available contraceptive methods. 

"In New York State, we have less contraceptive providers per capita than most other states ... so access without a doctor's appointment is crucial," Rodney added.

'A lot of fears'

In January, the U.S. Department of Homeland Security rescinded a 2021 policy that limited Immigration and Customs Enforcement agents "to the fullest extent possible" from going into a "protective area" like a hospital, school or church to take enforcement action.

"There are just a lot of fears and a lot of uncertainty, and so I think that in this moment, it's very important that there is a reliable option for people that they know they won't necessarily have to interface with the health system," said Maske, from Advocates for Youth. 

Dr. Leah Kaufman, an associate professor in the Division of Obstetrics and Gynecology at Stony Brook Medicine, said the timing could benefit people who are afraid to seek care in traditional medical settings.

"Currently we have many patients who are fearing coming into the medical community for a lot of different reasons. They should also have access to control over reproductive choice and timing," said Kaufman. 

"Thankfully, in New York State, access to abortion is an option and abortion is legal, but that's not the case in all states, and the best option always is for women to have that control over timing and to be able to have access to safe contraception," Kaufman added.

But awareness of this first-in-the-nation contraception option remains low, according to one recent survey.

Health research group KFF found in its Women's Health Survey in November that only 26% of women aged 18 to 49, out of 3,901 women polled, said they have heard of Opill.

At least one religious organization was critical of the FDA's decision to approve Opill. The U.S. Conference of Catholic Bishops released a statement at that time saying: "This action by a government entity flies in the face of responsible medical practice and concerns for women’s health. Claims that the benefits of this action outweigh the risks are unfounded, especially in light of strong evidence of the many harmful risks of hormonal contraception to women’s health."

The organization didn't immediately respond to a request for comment Monday.

 Dr. Monique De Four Jones, the associate chief of labor and delivery at Long Island Jewish Medical Center, recently recalled publicity last year surrounding Opill's entry into the over-the-counter retail market.

"Then it kind of got forgotten," De Four Jones added in an interview, while recalling her 27-year-old daughter recently pointing it out in a store. 

The drug, which according to the FDA shouldn't be used by people who had or have breast cancer or be used in conjunction with another hormonal birth control product, costs $20 a month. 

"The availability is nice for people, because they're able to go to the pharmacy or ... log on to the computer and get their birth control sent to them without a hassle," De Four Jones said.