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Over the Counter Birth Control Pill-A Step Froward

While most doctors and women are reeling from the aftermath of the reversal of Roe vs. Wade and we are hearing countless horror stories of how it is negatively impacting women across the United States, some good news is worth reporting and celebrating. The FDA has approved the first over-the-counter oral contraceptive pill (OCP) to be sold without a prescription. With over half all pregnancies being unintended and most in women in their twenties, this is great news.

It will be sold under the brand name Opill and the decision was overwhelmingly supported by physician groups (AMA, American College of Obstetricians and Gyn, American College of Physicians, American Academy of Family Practice and on and on). Over 77 percent of women also favor getting their pill without a prescription.

How does the pill work? It contains only progesterone and progesterone only pills have been widely used in the US since 1973. Progesterone thickens the mucus in the cervix, preventing sperm from entering. It also prevents ovulation but because it is low dose that is not 100% reliable alone. Experts believe 4/10 women will continue to ovulate. It has a failure rate of about 7%, comparable to combination OCPs that contain both estrogen and progestin and it is more effective than condoms or spermicides.

Another benefit is that a woman can start taking the pill anytime in her cycle and is effective within 48. hours of taking the first pill. Doing a pregnancy test first is a good practice.

Opill has fewer side effects than other combination pills. Spotting can occur but it doesn't raise blood pressure or increase strokes or blood clots.

It all sounds good but there are some unanswered questions. We don't know what the cost will be. Since prescription OCPs are now covered by health insurance (thank you Obamacare!), insurance companies usually do not cover non-prescription medications. President Biden signed an executive order directing HHS and Secretaries of Treasury and Labor to cover these contraceptives but it is unknown how long that will take. I'm also concerned about that potential 7% failure rate, now that abortion is so difficult to obtain in Red States.

We took one tiny step forward but it doesn't reverse the huge backward step handed down by the Supreme Court in June, 2022. Maternal deaths in the U.S. are 10 times higher than in comparable, wealthy countries. Our last reported statistics are from 2021. I predict a sharp rise in maternal and infant deaths as a result of the reversal of Roe v. Wade. Stay tuned and we will see if I am sadly correct.


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