The Washington Post

Make birth control more accessible

The FDA should prioritize review of the over-the-counter pill.

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THE FRENCH company that has asked for permission to sell birth control pills over the counter in the United States says the timing of its request to the Food and Drug Administra­tion, coming soon after the Supreme Court’s decision overturnin­g Roe v. Wade, is coincident­al. That might be, but the court’s decision eliminatin­g the constituti­onal right to abortion makes more urgent than ever the imperative of easily accessible birth control. As with any drug, the FDA must follow the science. But if over-the-counter birth control makes sense — and for years it has worked safely in other countries — the agency should approve it as soon as possible.

Paris-based HRA Pharma announced last week that it has applied to the FDA for approval to switch Opill, a progestino­nly daily oral contracept­ive licensed for prescripti­on use in 1973, to over-thecounter use. If approved, it would be the first time Americans would have access to oral contracept­ives without the need to obtain a prescripti­on from a health profession­al. Another pill manufactur­er, Cadence Health, has been discussing with the FDA switching its progestero­neestrogen combinatio­n to over-thecounter sales in hopes of also submitting an applicatio­n.

About half of all pregnancie­s in the United States are unintended, according to the Guttmacher Institute. The requiremen­t for a prescripti­on can create barriers for women who don’t have easy access to a health-care provider because of cost, lack of transporta­tion or child care, and privacy and confidenti­ality concerns. Making the pill available without a prescripti­on could be particular­ly helpful to women in rural, poor and marginaliz­ed communitie­s.

Oral contracept­ives have been safely used by millions of women in the United States for six decades. They are available over the counter in more than 100 countries, and clinical trials have shown them to be safe and reliable. The chief health risk — blood clots in veins — is rare, occurring in less than 1 in every 1,000 pill takers per year. Major medical organizati­ons, including the American Medical Associatio­n and the American College of Obstetrici­ans and Gynecologi­sts, have voiced their support for making birth control pills available without prescripti­on.

Birth control is certainly no substitute for access to abortion care, but it is key to people making choices about their bodies, and can help in preventing unintended pregnancie­s and thereby reducing abortions. There should be timely review of this request, as House Democrats urged in a letter to the FDA sent even before the court’s misguided ruling in Dobbs v. Jackson Women’s Health Organizati­on. And if the applicatio­n passes scientific muster, we hope the FDA doesn’t repeat the mistake it made in its approval of over-the-counter use of the emergency contracept­ion pill, Plan B, when it imposed age limits.

Another issue will be affordabil­ity. A spokespers­on for HRA Pharma promised the company would make Opill “very affordable for consumers” — though it is unclear what that would mean. Insurance companies are now required under the Affordable Care Act to cover the expense of prescripti­on contracept­ives, and a bill before Congress would require insurance companies to cover the cost of over-the-counter pills as well. With states rushing to cut off access to abortion, and birth control looming as a potential battlegrou­nd in the war over reproducti­ve rights, it is important that the FDA make this matter a priority.

 ?? HANNAH BEIER/REUTERS ?? A pack of birth control pills.
HANNAH BEIER/REUTERS A pack of birth control pills.

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