The New Yorker:

You can now buy a pill over the counter, but a conservative backlash is promoting anti-contraceptive disinformation.

By Margaret Talbot

This year, for the first time in the roughly sixty-year history of the birth-control pill in the United States, it can be bought over the counter. You might not know about this development—many people I’ve mentioned it to don’t—but you can now find an F.D.A.-approved version of the pill at your drugstore or online, without a prescription, at a cost of about twenty dollars for a one-month supply, or less than fifty dollars for a three-month one. At the CVS in my neighborhood in Washington, D.C., it’s near the condoms, on an open shelf (unlike, for example, the locked-up laundry detergents and air fresheners). The effort to bring the product, sold under the brand name Opill, to the market was more than two decades in the making. It involved numerous studies of safety and effectiveness, investigating everything from the pill’s optimal formulation to how well people could understand the package insert, including the warnings about a few conditions, such as a history of breast cancer, that would preclude taking it. (They could understand them quite well, the studies showed.)

For much of that time, the campaign for over-the-counter access was led by Free the Pill—a coalition of reproductive-justice activists, nurses’ and other medical professionals’ associations, and ob-gyn professors—under the aegis of Ibis Reproductive Health, a nonprofit headquartered in Cambridge, Massachusetts. What the group lacked, at first, was a pharmaceutical company willing to manufacture a pill under the conditions it stipulated and to pursue F.D.A approval for its over-the-counter use. Most birth-control pills prescribed in the U.S. are a combination of two hormones, estrogen and progestin. The hormones suppress ovulation and thicken the mucus lining of the cervix, impeding sperm from reaching any egg that is released. Free the Pill wanted the first over-the-counter oral contraceptive to be progestin only, a formulation sometimes called the mini pill. A progestin-only version would not carry the same risk of a rare but serious complication, deep-vein thrombosis, associated with the combination pills, and unlike the combination version, was recommended for use immediately postpartum. (Progestin-only pills have the slight disadvantage of needing to be taken within the same three-hour window each day to be maximally effective, and, until recently, many doctors were under the misapprehension that they were less effective in general than the combination pills.)

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