How Women Feel About an Over-the-Counter Birth Control Pill

On Thursday, the Food and Drug Administration approved a hormonal birth control pill, called Opill, to be sold over the counter — a landmark decision that was largely received with excitement by many women and teenage girls in New York. The pill will be sold in stores and online, without age restrictions, beginning early next year.

If Shandra Rogers, 21, had had over-the-counter access to Opill as a teenager, she might have avoided an unwanted pregnancy, she said.

Ms. Rogers, a student at Howard University on summer break, said she became pregnant when she was 15. She used her mother’s health insurance to get an abortion — but even with coverage, the process was arduous.

“There were a lot of steps, like who will accept my health insurance?” she said. “Are they going to give me proper care, as a Black woman?” And most clinics were “far away — they’re removed from our community,” she added. Those same issues, she said, apply to contraceptives, and can end up dissuading girls from seeking them out.

An over-the-counter pill would eliminate a lot of barriers, she said.

Nearly half of all pregnancies in the United States are unintended. Rates are highest among women in their twenties. The move to greenlight Opill, which is commonly known as a mini pill because it contains only progestin, is “a total game changer” for that demographic, said Dr. Elise Berlan, a physician at Nationwide Children’s Hospital in Columbus, Ohio, who served as an independent scientific adviser to the F.D.A. when it was debating Opill’s approval.

For young people, accessing birth control can be “really challenging,” she said. “Sexual health education is very spotty, so there are a lot of people who just don’t have very good information,” she added. And it’s further complicated “for folks who are low-income, who have transportation issues or who live in rural parts of the U.S.”

A survey conducted last year by KFF, a research company, found that 77 percent of women 18 to 49 favored the decision to make a pill available without a prescription. Thirty-nine percent said they would be likely to use it, citing convenience as the main reason. Of those who said they probably would not use it, the main reason was that they did not have plans to use oral contraception; the second-most-cited reason was that they would want to first discuss it with a provider.

The New York Times interviewed 18 women and girls about the F.D.A. decision on Thursday and Friday. Some teenagers noted that having access to the pill in a store would be helpful for those who did not feel comfortable speaking with their parents about contraception. “My mom does not approve of birth control” because of her more conservative Sri Lankan heritage, said Tharushi Samarasinghe, a 19-year-old student at Hunter College. “I took birth control once for hormonal issues as I was going through puberty. I was on it for a year and then my mom was like, ‘No more.’”

Elizabeth, 18, said she was wary about the potential side effects of the mini pill, but described it as a great option for someone like her, whose parents were “pretty conservative.” She added: “They raised me in a Catholic church. I’m not comfortable talking to them about this.” (She requested that her last name be withheld to avoid potential conflict with her family.)

For others, safety concerns had long kept them away from hormonal birth control options, and, they said, over-the-counter availability wouldn’t change their minds. “I have never used it in my life — I’m 51 years old,” said Lisa Verlin, a babysitter in Manhattan. “I am not comfortable using that because of all the side effects.” (According to the Centers for Disease Control and Prevention, the most common side effect of the Opill is unscheduled bleeding. While the pill is not associated with many serious long-term risks, it’s not recommended for those who have had breast cancer or severe liver disease.)

The idea that there were no age restrictions gave some women pause. For June Jean, 55, the thought was so disturbing that she shook her head vehemently. “No good, no,” she said. “I’m an old-fashioned girl but I don’t think girls — 13, 14 years old — should be able to go and just get pills.”

“So you could go pick it up if you’re, like, 12?” said Melina Luna Smith, 43, who runs a nonprofit organization. “So much is happening to your body when you’re young, so I think it’s important to have somebody speaking to that — some medical guidance.”

She said she would be “too chicken” to use it without having more information. What women need, she added, is better access to doctors, not just easy access to contraceptives.

For people with access to health care, an over-the-counter pill, which is as effective as prescribed pills, was seen as a convenient fallback option. Dana Pangori, who is 24 and works in advertising sales, said her primary care doctor was often so busy it could be hard to get a pill prescription refilled. “I’ve actually been off of it because I have a hard time reaching her,” Ms. Pangori said. Before moving to New York, she lived briefly in Michigan and Illinois, and she said that each time she moved it was burdensome to find a local doctor to refill her prescription.

An unresolved concern for many of the women interviewed was how much Opill would cost. Perrigo Company, the pill’s manufacturer, hasn’t said what it will charge for each pack of 28 pills, though the company’s chief executive said in a statement that Perrigo was committed to keeping it “affordable.” While most women who spoke to The Times suggested that they would pay between $20 and $30 for a pack, the KFF survey found that only one in six of those most likely to use the pill would be willing or able to pay more than $20 per month. That pricing would place it in range with other over-the-counter options: A pack of 12 condoms, for example, is often around $10, while the emergency contraceptive pill Plan B costs about $50.

The availability of the pill in stores represents a broad shift in attitudes toward hormonal birth control pills, said Claudia Goldin, an economics professor at Harvard University who studied how the introduction of the first oral birth control pill in the 1960s altered women’s career and marriage decisions.

“Many of us remember a time when you had to go up to the desk and ask the pharmacist for a condom,” she said. Now the pill is “just going to be sitting there on the shelf and you can just pick it up like you buy your Advil — no shame. That’s huge.”