The dark future of over-the-counter birth control

For the first time, an oral contraceptive is going to be available over the counter, without a prescription. On July 13, the Food and Drug Administration (FDA) announced that it has approved the contraceptive pill Opill. Many are praising the FDA’s decision as a significant step toward making contraception more widely available. Perrigo Company, the pill’s Dublin-based manufacturer, stated that Opill will most likely be available in grocery and convenience stores, as well as online, in early 2024. Perrigo’s president and CEO Murray Kessler called the FDA’s decision “a new, groundbreaking chapter in reproductive health.”

It may indeed be groundbreaking—but not for the reason Kessler believes. Contrary to popular myth, increased use of contraception is correlated to an increase in abortions. And despite what proponents claim, hormonal birth control has a damaging effect on both mental and physical health.

The decision is, in part, a response to the overturning of Roe v. Wade last year. Despite increasing concerns about the side effects of hormonal birth control, the FDA’s panel of seventeen advisors voted unanimously that the benefits of Opill—prevention of pregnancy—dramatically outweigh any risks. Karen Murry, deputy director of the FDA’s office of nonprescription drugs, stated: “Overall, the total public health impact of the potential harm . . . is likely outweighed by the probable larger public health impact of prevention of a large number of unintended pregnancies with all their attendant harms.”

Opill, like other forms of hormonal birth control, primarily consists of progestin, “a hormone that thickens mucus in the cervix to make it harder for sperm to enter the uterus,” according to the New York Times. Opill is said to be less effective than pills with both progestin and estrogen, yet defenders of the FDA’s decision say that Opill is still highly effective as long as it is taken at the same time every day. According to a poll conducted by KFF last year, over three-quarters of women of reproductive age favored an over-the-counter contraceptive pill, with forty percent saying they would probably use it.

The U.S. Conference of Catholic Bishops, the Catholic Medical Association, the National Catholic Bioethics Center, and the National Association of Catholic Nurses published a joint statement last November opposing the approval of Opill. In it, they highlighted documented side effects including depression, abnormal bleeding, ovarian cysts, and risks to those with liver disease or breast cancer. The statement, representing thousands of health providers and medical ethicists, argued that approving Opill is a violation of the Hippocratic tradition. The FDA has dismissed the statement’s objections—but did not address a recent study indicating that women who begin taking the pill as teens have a 130 percent higher rate of depression.

Dr. Christina Francis, the CEO of the American Association of Pro-Life Obstetricians and Gynecologists, also has concerns. There is a “definite possibility,” she says, that Opill has abortifacient qualities. “There is some evidence that is suggestive that any progesterone contraceptive altering the endometrium lining in such a way that it could prevent the embryo from implanting, but more research is needed,” Francis told me. “Anyone who wants to use a contraceptive while being one hundred percent certain it has no abortifacient qualities should avoid using this one.” She also noted that there is little interest in funding research to determine with certainty if these types of contraceptives function as abortifacients.


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