thesis statement about birth control pills

Popping the Pill: Why Birth Control Should Be Available Over-the-Counter

• Post author By Baines Report
• Post date November 22, 2021
• 1 Comment on Popping the Pill: Why Birth Control Should Be Available Over-the-Counter

By Shelby Frye

In 2020, the birth control pill celebrated the 60th anniversary of its approval from the Food and Drug Administration. Six decades after this stamp of  approval, the pill remains one of the most popular contraceptive options in the United States. There are two types of birth control pills- the combined oral contraceptive (COC), and the progestin-only pill (POP). Despite their popularity, birth control pills are inaccessible to many people because it requires a prescription. Because the pill is not available over-the-counter (OTC), many people, especially those with low incomes or no insurance, have reduced choice in their own health decisions and are at higher risk for unintended pregnancy. And while the United States has been dragging its feet over this issue, over 100 countries in the world have granted OTC status to birth control pills. 

What’s more, birth control pills already clearly meet the FDA requirements for OTC status are already clearly met for birth control pills: the benefits of the drugs outweigh the risks, the potential for misuse is low, the condition can be self-diagnosed, and directions for use are clear. In fact, progestin-only emergency contraception is already available OTC in the United States, with no age restriction. 

One of the main arguments against allowing birth control pills to be sold OTC is that they are potentially dangerous and require a doctor’s oversight before they should be used. However, it is well-documented that the birth control pill is very safe, with the Centers for Disease Control and Prevention citing few medical conditions that would prevent someone from taking it.  Research supports the lack of contraindications—medical conditions that may make a certain treatment harmful— of the birth control pill as well as the accuracy of self-screening those contraindications. The probability of contraceptive users overlooking a contraindication is low, casting further doubt on the necessity of seeing a doctor before obtaining birth control. 

Requiring a doctor’s prescription to access the pill may deter those seeking birth control due to the high cost of a doctor’s visit, difficulty getting off of work or a lack of transportation. This places a unique burden on people of color, the uninsured and the poor, as well as young, single people because they are less likely to have the resources to get a prescription. The unnecessary obstacle may force the person seeking the pill to turn to other, less safe birth control options. Pharmacies typically have more convenient hours than doctor’s offices, and they tend to be more common, allowing easier access to contraceptives for most people if the pill were available OTC.  

By making birth control pills more accessible via OTC access, unintended pregnancies may be reduced in vulnerable communities. In the U.S., unintended pregnancies account for approximately half of all pregnancies. Moreover, unintended pregnancies are nearly five times as likely among those with low incomes compared to higher earners, and rates are also higher for people of color and young people as compared to white, older people.

Teen pregnancies are especially high in communities of color, highlighting the need to ensure OTC access with no age restriction. In 2019, the teen birth rate for people of color was over 2x as high as the birth rate for white teens. The CDC  states that access to contraceptives, among other reproductive health services, will improve health outcomes and equity among adolescents. Ultimately, approving OTC status for birth control pills will allow folks to control their pregnancies and give them greater autonomy in planning their own families. 

After all this evidence, then, what is the holdup?  Let’s face it: politics. Although there is some bipartisan support for OTC birth control access (most surprisingly, from Representative Alexandria Ocasio-Cortez and Senator Ted Cruz), the two parties cannot agree on what that access should look like. Some Republicans want to see an age restriction on OTC birth control, and some Democratic lawmakers worry that insurance companies will choose not to cover birth control if it becomes available OTC, placing an even bigger financial burden on contraceptive seekers. Of course, all of this seems to sit perfectly within a culture of paternalism, in which we don’t trust women to make their own decisions about their own bodies, even taking a pill that is arguably safer than Tylenol. Congress has a job: to put politics aside, look at the overwhelming evidence, and pass legislation revoking the FDA’s birth control prescription requirement. If they do, millions of people, and society, stands to gain.

• Tags National , Op-Ed

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The learning network | should birth control pills be available to teenage girls without a prescription.

Should Birth Control Pills Be Available to Teenage Girls Without a Prescription?

Questions about issues in the news for students 13 and older.

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Would over-the-counter birth-control pills lead to fewer unwanted pregnancies? Are they safe enough to be sold next to products like aspirin or cold medicine?

Should birth-control pills be available to teenage girls without a prescription?

In the news analysis “ Is It Time for Off-the-Shelf Birth-Control Pills? ” Elisabeth Rosenthal wonders if the time is ripe for a new government approach to oral contraceptives.

When a federal judge recently ordered the Food and Drug Administration to make the morning-after pill available to women of all ages without a prescription, the ruling was a political embarrassment for the Obama administration and unleashed protests from abortion foes and abstinence advocates. But that controversy may look like a tempest in a teapot compared with a broader and no less heated discussion that is roiling the medical community: should birth-control pills of any type require a doctor’s prescription? Or should they be available, like Tylenol, on pharmacy shelves? Last December the American College of Obstetricians and Gynecologists released an official position paper concluding that the time had come for birth-control pills to be sold over the counter. It was the first time the group had endorsed such sales, concluding that scientific evidence suggested that the practice was safe and calling it “a potential way to improve contraceptive access and use, and possibly decrease the unintended pregnancy rate.” After all, oral contraceptives have been available in the United States for more than half a century, and few medicines have been so thoroughly vetted. Despite some catchy new brand names, the pills I took 25 years ago are essentially the same as those my daughter takes today. If anything, pills have become safer because they contain lower doses of estrogen.

Students: Tell us …

• Should birth-control pills be available to teenage girls without a prescription? Why or why not?
• Do you think the requirement that women get a doctor’s prescription discourages some sexually active teenage girls from taking birth-control pills? Would changing the rule decrease the rate of unintended pregnancies?
• Why do you think some parents might be concerned about making birth-control or morning-after pills available without a prescription?
• The Obama administration wants to set a minimum age of 15 for over-the-counter morning-after pills. Do you agree that there should be a minimum age? If so, what age?

Students 13 and older are invited to comment below. Please use only your first name . For privacy policy reasons, we will not publish student comments that include a last name.

Comments are no longer being accepted.

Over-the-counter birth control should be available to all girls. First of all, there are many health risks – for the infant and the mother – associated with teen pregnancy. Also, it is commonly known that teen pregnancy correlates with with lower annual income, high-school drop-out, and substance abuse. Moreover, from a pragmatic standpoint, the financial burdens that teen pregnancy places on our healthcare system at large are immense. With this corollary data in mind, why would we not want to give adolescents every possible form of protection? I think it is ridiculous to say that birth control will encourage sexual activity; people will have sex regardless of their access to birth control, and it is foolish for individuals to think they can demand that all Americans abide by their moral standard of no premarital sex. Finally, I think sex is a personal decision, something that the government should have no part in. Young females should be making their decisions based on their own emotional preparedness and discussions with trusted adults. Ultimately, our society has a problem with labeling female sexuality as “promiscuous,” when, really, it is natural. Being a virgin or having sex does not make you any better or worse of an individual. All we can hope is that we can give women and girls (and men and boys, lets not forget that they should also be responsible and part of the discussion when it comes to birth control) the tools to make the best decision for themselves.

By now, we have a big problem in our society called “unwanted pregnancy “in everywhere, the main reason we do not have education in that topic. Another thing, it should be influenced in poor countries like countries that belong to Africa continent. Moreover, in the United States of America it is a rule to have a prescription for whatever medicament .Also, I disagree with that topic about the teenagers should have a prescription in this case birth control pills. According with the mayor Bloomberg, he does not want more unwanted pregnancy, then, it is not necessary to get a prescription for that kind of medication. In fact, no one care about it.

Yes birth control pills should be available to teenage girls to prevent them from getting pregnant. No when a woman gets a doctors prescription it doesnt discourage the teenage girl from taking birth pills. Maybe it could decrease the rate of unintended pregnancies. Parents might be concerned about making birth control because they want the best for their kid. They wont want their kid to be young giving birth to a new child.Parents might be concerned with morning after pills because they must follow their prescription for no problem to happen to them. Yes i agree with a minimum age of 15 because thats when most people start getting pregnant and decides to do what they want.

About, Birth Control Pills Be Available to Teenage Girls without a Prescription, I agree because now many Girls leave their study because they are pregnant or spread with disease for lack of prevention, but for many parents is impossible believe that one girl of 15 age can buy pills without prescription. This ruling will be controversial and discussion topic, the government medical community between the parents and church representing. With this ruling was a political embarrassment for the Obama administration permit avoid that many teenage truncate their future.

I think birth-control pills should be available to teenage girls without a prescription. Some teenage girls feel shy to go to doctor for prescription. That’s why my opinion is birth-control pills should be available over the counter like Tylenol, aspirin. Otherwise teenage girls will be pregnant such a young age and that is very harmful for their body. In this way girls don’t have to do abortion. Sometimes some parents don’t want to go to doctor for a prescription because they don’t have time. They also want that birth-control pills should be available over the counter.

I really think that we need a control about all the medication and more if those are without prescription. Basing on article, I think if we have available pill for teenager is more possible than the teenagers get less responsibility when have sex. If the parents are concerned for their son get pills that is their responsibility. If teenager can get birth-control pills also they could be not thinking about venereal diseases, because the first solution is not having baby.

I think birth control pills should be available to teenage girls without prescription for many reasons. Sometime girls are afraid to go to a doctor and ask for the pill, so then months later they have the baby. Also sometimes teenage girl don’t know what to do because they are not aware of the pill. Some parent may be concern because they might think the pill will affect their daughter. Moreover, they might think getting the pill more easily, it will increase sexually active teenagers. I agree with Obama administration because at age of 15 girls are a little more mature, and will take the pill more responsibly.

I think they shouldn’t sell these pills without a prescription. I know a lot of people think that if they are selling this like an easy way for them to get it to avoid the risk of get pregnant. I guess some medications could cause a second reaction to some people, I could say just selling birth control pills without prescription is not the problem. I think the first thing has to start from their house with their parent’s orientation about those things. Most of the young people around our society take that decision without stop to think about the risk or consequences plus most of them take this as a game the evidence result that they are not sufficient matures, oriented or prepare for it.

I think girl should not use birth control pills because I heard that if they take birth control in a young age it would be hard for them to get baby. If we allowed girls to take birth control pills would have sex. I think some parent make these pills available for them because they don’t want to risk their daughter having a baby. I disagree with Obama he should set a minimum of an age of 18 and over for the birth control pills.

Alot of teenagers are dropping out because they get scared when they find out that they are prenant. I think it is okay for teens to be able to go to buy the pill themselves because when they are that young there parents probably don’t even know they are having sex therefore they are afraid to tell them if they end up pregnant then you have a teenage daughter scared out of her mind about being a mom.

Honestly… I think it’s a good idea because in today’s society, young people do whatever they think is good for them. They just need to be aware of what results will bring each decision they make.

Yes the birth control pills should be available to teenage girls at age 17 and over with a prescription because the girls nowadays are having sex so early age they are graduating from school with babies. I think should be a requirement for girl take the pills but the sometimes the pills doesn’t work and still can get pregnant. The parents might be concerned because parents can’t control all the time their children’s. I agree with Obama administration the correct age should be 15 and over and giving some instructions but for me the minimum age could be 17.

Over-the-counter birth control should be available to all girls. First of all, there are many health risks – for the infant and the mother – associated with teen pregnancy. Second of all its is ridiculous to say that birth control will encourage sexual activity; people will have sex regardless of their access to birth control. I think sex is a personal decision, something that the government should have no part in. Young females should be making their decisions. Our society now a day has a problem with labeling female sexuality as “promiscuous,” when, really, it is natural. Being a virgin or having sex does not make you any better or worse of an individual it’s your choice on wither you want to have sex or not, but better safe than sorry. Giving birth control and protection will decrease teen pregnancy and sexual transmitted diseases.

it should available for every body over the counters because if you dont you know what’s going to happen alot of babies as well as all babies will rely on food stamps or other benifits. And people have sex desires but they dont want to have a baby in their early age that way it is in benifit of both couple, but if you see the other side of the story,there are a lots of side effect of those pills such as stomach ach, dizzyness, unusuall headache, etc. i think it should be available but those who doesnt effect your body in any other way besides controlling pregnency’s but it is not possible.

think, that the birth control pills should not be available to teenage girls because if they approve the teenage will have the door open to have sex anytime they want. Also through the times they will see the consequence because take too much pills and the end, the body will not resist all those medication. And it not just to get pregnant, the problems is that there are lot diseases and taking pills is not the solution. Our body is a temple we have to care like a treasure. Have sex is not the most important in our life. God gave us the freedom to decide what way we want to take. Now think which way you want to choose.

Yes they should be available with out a prescription because if a girl is having sex, nothing is going to stop her. There’s no strong evidence (?) that they are super dangerous. The biggest problem for some sexually active girls is that they are embarrassed/afraid of talking with a doctor or parent regrading contraceptives, and this may give options to more girls, which could decrease the rate of unintended pregnancies.

Some parents might be concerned, because some parents are very controlling. Many parents don’t even, really want to know if their kids are having sex. There could be health risks, that parents would b e concerned about. This also is not just about young people, prostitutes of all ages could use these over the counter contraceptives as well.

Human biology varies within it’s development, and some females may become sexually active/mature at a very young age. So putting a limit on the age doesn’t really make much sense, as far as effectiveness of contraception goes. So no age limit. Ultimately people should be allowed to make their own decisions regarding sex.

I don’t think that it should be given out with out a descxription. Because doctors need to check on the girls first so that they can see if the girls really need it.

I think teenager girls shouldn’t take birth control pills unless they get a prescription or a note from their doctor to make sure if they can take it. It helps teenager girls to make sure their body is in good health , and also to make sure if their body can take it.

Birth control I think should be prescribted because if you dont go to a doctor and get checked, you can risk your health. I personaly think that young girls, should be honest to a trusted adult to talk about the situation they are in, wether it’s to not get pregnent, or control thier period. I’ve heard that birth control can have some affects on diffrent people in diffrent situations, so the wise thing to do is go to a doctor to get clear information on it and if something was to go wrong, they could immidiatly fix the problem.

I think that if we were to set down the age limit to get morning after pills and birth-control pills to 15 or so they would at least have a parents consent to get them until 17 or 18. It could also give high school girls or younger a reason for it do be okay to be going those things. It wouldn’t be good with younger girls getting birth-control at that age without knowing everything about them, different side effects, and what they can and cant do for you.

Absolutely not. I had been taking birth control pills for about three years when I had serious complications from them. Right away, the doctors said it was the pill causing clots. This is evidently fairly common. Young girls should not be getting this medication without a doctor monitoring them. Many might not even tell their doctor they are taking them, for fear their parents will find out. Also, these pills work by altering your reproductive hormones. What are the long-terms effects of this in girls who are still undergoing puberty? This is a ridiculous idea. Also, teenagers already feel untouchable. If they are getting birth control pills without a conversation with their doctor, I think we will only see a rise in STDs. Pills protect against pregnancy, not AIDS or herpes. At least they will be screened for these things and have a talk about prevention with their doctor if they have to get a prescription. Many schools have abstinence only education now, so they might not be hearing it in school.

that i think there should be a pill it will help the econmy and it allows more acess to this stuff that can help people.

NO. Definitely not. They shouldn’t even be available with a prescription. The choice to misuse yourself in such a way as to need this abominable pill is horrible, and nobody should be allowed to dodge the consequences of their choices. This will lead to less fear of abusing people that way in the future, and yet another excuse to make that mistake. Additionally, it kills something unborn yet alive, which you have made (in this case, from an awful choice), and, depsite your willingness to commit the act that produces a child you are unwilling to allow them to be born. That is to say nothing of the many possible side effects which have a wide range of possible damage. Birth control is a disgusting menace of our day.

I disagree the birth control pills for the reasons that I do think it is a kind of way harming girl’s body because medicine is no good for people always and especially at girls’ growing age. However people would not concern about that instead of keeping using it. If it is really necessary to make a minimum age of giving the pills to girls, I think it is more reasonable to agree 18 years old.

It is ridiculous to me that some people are so close minded that they believe birth control should be given to young girls over the counter without a prescription. First of all, your opinion is irrelevant if you are saying that they should be given over the counter because young girls have diseases….birth control does not prevent STDs or protect against any kind of disease. You would know that if you went to a gynecologist, someone who specializes in female health and can teach you more about your body and the pill. Fifteen year olds who are too afraid to tell their parents they are sexually active and want to buy birth control without their guardians knowing should not be having sex. The requirement that woman need a doctor’s prescription may be discouraging to some teenage girls, but maybe that is a good thing. Changing the rule of not needing a prescription won’t decrease the rate of unintended pregnancies, it will increase the rate of girls improperly taking birth control and unnecessarily taking it. Gynecologists can explain to patients all the symptoms, rules, and reasons of birth control rather than them buying them off a shelf at CVS without any knowledge. Part of going on an oral contraceptive is being responsible enough to talk to someone about your bodily functions. It is disgusting to me that there is even a thought of offering them to just anyone in the public as if they are candy.

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Should oral contraceptive pills be available without a prescription? A systematic review of over-the-counter and pharmacy access availability

Caitlin e kennedy.

1 Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA

Ping Teresa Yeh

Lianne gonsalves.

2 Department of Reproductive Health and Research, Organisation mondiale de la Santé, Genève, Switzerland

Hussain Jafri

3 WHO Patients for Patients Safety Program, Organisation mondiale de la Sante, Geneve, Switzerland

Mary Eluned Gaffield

James kiarie, manjulaa l narasimhan, introduction.

Making oral contraceptives (OC) available over the counter (OTC) could reduce barriers to use. To inform WHO guidelines on self-care interventions, we conducted a systematic review of OTC availability of OCs.

We reviewed data on both effectiveness and values and preferences surrounding OTC availability of OCs. For the effectiveness review, peer-reviewed articles were included if they compared either full OTC availability or pharmacist-prescribing (behind-the-counter availability) to prescription-only availability of OCs and measured an outcome of interest. For the values and preferences review, we included peer-reviewed articles that presented primary data (qualitative or quantitative) examining people’s preferences regarding OTC access to OCs. We searched PubMed, CINAHL, LILACS and EMBASE through November 2018 and extracted data in duplicate.

The effectiveness review included four studies with 5197 total participants. Two studies from the 2000s compared women who obtained OCs OTC in Mexico to women who obtained OCs from providers in either Mexico or the USA. OTC users had higher OC continuation rates over 9 months of follow-up (adjusted HR: 1.58, 95 % CI 1.11 to 2.26). One study found OTC users were more likely to report at least one WHO category 3 contraindication (13.4% vs 8.6%, p=0.006), but not category 4 contraindications; the other study found no differences in contraindicated use. One study found lower side effects among OTC users and high patient satisfaction with both OTC and prescription access. Two cross-sectional studies from the 1970s in Colombia and Mexico found no major differences in OC continuation, but some indication of slightly higher side effects with OTC access. In 23 values and preference studies, women generally favoured OTC availability. Providers showed more modest support, with pharmacists expressing greater support than physicians. Support was generally higher for progestogen-only pills compared with combination OCs.

A small evidence base suggests women who obtain OCs OTC may have higher continuation rates and limited contraindicated use. Patients and providers generally support OTC availability. OTC availability may increase access to this effective contraceptive option and reduce unintended pregnancies.

Systematic review (PROSPERO) registration number

CRD42019119406.

Key questions

What is already known.

• Making oral contraceptives (OC) available over the counter (OTC) may increase access.

What are the new findings?

• A systematic review of the literature identified four studies using comparative designs to examine the effect of OTC availability of OCs and 23 studies examining values and preferences of patients and providers, mostly from the USA and Mexico.
• The more recent and rigorous studies suggested OTC users had higher rates of OC continuation over time; there was some indication that OTC users had lower rates of side effects but slightly higher rates of use of OCs despite contraindications.
• Values and preferences suggested general support for OTC availability or pharmacy access, with more support among women and pharmacists than among physicians.

What do the new findings imply?

• Making OCs available OTC, perhaps with progestogen-only pills that have fewer contraindications to use, may be an approach to increasing access to and use of this effective contraceptive option.

Ensuring access to contraceptive methods, including for vulnerable populations and young people, is essential for the well-being and autonomy of women and girls. Oral contraceptives (OC), both combined oral contraceptives (COC) and progestogen-only pills (POP), are widely used effective methods of birth control. However, access to OCs varies globally—in some countries, OCs are available over the counter (OTC), while other countries restrict access to OCs either by requiring eligibility screening by trained pharmacy staff before dispensation (pharmacy access, or behind-the-counter availability), or by requiring a healthcare provider’s prescription. A 2015 review of OC access across 147 countries found that 35 countries had OCs legally available OTC, 11 countries had OCs available without a prescription but only after eligibility screening by trained pharmacy staff, 56 countries had OCs available informally without a prescription and 45 countries required a prescription to obtain OCs. 1 Given the persistently high proportion of unintended pregnancies globally—44% according to some estimates 2 —making OCs available OTC in more settings has the potential to reduce barriers to access, thereby increasing use of this effective contraceptive option and reducing unintended pregnancies.

While different regulatory criteria are needed in different countries to make a specific medication available OTC or with eligibility screening by pharmacy staff, the WHO is responsible to provide overall guidance to critical questions of whether interventions should be recommended or not. We conducted this systematic review in the context of developing WHO normative guidance on self-care interventions for sexual and reproductive health and rights. We included both a review of effectiveness data and a review of data on values and preferences.

Effectiveness review: PICO question and inclusion criteria

We sought to answer the following question: should contraceptive pill/oral contraceptives be made available over the counter without a prescription?

Our effectiveness review followed the PICO question format:

Individuals using contraceptive pill/oral contraceptives.

Intervention

Availability of contraceptive pill/oral contraceptives OTC (without a prescription) or behind the counter (pharmacy access, including dispensing from trained pharmacy personnel and pharmacist prescribing of hormonal birth control).

Availability of contraceptive pill/oral contraceptives by prescription only.

• Uptake of OCs (initial use).
• Continuation of OCs (or, conversely, discontinuation).
• Adherence to OCs (correct use).
• Comprehension of instructions (product label).
• Health impacts (unintended pregnancy, side effects, adverse events or use of OCs despite contraindications).
• Social harms (eg, coercion, violence (including intimate partner violence, violence from family members or community members, and so on), psychosocial harm, self-harm, and so on), and whether these harms were corrected/had redress available.
• Client satisfaction.

To be included in the effectiveness review, a study had to meet the following criteria:

• Employ a study design comparing OTC availability of OCs (with or without pharmacist dispensation) to prescription-only availability of OCs.
• Measured one or more of the outcomes listed above.
• Published in a peer-reviewed journal.

We focused on daily contraceptive pill/oral contraceptives for routine pregnancy prevention and did not include studies examining pills specifically for emergency contraception.

Where data were available, we stratified all analyses by the following subcategories:

• Behind-the-counter (pharmacy access) versus OTC availability without a prescription.
• COCs versus POPs.
• Point of access (eg, stores, pharmacies, and so on).
• Prior use of contraception.
• Age: adolescent girls and young women (aged 10–14, 15–19 and 15–24) and adult women (aged 25+).
• Vulnerabilities (ie, poverty, disability, religion).
• High-income versus low/middle-income countries.
• Literacy/educational level.

Study inclusion was not restricted by location of the intervention or language of the article. We planned to translate articles in languages other than English if identified. The complete protocol was registered and is available in PROSPERO (CRD42019119406).

Values and preferences review: inclusion criteria

The same search strategy was used to search and screen for study inclusion in a complementary review of values and preferences related to OTC access to OCs (including pharmacy access). We included studies in the values and preferences review if they presented primary data (qualitative or quantitative) examining people’s preferences regarding OTC access to OCs. We included studies examining the values and preferences of both people who have used or potentially would use OCs themselves as well as providers (including pharmacists) and other stakeholders, such as male partners, policymakers and insurance providers.

Search strategy

The same search strategy was used for both the effectiveness review and the values and preferences review. We searched four electronic databases (PubMed, the Cumulative Index to Nursing and Allied Health Literature (CINAHL), Latin American and Caribbean Health Sciences Literature (LILACS) and Embase) through the search date of 30 November 2018. The following search strategy was developed for PubMed and adapted for entry into all computer databases; a full list of search terms for all databases is available from the authors on request.

(‘Contraceptives, Oral’ [Mesh] OR ‘oral contraceptive pill’ [tiab] OR ‘oral contraceptive pills’ [tiab] OR ‘birth control pill’ [tiab] OR ‘birth control pills’ [tiab] OR ‘oral contraceptives’ [tiab] OR ‘oral contraception’ [tiab] OR ‘hormonal birth control’ [tiab] OR ‘hormonal contraception’ [tiab] OR ‘the pill’ [tiab]) AND (‘Nonprescription Drugs’ [Mesh] OR ‘nonprescription’ [tiab] OR ‘over the counter’ [tiab] OR ‘over-the-counter’ [tiab] OR ‘without a prescription’ [tiab] OR ‘pharmacist-prescribed’ [tiab] OR ‘pharmacy access’ [tiab] OR ‘clinician-prescribed’ [tiab] OR ‘physician-prescribed’ [tiab] OR ‘without prescription’ [tiab] OR ‘community pharmacy services’ [Mesh] OR ‘community center’ [tiab] OR ‘community centre’ [tiab] OR store [tiab] OR online [tiab] OR mobile [tiab] OR telehealth [tiab])

To identify articles that may have been missed through online database searching, we used several complementary approaches. We reviewed the resources section of the OCs OTC working group website, 3 which gathers scientific articles and reviews on this topic, and reviewed the citations included in several related recent reviews. 1 4 5 Secondary reference searching was also conducted on all studies included in the review. We searched for ongoing trials through ClinicalTrials.gov, the WHO International Clinical Trials Registry Platform, the Pan African Clinical Trials Registry, and the Australian New Zealand Clinical Trials Registry. Finally, selected experts in the field were presented with our list of included articles and asked to share any additional article we had missed.

Titles, abstracts, citation information and descriptor terms of citations identified through the search strategy were initially screened by a member of the study staff. Remaining citations were then screened in duplicate by two reviewers (CEK and PTY) with differences resolved through consensus. Final inclusion was determined after full-text review.

Data extraction and analysis

For each included article, data were extracted independently by two reviewers using standardised data extraction forms. Differences in data extraction were resolved through consensus.

For the effectiveness review, data extraction forms covered the following categories:

• Study identification: author(s); type of citation; year of publication, funding source.
• Study description: study objectives; location; population characteristics; type of oral contraceptives; description of OTC access; description of any additional intervention components (eg, any education, training, support provided); study design; sample size; follow-up periods and loss to follow-up.
• Outcomes: analytical approach; outcome measures; comparison groups; effect sizes; CIs; significance levels; conclusions; limitations.
• Risk of bias: assessed for randomised controlled trials with the Cochrane Collaboration’s tool for assessing risk of bias, 6 and for non-randomised trials but comparative studies with the Evidence Project risk of bias tool. 7

For the values and preferences review, data extraction forms included sections on study location, population, study design and key findings.

We did not conduct meta-analysis due to the small number and heterogeneous nature of included studies. Instead, we report findings based on the coding categories and outcomes.

Patient and public involvement

Several of the authors are current or past OC users. HJ, chair of the advisory group for the WHO Patients for Patients Safety Program, was involved as a community representative starting with the phase of protocol development. He commented on the overall study design and protocol, including patient-relevant outcomes, interpretation of results and writing/editing the document for readability and accuracy. Patients were involved in a global survey of values and preferences and in focus group discussions with vulnerable communities conducted to inform the WHO guideline on self-care interventions 8 ; they thus play a significant role in the overall recommendation informed by this review.

Search results

Figure 1 presents a flow chart showing study selection for both the effectiveness and values and preferences reviews. The initial database search yielded 929 records, with 15 records identified through other sources; 782 remained after removing duplicates. After the initial title/abstract review, 68 articles were retained for full-text screening. Ultimately, six articles reporting data from four studies met the inclusion criteria and were included in the effectiveness review. 9–14 An additional 24 articles from 23 studies were included in the values and preferences review. 13 15–37

Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) flow chart showing disposition of citations through the search and screening process.

One study was considered for the effectiveness review but ultimately judged to not meet the inclusion criteria. 38 In Kuwait, where OCs are available OTC, the study compared women who consulted with a physician and those who did not. We excluded the study because it was not clear whether women received OCs from these physicians or not. However, we note that the study found no difference across groups in OC continuation, duration of first OC use, method failure and reasons for discontinuation.

Effectiveness review

Table 1 shows the characteristics of the four studies included in the effectiveness review. 9–14 The first study, the Border Contraceptive Access Study, was a longitudinal cohort study conducted among women living in El Paso, Texas, USA, from 2006 to 2008 with results reported in a number of articles. 10 12 13 The study used convenience sampling to enrol 1046°C users who obtained OCs either OTC from a Mexican pharmacy (n=532) or from a family planning clinic in El Paso (n=514). These women were interviewed at baseline and then followed in three additional surveys over 9 months. The second study, an analysis of data from the 2000 Mexican National Health Survey 14 by an overlapping group of researchers, was a cross-sectional comparison of women who reported obtaining OCs OTC to women who reported obtaining them from a healthcare provider. The third and fourth studies were significantly older, drawing on data from the 1970s. They presented cross-sectional comparisons of women whose initial contraceptive method was OCs, obtained OTC from a pharmacy/drugstore, from a private provider/clinician or the national family planning programme: one analysed data from the 1979 Mexico National Fertility and Mortality Study among 2063 women 9 and the other was a 1974 Fertility and Contraceptive Use survey in Bogotá, Colombia, among 893 women. 11 All studies included mainly women using COCs, rather than POPs, although pill formulations likely differed by time.

Descriptions of studies included in the effectiveness review

OC, oral contraceptive; OTC, over the counter.

As all studies were observational, table 2 shows the risk of bias assessments using the Evidence Project tool. The Border Contraceptive Access and Mexican National Health Survey studies found that women who obtained their OCs OTC were different in at least some sociodemographic characteristics than those who obtained them from clinics; however, both studies employed analyses that adjusted for confounders to address this discrepancy. 10 12–14 The Mexico National Fertility and Mortality Study and Colombian Fertility and Contraceptive Use Survey said there were only minor sociodemographic differences between groups but did not present actual statistics to support these statements; neither study adjusted for confounders. 9 11 The Border Contraceptive Access Study relied on convenience sampling, but was strengthened by its longitudinal design. 10 12 13 Conversely, while the other three studies were cross sectional in nature, they were strengthened by their multistage sampling strategies. 9 11 14

Evidence Project risk of bias assessment 7 for studies included in the effectiveness review

*Four-stage probability proportionate to size sampling.

†Authors state that the comparison groups were similar, but no comparative data provided to assess this.

‡Three-stage probability sampling.

N/A, not applicable; NR, not reported.

The included studies reported on three of the PICO outcomes: continuation of OCs, health impacts (specifically, use of OCs despite contraindications and side effects) and client satisfaction. For the other PICO outcomes, we found no studies. Results from each study are presented in table 3 and described below.

Outcomes of studies included in the effectiveness review

OC, oral contraceptive;OTC, over the counter.

Continuation of OCs

The Border Contraceptive Access Study reported the proportion of women who continued OC use over the 9-month study period. 12 Overall, 25.1% of clinic users discontinued by the end of the study period compared with 20.8% of OTC users (p=0.12). In an unadjusted Cox proportional hazards model, OTC users were more likely to continue OC use than clinic users (unadjusted HR: 1.48, 95% CI 1.07 to 2.04); this estimate changed only slightly in the adjusted model and remained statistically significant (adjusted HR: 1.58, 95% CI 1.11 to 2.26).

The two studies from the 1970s also examined continuation. The Mexico National Fertility and Mortality Study presented continuation rates at 12 months per 100 women who accepted OCs as their first contraceptive method. 9 No difference by OC source was found: 59% of private physician or clinic users, 57% of government family planning programme users and 60% of OTC users remained on OCs after 12 months. The Colombian Fertility and Contraceptive Use Survey presented first contraceptive method continuation rates for women who chose OCs at 12 and 24 months. 11 Though a validation survey found that the continuation rates were overestimated by approximately 10%–15%, the study found that at both 12 and 24 months, OC continuation was approximately 5% higher for clinic users than OTC users.

Use of OCs despite contraindications

The two studies from the 2000s reported on the use of OCs despite contraindications.

The Border Contraceptive Access Study reported use of OCs despite contraindications using the WHO Medical Eligibility Criteria (MEC) (third edition) relative (category 3) and absolute (category 4) contraindications. 10 At the baseline survey, at least one category 3 or 4 contraindication was reported by 21.4% of OTC users and 13.8% of clinic users (p=0.002). OTC users were more likely to have any category 3 contraindication (13.4% vs 8.6%, p=0.006), but there was no difference in category 4 contraindications (7.4% vs 5.3%, p=0.162). The study also provided a list of specific contraindications. For most contraindications there was no significant difference for OTC and clinic users; however, OTC users were significantly more likely than clinic users to have category 3 hypertension (140–159/90–99) (8.4% vs 4.5%, p=0.036) or to both smoke (<15 cigarettes per day) and be 35 years or older (6.4% vs 3.1%, p=0.017).

The 2000 Mexican National Health Survey analysis reported use of OCs despite category 3 contraindications using the WHO MEC Criteria from 1996 based on hypertension and smoking at or over age 35. 14 Overall, the study found no significant differences in contraindications between OC users who obtained their pills OTC versus those who obtained them at a clinic ( table 3 ). This finding held true when comparing OTC to clinic users on contraindications related to hypertension (≥160/100) (1.7% vs 1.8%), smoking and age 35 or older (9.4% vs 7.5%), and both contraindications combined (4.5% vs 3.6%).

Side effects

Two studies reported on side effects related to OC use. The Border Contraceptive Access Study found that, at baseline, 22.3% (104/466) of OTC users reported side effects compared with 30.4% (144/474) of clinic users (p<0.01). 12 The Colombian Fertility and Contraceptive Use Survey found that 51% of OTC users and 44.4% of clinic users reported any side effect from initial OC use. 11 Neither group reported the most important complications of OC use (thrombophlebitis and thromboembolism), and similar proportions reported the most common side effect (headache). OTC users were more likely to mention nervousness, skin problems, pain and bleeding problems, while clinic users were more likely to complain of weight changes, varices and other side effects (not specified).

Satisfaction

One study—the Border Contraceptive Access Study—reported client satisfaction but did not present exact results. They stated, ‘three quarters of clinic users and more than 70% of pharmacy users said they were very satisfied with their source (results not shown). Only about 4% of each group said they were either somewhat or very unsatisfied with their source.’ 13

Values and preferences review

We identified 24 articles from 23 studies that met the inclusion criteria for the values and preferences review. Of these, 13 articles focused on the perspectives of female OC users, potential users, or women in general, 13 15 16 18 19 21–24 29–31 37 9 focused on the perspectives of healthcare providers (particularly physicians) and pharmacists 17 25 26 28 32–36 38 , 39 and 1 focused on the general public; 27 one article included both women and healthcare providers. 20 Almost all studies were conducted in the USA, except for one each in Canada, 32 France 17 and Ireland 15 ; one publication from the Border Contraceptive Access Study included in the values and preferences review included women residing in El Paso, Texas, who accessed OCs in both the USA and Mexico. 13 Studies used both quantitative and qualitative methodologies.

Studies covered both OTC and pharmacy access. While most studies of women asked about hypothetical values and preferences around OTC availability, a few studies reported the perspectives of women who had actually used OTC or pharmacy access services. 13 20 Most studies distinguished between pharmacy access and OTC availability, although a few were less clear about which approach they were studying, using terms such as ‘access to oral contraceptives without a prescription,’ which we assumed to be OTC availability. Using our best assessment of which model studies were examining, we present data for the values and preferences studies separated by true OTC access ( table 4 ) and pharmacy access ( table 5 ), and present results accordingly below. Two studies examined perspectives on both OTC and pharmacy access, so are presented in both tables 4 and 5 . One cross-sectional survey among young women aged 14–17 in the USA found slightly higher support for dispensation in pharmacies compared with full OTC availability (79% vs 73%), but slightly higher potential use of full OTC availability compared with pharmacy access (61% vs 57%). 30 Another cross-sectional survey among healthcare providers in the USA found much higher rates of support for pharmacy access (74%) compared with full OTC access (28%), although this study combined the pill, patch and ring together in one question about hormonal contraceptives. 35

Study descriptions and key findings of studies included in the values and preferences review examining OTC access

OC, oral contraceptive; OCP, Oral Contraceptive Pill; OTC, over the counter;POP, progestogen-only pill; STI, sexually transmitted infection; aOR, adjusted OR.

Study descriptions and key findings of studies included in the values and preferences review examining pharmacy access

OC, oral contraceptive;OTC, over the counter;STI, sexually transmitted infection.

Across studies using both quantitative and qualitative methods, women generally expressed high interest in hypothetical OTC availability of OCs. In quantitative studies, support for OTC availability of OCs ranged from a third of female students in two US colleges/universities 19 31 to 89% of current OC users aged 18–50 in Ireland. 15 However, most quantitative surveys of potential OC users found that a majority of participants supported OTC availability. 15 18 21 24 30 Slightly lower but still sizeable proportions of women said they would obtain OCs OTC if available. 23 24 30 Ease of access, convenience, privacy and time saved from clinician visits for prescriptions were the main benefits women anticipated from OTC availability. 13 16 18 30 However, across studies, participants noted concerns about cost, continued use of other preventive screening options (eg, for Pap smears, pelvic exams, clinical breast exams and sexually transmitted infections) and the safety of such access, particularly for young people, first-time pill users and women with medical conditions. 13 16 18 19 23 30 31

Healthcare professionals from France and the USA, particularly medical doctors, voiced moderate to low support for OTC availability of OCs, often citing safety concerns, OC efficacy, concerns about correct OC use or missed examinations for medical contraindications. 17 28 35 Providers generally supported making POPs available OTC more than they supported making COCs available OTC. 26

Pharmacy access

Among potential or current OC users, most women were in favour of pharmacy access, and substantial proportions said they would obtain OCs through pharmacy access if it were available. 29 30 37 Some women currently not using any contraception said they would begin using a hormonal contraceptive if pharmacy access were available. 29 One study found that women (and pharmacists) were satisfied with pharmacist-led OC use and expressed willingness to continue seeing pharmacist prescribers. 20 While young women appreciated their traditional healthcare providers, they liked the increased access and convenience of obtaining OCs directly from a pharmacy. 37

In studies among healthcare providers, pharmacists were generally very supportive of pharmacy access to OCs, while physicians tended to be more moderately supportive. 20 25 28 32–36 Increased access to care, preventing unintended pregnancies and convenience for patients were the most frequently identified potential benefits. 25 33–35 Safety, time constraints, lack of private space in the pharmacy, increased liability and reimbursement were identified as potential barriers. 25 28 33 36 There was also concern from pharmacists about physician’s resistance to making OCs available at pharmacies 28 and concern from physicians about pharmacist’s refusal to provide services. 34

Finally, in a study of digital comments on online media articles about pharmacy access to OCs in the USA, commentators were generally positive and cited benefits including increasing access to healthcare, reducing unintended pregnancies and supporting individual autonomy, but noted these must be balanced with potential safety and logistical concerns. 27

In this systematic review, we identified four studies using comparative designs to examine the impact of OTC availability of OCs. Two studies conducted in the 2000s examined women who obtained OCs OTC in Mexico and compared them with women who obtained OCs from providers in either Mexico or the USA. The other two studies were significantly older (from the 1970s) and compared first contraceptive method users who either obtained OCs OTC from a pharmacy or drugstore or through a provider or family planning programme; the OC formulations in these studies were likely different, and women 45 years ago potentially differ from women today in terms of desired fertility, decision-making around contraceptive methods and perception/tolerance of and tendency to report side effects. While the more recent studies suggested OTC users had higher rates of OC continuation over time and fewer side effects, there was some indication that OTC users had slightly higher rates of use of OCs despite contraindications. Contraindications are an important concern; however, research has indicated that women can self-screen for contraindications fairly well using a simple checklist. 40 41 Despite the strengths of the studies included in the review, the small evidence base provides limited guidance for countries considering OTC availability of OCs.

We identified a much larger evidence base on the values and preferences of potential users, providers and the public. However, this evidence was also limited, since almost all studies were conducted in the USA. Women were generally in favour of OTC availability; healthcare providers were as well, with pharmacists expressing higher support than physicians for pharmacy access. Among both women and providers, support was generally higher for dispensation in pharmacies compared with full OTC availability, and for OTC access to POPs rather than COCs. Given the near-universal use of COCs at the times and locations where the studies included in the main review were conducted, we had no comparative effectiveness data on POPs. This is unfortunate, as POPs have been suggested as a good option for initial OTC availability, given that they have fewer contraindications to use.

An additional concern about OTC availability is that the concomitant reduced visits to clinicians may also translate to a reduction in routine preventive screening (including for Pap smears, pelvic exams, clinical breast exams and screening for sexually transmitted infections). This was not one of our prespecified PICO outcomes since such exams are not required to receive OCs per the WHO’s Selected Practice Recommendations for Contraceptive Use. 42 However, the Border Contraceptive Access Study did report on preventive screening; while women who obtained their OCs from a clinic reported slightly higher rates of some screenings, both groups (OTC and clinic users) had high overall rates of reported screenings with relatively minimal differences between groups. 43 One values and preferences study also found that US women said they would continue to get screened if OCs were made available OTC, 23 although clinicians were afraid they would not. 35 These findings offer some indication that OTC access for OCs may not necessarily result in reduced use of other preventive services.

OTC availability is only one way to increase access to OCs. A previous systematic review found that increasing the number of OC pill packs dispensed or prescribed increased OC continuation, although it also resulted in increased pill wastage. 44 There are also internet-based platforms for ordering OCs, which comply with clinician prescriptions or pharmacist screening, but conduct all screenings online. 45 A modelling study found that making out-of-pocket pill pack costs low or free would increase OC use. 46 Finally, increased insurance coverage for OCs should also reduce access barriers to OC use, regardless of access point. Although moving OCs to OTC status should lead to fewer clinician visits for women, thus decreasing costs related to travel, time and other medical expenses associated with those visits, OTC access could potentially increase the cost of OCs if insurance does not cover OTC purchases, or if women are unaware that they can use insurance in OTC purchases. Insurance considerations should be explicitly considered in policy discussions of OTC availability, as insurance coverage will be particularly important for some of the most vulnerable groups, such as low-income women and girls.

Our review has several strengths, including our broad search strategy and our inclusion of both effectiveness and values and preferences studies. However, conclusions from our review are limited by the small evidence base in this area. We identified four observational studies in our main effectiveness review, from the same global region, and there may have been residual confounding in comparing OTC and clinic OC users despite some analyses being adjusted. Although there were more studies in the values and preferences review, they were also geographically limited, and many relied on participants’ responses to hypothetical questions about OTC availability. While it is challenging to conduct randomised trials of what is fundamentally a policy intervention, researchers should be encouraged to take advantage of natural experiments such as the Border Contraceptive Access Study or to study changes to policies such as those recently allowing pharmacy access to OCs in the US states of Oregon and California. Further, many countries already allow OTC availability of OCs, so policy decisions can also take into consideration the wide range of country experience in this area.

Despite the limitations of the evidence base, this review provides important information to guide policy decisions around OTC availability of OCs. This evidence has been used to inform the development of WHO recommendations for self-care interventions for sexual and reproductive health and rights in relation to OTC availability of OCs. The benefits and harms of OTC availability of OCs and the values and preferences of patients and providers found in the present review, along with a separate survey of community values and preferences and consideration of resource use, human rights and feasibility, will shape the recommendation. Additional research into outcomes critical to decision-makers where little comparative data currently exist should be done to address the gaps identified.

Acknowledgments

We thank Laura Ferguson and Nandi Siegfried for their comments on the review protocol. We also thank Johns Hopkins research assistants Rui (Renee) Ling, Kaitlyn Atkins, Priyanka Mysore, Molly Petersen and Anita Dam for help with screening the initial database search results, conducting hand searching and secondary reference searching, and duplicate data extraction. Finally, we thank Daniel Grossman and Sara Yeatman for their timely and thorough responses to questions about their studies, and the excellent comments from the anonymous reviewers who really helped improve the manuscript.

Handling editor: Soumyadeep Bhaumik

Contributors: MN conceptualised the study. CEK and PTY designed the protocol with input from JK, MLG, LG, HJ and MLN. PTY ran the search and oversaw screening, data extraction and assessment of bias. CEK drafted the manuscript, while all authors reviewed the draft and provided critical feedback. All authors had full access to all of the data (including statistical reports and tables) in the study and can take responsibility for the integrity of the data and the accuracy of the data analysis. All authors read and approved the final manuscript. The corresponding author, as guarantor, accepts full responsibility for the finished article, has access to any data and controlled the decision to publish.

Funding: This study received financial support from the UNDP-UNFPA-Unicef-WHO-World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP) and the Children's Investment Fund Foundation (CIFF). HRP was involved in the study design.

Disclaimer: The funders played no part in the decision to submit the article for publication, nor in the collection, analysis and interpretation of data.

Competing interests: None declared.

Patient consent for publication: Not required.

Provenance and peer review: Not commissioned; externally peer reviewed.

Data availability statement: All data come from published journal articles. Extracted data are available on request to the corresponding author.

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How The Approval Of The Birth Control Pill 60 Years Ago Helped Change Lives

Sarah McCammon

Birth control pills in 1976 in New York. The birth control pill was approved by the FDA 60 years ago this week. Bettmann/Getty Images hide caption

Birth control pills in 1976 in New York. The birth control pill was approved by the FDA 60 years ago this week.

Updated at 9:44 a.m. ET

As a young woman growing up in a poor farming community in Virginia in the 1940s and '50s, with little information about sex or contraception, sexuality was a frightening thing for Carole Cato and her female friends.

"We lived in constant fear, I mean all of us," she said. "It was like a tightrope. always wondering, is this going to be the time [I get pregnant]?"

Cato, 78, now lives in Columbia, S.C. She grew up in the years before the birth control pill was approved by the U.S. Food and Drug Administration, on May 9, 1960. She said teenage girls in her community were told very little about how their bodies worked.

"I was very fortunate; I did not get pregnant, but a lot of my friends did. And of course, they just got married and went into their little farmhouses," she said. "But I just felt I just had to get out."

At 23, Cato married a widower who already had seven children. They decided seven was enough.

By that time, Cato said, the pill allowed the couple to avoid having more babies — and she eventually was able to go on to college.

"It was just like going from night to day, as far as the freedom of it," Cato said. "And to know that I had control, that I had choice, that I controlled my body. It gave me a whole new lease on life."

Loretta Ross, an activist and visiting women's studies professor at Smith College , was among the first generation of young women to have access to the birth control pill throughout their reproductive years.

Ross, now 66, said by the time she came of age around 1970, the pill was giving young women more control over their fertility than previous generations had enjoyed.

"We could talk about having sex – not without consequences, because there were still STDs ... but at the same time, with more freedom than our foremothers had," Ross said. "So it changed the world."

For all it's done for women, Ross said that the pill has a complex and controversial history; it was first tested on low-income women in Puerto Rico . Ross said the pill also has limitations. She'd like to see it made available over the counter, as it is in some countries — not to mention, a pill for men.

When the pill was approved in 1960, women had few relatively few contraceptive options, and the pill offered more reliability and convenience than methods like condoms or diaphragms, said Dr. Eve Espey , chair of the Department of Ob/Gyn and Family Planning at the University of New Mexico.

"There was a huge, pent-up desire for a truly effective form of contraception, which had been lacking up to that point," Espey said.

By 1965, she said, 40% of young married women were on the pill.

For Pat Fishback, now 80 and living in Richmond, Va., the newly available pill allowed her to delay having children in her early 20s until she'd been married for a couple of years.

"It also made having children a positive experience," Fishback said. "Because we had actually, emotionally and intellectually, gotten to the point where we really desired to have children."

It took a bit longer for unmarried women to gain widespread access to the pill and other forms of contraception: Linda Gordon, 80, a historian at New York University , remembers the stigma around single women and contraception at the time.

"When I was in college, a number of women had a wedding ring — a gold ring — that we would pass around and use when we wanted to go see a doctor to get fitted for a diaphragm," Gordon said. "In other words, there were people finding their way to do that, even then."

The pill also gave rise to a variety of other forms of hormonal contraception, many of which are popular today , Gordon said. According to the Centers for Disease Control and Prevention, nearly 13% of American women of reproductive age use the pill — making it the second-most popular form of contraception, after female sterilization.

Gordon said that 60 years after the pill's approval, contraception remains a contentious political issue.

Just this week, the U.S. Supreme Court heard arguments in a case involving the birth control mandate in the Affordable Care Act. A decision on whether some institutions with religious or moral objections can deny contraceptive coverage to their employees is expected in the months to come.

• birth contr
• unmarried women
• contraceptive
• young women
• reproductive rights
• reproductive health
• family planning
• Birth Control
• Supreme Court

"Beyond birth control:" the Yaz/Yasmin controversy and the risk evaluation of hormonal contraceptives

Downloadable content.

• Geampana, Alina
• Jennifer Fishman (Supervisor)
• Concerns about the safety of the pill have come to the fore recently, due in large part to the public outcry over deaths allegedly caused by popular contraceptives Yaz and Yasmin. Media reports link the drugs to at least 23 deaths in Canada and over 100 in the U.S. as well as thousands of injuries worldwide, as a result of a purported increased incidence of blood clots. The question of what should be considered an acceptable risk threshold for approved contraceptive pills has been contested by many groups, including regulatory bodies, medical professionals, epidemiologists, and consumers. This thesis provides an in-depth sociological examination of the Yaz/Yasmin controversy through qualitative analysis of stakeholder interviews and content analysis of key medical, regulatory, and legal documents. I examine the most recent safety debates in order to analyze the central phenomena that play a role in the regulation and risk/benefit assessment of oral contraceptives: managing data uncertainty, calculating reproductive risks against ancillary benefits, and the precariousness of informed consent. After an introductory chapter in which I situate the thesis within the larger scholarly conversations on contraceptive assessment specifically and technological risk more generally, the findings are presented in three article-length manuscripts. In the first article, I investigate strategies that regulatory bodies and professional associations use to assure the public of the safety of Yaz and Yasmin. I found that a discourse of pregnancy risks is employed in official risk communication. I argue that this has gendered implications for the development of contraceptives and their risk assessment. In the second article, I explore how pill users who have experienced side effects understand the risks of hormonal contraception and advocate for changes in risk communication and drug regulation. I found that women highlighted the inadequacy of risk information received from both doctors and pharmaceutical companies. In addition, affected users rejected the use of reproductive risk as the primary comparative risk when assessing pill safety. In the third paper, I look at processes through which individual stakeholders measure and debate contraceptive risk. Here, I highlight how contraceptive risk assessment is characterized by systemic uncertainty and doubt. Furthermore, the paper stresses the tough choices that users have to make in a climate of indecision coupled with pharmaceutical companies' involvement in research and marketing. While we know that the history of the pill has been fraught with many debates about its safety, less attention has been paid to the current changing context and how different social actors still contest the measurement and meaning of contraceptive risk. I found that many questions about risks are unresolved or dealt with in ways that create divergence between professionals and affected users. In the concluding chapter, I discuss the sociological implications of my findings, the limitations of this study and potential directions for future research on the evaluation of contraceptive risk. The Yaz/Yasmin controversy has amplified contemporary critiques of the pill. In documenting and analyzing the dynamics of this risk debate, this thesis contributes to a deeper understanding of how the risks and benefits of contraception are currently assessed in the North American context.
• Les inquiétudes concernant l'innocuité de la pilule ont récemment été au cœur de toutes les discussions et ce en grande partie à cause du tollé général provoqué par les décès vraisemblablement entraînés par les contraceptifs Yaz et Yasmin, très répandus sur le marché. Les rapports des médias associent ces médicaments à au moins 23 morts au Canada et plus de 100 aux États-Unis, ainsi qu'à des milliers de victimes à travers le monde par suite d'une incidence supposée accrue de caillots sanguins. La question de savoir quel devrait être le seuil de risque acceptable pour les pilules contraceptives approuvées a été débattue par de nombreux groupes, parmi lesquels des organismes de réglementation, des professionnels du milieu médical, des épidémiologistes et des consommatrices. La présente thèse fournit une analyse sociologique en profondeur de la controverse Yasmin/Yaz à travers une analyse qualitative des entretiens effectués avec les parties prenantes et une analyse de contenu de documents clés sur les plans médical, réglementaire et juridique. Nous examinerons les débats les plus récents concernant l'innocuité afin d'analyser les principaux événements qui influent sur la réglementation et l'évaluation du rapport risque/avantage des contraceptifs oraux: la gestion de l'incertitude des données, le calcul des risques liés à la procréation par rapport aux avantages complémentaires, et la précarité du consentement éclairé. Après un chapitre introductif dans lequel nous situerons la présente thèse au sein des discussions académiques plus étendues au sujet de l'évaluation contraceptive en particulier et du risque technologique en général, les résultats seront présentés sous forme de trois manuscrits de la longueur d'un article. Dans le premier article, nous enquêterons sur les stratégies déployées par les organismes de réglementation et les organisations professionnelles pour assurer au public l'innocuité de Yaz et Yasmin. À cette occasion, nous avons constaté qu'un discours concernant les risques de grossesse est utilisé dans le cadre de la communication officielle des risques. Dans le deuxième article, nous examinerons la manière dont les utilisatrices de la pilule qui ont subi des effets secondaires perçoivent les risques de la contraception hormonale et militent en faveur de changements en matière de communication des risques et de réglementation des médicaments. Nous avons découvert que les femmes ont souligné l'insuffisance d'informations en matière de risques délivrées par les médecins et les entreprises pharmaceutiques. En outre, les utilisatrices affectées ont rejeté l'utilisation du risque sur le plan de la reproduction comme comparatif principal. Dans le troisième article, nous nous pencherons sur les processus utilisés par chacune des parties prenantes pour évaluer et aborder le risque lié à la contraception. Cet article met en lumière les choix difficiles que doivent faire les utilisatrices dans un climat marqué par l'incertitude des risques encourus et l'implication des entreprises pharmaceutiques dans la recherche et la commercialisation des médicaments. Nous sommes parvenu à la conclusion que de nombreuses questions concernant les risques restent en suspens ou sont traitées d'une manière qui entraîne des divergences entre les professionnels et les utilisatrices concernées. Dans le chapitre final, nous aborderons les conséquences sociologiques de nos découvertes, les limites de la présente étude et les orientations possibles pour des recherches futures concernant l'évaluation des risques liés à la contraception. La controverse Yaz/Yasmin a accru les critiques actuelles au sujet de la pilule. À travers la documentation et l'analyse des dynamiques de ce débat concernant les risques, la présente thèse contribue à une meilleure compréhension de la manière dont les risques et les avantages de la contraception sont analysés à l'heure actuelle dans le contexte nord-américain.
• McGill University
•  https://escholarship.mcgill.ca/concern/theses/5x21th777
• All items in eScholarship@McGill are protected by copyright with all rights reserved unless otherwise indicated.
• Department of Sociology
• Doctor of Philosophy
• Theses & Dissertations

Feminism, biomedicine and the 'reproductive destiny' of women in clinical texts on the birth control pill

Affiliations.

• 1 a Department of Sociology , Wilfrid Laurier University , Waterloo , Canada.
• 2 b Dalla Lana School of Public Health , University of Toronto , Toronto , Canada.
• PMID: 29043903
• DOI: 10.1080/13691058.2017.1384852

The birth control pill is one of the most popular forms of contraception in North America and has been a key player in women's rights activism for over 50 years. In this paper, I conduct a feminist deconstructive analysis of 12 biomedical texts on the birth control pill, published between 1965 and 2016. This study is situated amongst the feminist scholarship that challenges the representation of women's bodies in biomedicine. Findings suggest that clinical texts on the birth control pill continue to universalise women's lives and experiences, and essentialise them based on their reproductive capacities. One way the texts accomplish this is by making women absent or passive in the literature thereby losing concern for the diversity of their lives, interpretations and identities as more than reproductive beings. The consequence of such representations is that biomedical texts disseminate limited forms of knowledge, in particular concerning definitions of 'natural' and 'normal' behaviour, with important consequences for the embodied experiences of women.

Keywords: Contraception; medicine, clinical texts; reproduction; the pill.

Publication types

• Historical Article
• Contraception
• Contraceptives, Oral / history*
• History, 20th Century
• History, 21st Century
• Textbooks as Topic
• Women's Health*
• Women's Rights
• Young Adult
• Contraceptives, Oral

91 Birth control Essay Topic Ideas & Examples

🏆 best birth control topic ideas & essay examples, 📌 simple & easy birth control essay titles, 👍 good essay topics on birth control, ❓ research questions about birth control.

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• Giving Birth Control to Teenagers It is paramount to say that it is a significant problem that needs to be addressed because the number of cases of teenage childbearing is one of the highest in the United States compared to […]
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• Open access
• Published: 05 January 2021

Knowledge and attitudes towards contraceptives among adolescents and young adults

• Aanchal Sharma   ORCID: orcid.org/0000-0002-9093-0513 1 , 2 ,
• Edward McCabe 3 ,
• Sona Jani 3 ,
• Anthony Gonzalez 4 ,
• Seleshi Demissie 5 &
• April Lee 3  

Contraception and Reproductive Medicine volume  6 , Article number:  2 ( 2021 ) Cite this article

4 Citations

Metrics details

Despite endorsements supporting the use of intrauterine devices (IUDs) for adolescents and young adult women (AYA), they have limited knowledge about them Male partners can influence contraceptive decisions, however their perceived knowledge about IUDs is lower than their objective knowledge. We aim to establish current AYA baseline contraceptive knowledge and attitudes so providers can better target their sexual health educational interventions.

Females and males, aged 13 to 23 years old, from our suburban adolescent clinic, completed an anonymous survey that assessed their knowledge and attitudes towards methods of contraception, with an emphasis on the IUD.

Completed surveys totaled 130 (99 females/31 males). Demographic results revealed 31.3% Black/African-American, 30.5% Latino/Hispanic, 17.6% White, 3.0% Asian, and 14.5% Other. The majority of participants (80%) were sexually active. The majority (69.5%) stated they/their partner were currently using a contraceptive method; only 2.6% used IUDs. Half of females (56.6%) and 10.1% of males had heard of IUDs. Despite this, male and female participants lacked knowledge regarding specific IUD facts. Of the participants who had used emergency contraception (EC), only 6.4% knew the copper IUD could be used for EC.

Contraceptive knowledge deficits, especially regarding the IUD, continue to exist for AYA patients. Many participants stated they required EC despite “satisfaction” with their birth control method(s) and most were unaware that the copper IUD could be used as EC. These discrepancies highlight the importance of comprehensive contraceptive education for AYA patients. Enhanced and consistent contraceptive options counseling can help providers ensure that their AYA patients make well-informed decisions about family planning, thus improving their quality of life.

Plain English summary

In this study, we demonstrate that barriers of access, awareness and knowledge continue to exist for adolescents and young adults (AYA) when it comes to contraception. Specifically, despite awareness about the intrauterine device (IUD), AYA lack adequate knowledge regarding its utility. The results of our study highlight the need for comprehensive contraception educational initiatives. For example, placing an IUD for emergency contraception could then additionally provide ongoing contraceptive benefits. Curricula that highlight the dual use of the IUD could help AYA see the short- and long-term benefits of using the IUD. This study assesses the baseline contraceptive knowledge and attitudes of AYA, which could inform and help healthcare providers tailor the sexual health education they provide their AYA patients. This would ultimately help AYA patients to overcome the barriers they face when choosing contraceptive methods that are best suited for them. This study affirms the current contraceptive knowledge and beliefs of AYA patients and serves as a jumping-off point for education and provision of contraceptive options counseling.

Introduction/background

The American College of Obstetrics and Gynecology (ACOG) has recommended intrauterine devices (IUDs) as first-line contraceptive choices for parous and nulliparous adolescents [ 1 ]. The American Academy of Pediatrics (AAP) endorses the use of IUDs as contraception to parous adolescents and to those who consistently protect themselves against sexually transmitted infections (STI) [ 2 ]. IUD use has increased over the past decade; however, overall U.S. IUD use remains low [ 3 , 4 , 5 ]. Copper IUDs can also function as emergency contraception (EC), yet its use as such remains limited [ 6 ]. Existing research has revealed that young women have limited knowledge about and access to IUDs [ 7 ]. Despite its effectiveness, overall use of IUDs in the U.S. remains low. Only 12% of current contraceptive users reported long-acting reversible contraception (LARC) use between 2011 and 2013 [ 8 , 9 ]. Studies have explored the reasons for the continued low rate of use and insertion of the IUD in adolescents and young adults despite the recognition that the IUD is a safe and effective contraceptive method [ 10 , 11 ].

Whitaker et al. found that only 40% of 144 female participants aged 14–24 had heard about IUDs; once educated, they began to think positively about IUDs [ 7 ]. However, awareness is not enough. In a 2012 study done by Barrett et al., they found that only 39.4% of subjects who had heard about the IUD were able to identify its features [ 12 ]. Awareness and perceived knowledge of IUDs among males is low in comparison to condoms and birth control pills [ 12 ]. Since male partners can influence the contraceptive decision-making process, it is important that studies are done to understand their perspectives.

This study aims to understand baseline contraceptive knowledge and attitudes of adolescents. This understanding will help healthcare providers improve sexual health education and overcome barriers faced by patients when choosing contraceptives methods that are best suited for them.

Subjects were recruited from Staten Island University Hospital’s adolescent clinic. The study was offered to all patients in this clinical setting, which included male and female patients, aged 13 years old to 23 years old. The study was offered to all new and existing patients over a six-month period, from March 2018 to August 2018. Potential participants were provided with a written document containing information regarding the study and provided verbal consent if they chose to participate. They then completed a twenty-minute anonymous survey, written in English, that assessed their knowledge and overall attitudes towards different methods of contraception, with an emphasis on the IUD. Inclusion criteria consisted of age between 13 to 23 years old and the ability to read and comprehend in English.

The survey consisted of five questions regarding sexual history (including sexually transmitted infection history, pregnancy history, contraception use), three questions about emergency contraceptive use, a section on knowledge about birth control methods which consisted of yes/no and true/false/“I don’t know” questions, and a section on knowledge about the copper IUD which consisted of true/false/“I don’t know” questions. The survey also included demographic questions regarding age, gender, educational level, race/ethnicity, and health insurance status.

The primary objective of this study was to determine adolescent and young adult knowledge of the copper intrauterine device (IUD) as a method of both emergency and long-acting contraceptive method. Assuming that the expected prevalence of knowledge of the copper IUD among adolescents aged 13 to 23 years old is 50%, we estimated that a sample size of approximately 100 subjects would provide us with a two-sided 95% confidence interval for the true prevalence that would extend 10% from the observed prevalence. Within this clinical setting, a total of 131 participants completed the survey. Of the completed surveys, 130 completed surveys met criteria for inclusion in this analysis. One subject was excluded because the participant’s age was beyond the study’s range.

The study design received Northwell Health Institutional Review Board approval prior to implementation. Participants provided verbal informed consent prior to completing the survey. Data collection involved investigators entering responses from completed surveys into a password-protected research database (REDCap). Only investigators listed on this study had access to the data.

Statistical analysis

Demographic and clinical characteristics for the study population were summarized using means with standard deviations for continuous variables and frequencies with percentages for categorical variables. Differences between groups in continuous variables were estimated with independent-sample t test. For categorical variables, either Chi-square test or Fisher’s exact test were used as appropriate. All tests were two-tailed and Differences were considered significant at P  <  0.05. All statistical analyses were performed using SAS software (Statistical Analysis Systems Inc., Cary, NC, USA) Version 9.3.

There were 99 female participants (76.2%) and 31 male participants (23.8%). The mean age of participants was 18.3 years old. The majority (65.3%) of respondents were aged 18–23 years old and about one third (34.7%) were aged 13–17 years old. A majority of respondents were either in high school (38.5%) or college (44.3%). Demographic results revealed 31.3% Black/African-American, 30.5% Latino/Hispanic, 17.6% White, 3.0% Asian, and 14.5% Other. A majority of respondents had health insurance, either private (25.6%) or public (40.2%).

The majority (80%) of participants were sexually active. The majority (82.8%) reported having partners of the opposite sex, 14.1% reported having with partners of the same sex, and 3.0% reported having both partners of the same and opposite sex. Most (69.5%) participants stated they or their partner were currently using a contraceptive method. Of those using birth control, 71% used condoms, 38% used oral contraception pills (OCP), while only 2.6% used IUDs. Approximately one third (36.4%) of total respondents reported a history of EC use by them or their partner(s). The majority (90.5%) of total respondents reported no history of STIs and 90.4% reported no history of pregnancies in themselves or their partner(s).

Most of the participants surveyed were aware of contraceptive methods. Survey results indicated that 100% were aware of male condoms; 89.9% were aware of female condoms; 92.2% were aware of OCPs; 66.7% were aware of IUDs; 63.3% were aware of hormonal implants; 76.2% were aware of injectable contraceptive hormones; 72.1% were aware of hormonal vaginal rings; and 64.8% were aware of hormonal contraceptive patches. Of those who responded that they had heard of the IUD, 84.9% were females and only 15.1% were males [Table  1 ]. Of the participants who responded that they had heard of the IUD, 90.7% were sexually active, 72.1% stated that they themselves or their partner(s) were using a form of contraception, and 49.4% stated they or their partner(s) had used EC in the past ( p  <  0.001) (Table 1 ).

Almost half (49.2%) of participants who responded that they were satisfied with their method of birth control had used EC in the past ( p  <  0.001) (Table  2 ). Of those with a history of EC use by themselves or their partner(s), 83.0% reported that they or their partner(s) were using a method of birth control ( p  <  0.001) (Table  3 ). Only 17.8% who reported a history of EC use knew the copper IUD could be used for EC ( p  <  0.001) (Table 3 ).

The awareness of the IUD was also specifically assessed by gender, sexual history, birth control use, and EC use. Of those who had heard of the IUD, 90.7% reported history of sexual activity and 49.4% reported history of EC use by them or their partner(s) ( p  <  0.001) [Table 2 ]. Despite having heard of IUDs, both male and female participants lacked knowledge regarding the utility of the IUD, whether or not they were sexually active. (Table  4 ) Only 14.1% of those who had heard of the IUD knew that it could be used as EC ( p  <  0.001) (Table 4 ).

Participants were provided with an educational piece at the end of the survey, which stated: “The Intrauterine Device (IUD) is a small T-shaped device about 1 inch long. It is a very effective method of birth control that your health care provider inserts into the uterus. Non-hormonal (copper) and hormonal versions are available. The non-hormonal or copper version can be left in place for up to 10 years. The hormonal version can be left in place for up to 3 to 5 years.” They were subsequently asked if they would use and/or recommend the IUD as a form of birth control. Approximately half of the participants remained neutral despite receiving the education and some provided feedback on their decisions. Some participants listed common misconceptions as their reasons against choosing the IUD in their comment section of the survey. Some participants commented that they still did not have enough knowledge regarding the IUD in general and expressed reluctance to use it or recommend to others.

Participants were also provided with information regarding the copper IUD’s function as form of EC. The statement “Studies have shown that the copper IUD is the most effective form of emergency contraception” was provided to the participants. They were subsequently asked if they would use or recommend the copper IUD as a form of EC. Almost half of the participants remained neutral despite receiving this information and some provided feedback on their decisions. The provided feedback did reveal that some participants did feel like the copper IUD would be a good option for EC after reading the information about the efficacy of the copper IUD.

The results of this study showed that the knowledge base of participants in this study was significantly lacking. When participants were asked about specific IUD contraceptive information, a majority of respondents answered with “I don’t know”. This indicated a gap in the information being presented to this population. Though many claim awareness of the IUD, they failed to understand its function or its side effects. The results of this study were similar to the 2015 study performed by Marshall et al., which found that awareness and perceived knowledge of IUDs among males was low in comparison to condoms and birth control pills [ 12 ]. However, the same study had also shown that young men’s perceived knowledge of IUDs was lower than their objective knowledge, whereas this study reveals that most males did not know much about the utility of the IUD [ 12 ].

Our results revealing only 2.6% of our participants using IUDs mirrored previous studies that demonstrated the low utilization of IUDs in the United States (3–5, and). All of the study participants who had a history of EC use had used emergency contraception in the oral pill formulation. A significant percentage of participants were unaware that the IUD could also be used as a form of EC. Efficacy should play a role in satisfaction with one’s birth control; however, if EC is being accessed, the birth control method may be clearly ineffective. This was consistent with previous studies that have shown that the use of the copper IUD as EC remained limited [ 6 ].

Most participants remained “neutral” after reviewing an education section of the survey on the efficacy of the copper IUD as a contraceptive method. However, the positive responses to the education section of the survey on the efficacy of the copper IUD as a good EC option confirmed the importance of distributing factual written information to adolescents and young adults in order to expand knowledge. Provision of written information should create an opportunity to facilitate this reproductive health decision-making process by stimulating a discussion with their health care provider or health educator.

One strength of this study is that it included male as well as female participants. Another strength of this study is that the survey included questions regarding sexual orientation and gender of sexual partners. These variables have not usually been included in earlier contraception studies.

Our study is not without limitations. One limitation of this study was the small participant size. Our study population was also primarily of one geographical region located in a greater urban community. Further, our survey was only offered in English and required participants to be able to read in English. With a larger and more diverse study population, we might determine other factors involved in the reproductive health decision-making process.

Barriers continue to exist for adolescents and young adults when it comes to contraception - these include, but are not limited to: access, awareness, and knowledge. The IUD remains the first-line contraceptive method offered as recommended by ACOG and the AAP. This study shows that despite awareness about the IUD, adequate knowledge is lacking among adolescents and young adults regarding its utility. The results of this study highlight the importance of committed and consistent comprehensive contraceptive education interventions for adolescent and young adult patients. Future research should include an assessment of the sources of information used by adolescents and young adults to attain their contraceptive knowledge as well as whether or not they received sexual health education as part of their school curricula. Enhanced contraceptive options counseling can help providers ensure that their patients make well-informed decisions about contraceptive methods, thus improving their quality of life.

Availability of data and materials

The datasets during and/or analyzed during the current study available from the corresponding author on reasonable request.

Abbreviations

American Academy of Pediatrics

American College of Obstetrics and Gynecology

Adolescents and young adults

Emergency contraception

Intrauterine device

Oral contraception pill(s)

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The study design received Northwell Health Institutional Review Board (IRB) approval prior to implementation. IRB #: 17–0802.

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Aanchal Sharma

Department of Developmental Medicine, Boston Childrens Hospital, Boston, MA, USA

Division of Adolescent Medicine, Staten Island University Hospital, Staten Island, NY, USA

Edward McCabe, Sona Jani & April Lee

Department of Research, Staten Island University Hospital, Staten Island, NY, USA

Anthony Gonzalez

Biostatistics Unit, Feinstein Institute for Medical Research, Staten Island University Hospital, Staten Island, NY, USA

Seleshi Demissie

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AS, AL, and EM were responsible for data collection and analyzed and interpreted the patient data. SJ assisted in data collection. SD performed the statistical analysis. All authors were involved in the conceptualization of this study. All authors read and approved the final manuscript.

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Sharma, A., McCabe, E., Jani, S. et al. Knowledge and attitudes towards contraceptives among adolescents and young adults. Contracept Reprod Med 6 , 2 (2021). https://doi.org/10.1186/s40834-020-00144-3

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Science News

How over-the-counter birth control pills could improve reproductive health.

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By Aimee Cunningham

May 19, 2023 at 9:00 am

Updated July 13, 2023 at 10:55 am

Editor’s note: This story was updated July 13, 2023, to reflect the U.S. Food and Drug Administration’s approval of a nonprescription birth control pill.

For the first time, people in the United States will be able to buy birth control pills off the shelf. On July 13, the FDA approved the first daily oral over-the-counter contraceptive . Details of when and where the pill will be available and how much it will cost have not yet been released.

The pill, called Opill and known by the generic name norgestrel, is a progestin-only pill . That’s in contrast to combined oral contraceptive pills, which contain progestin — or another form of progesterone — along with a form of estrogen ( SN: 4/13/23 ). Progesterone and estrogen are two of the hormones that regulate the menstrual cycle.

Opill gained FDA approval for prescription use in the United States in 1973, under a different brand name. The advisory committees were tasked with considering a switch from prescription to over-the-counter status, which involves reviewing data that the drug can be used safely and effectively without the oversight of a physician.

On May 10, two advisory committees to the U.S. Food and Drug Administration voted unanimously to make a birth control pill available without a prescription . The FDA committees — one with expertise on non-prescription drugs, the other with obstetric and gynecological drugs — endorsed the switch, and they are not alone. Medical organizations including the American College of Obstetricians and Gynecologists, the American Medical Association and the American Academy of Family Physicians are also in favor of an over-the-counter birth control pill.

With the FDA’s over-the-counter nod, Opill is slated to become the most effective birth control method on store shelves, surpassing existing options like condoms and sponges. It would also remove barriers that can make getting this birth control option challenging for many people.

A birth control pill that will be more easily available comes as the United States faces a  maternal mortality crisis ,  abortion bans  and  possible restrictions on an FDA-approved abortion medication  ( SN: 3/16/23; SN: 6/24/22; SN: 5/18/23 ). Prior to Opill’s FDA approval, Science News talked with two sexual and reproductive health equity researchers about the impact of over-the-counter access to the pill on reproductive health and autonomy. The interviews were edited for length and clarity.

SN : What barriers do adults and adolescents face in terms of access to different birth control methods?

Rachel Logan, University of California, San Francisco: I think it’s the same barriers for both groups, although I think adolescents face more . It is transportation to health care appointments. [There are] barriers within care, such as some providers requiring a pelvic examination or a full gynecological exam before providing or prescribing contraceptive methods. [It is] a lack of insurance coverage. Unfortunately in this country, because we don’t have federally mandated, comprehensive sex ed, some people just may not know about all of the contraceptive methods that exist.

There continues to be the stigma associated with needing contraception and who uses contraception that is very patriarchal and really demeaning to people, like it says something about you if you have to use these methods, as opposed to [contraception being] an essential tool in your reproductive health journey. Another area that I don’t think is talked enough about is contraceptive coercion — that could be from a parent, a partner or a health care provider — where your options to use the method of your choice are limited for whatever reason.

SN : What does it mean for adults and adolescents to have over-the-counter access to hormonal birth control, especially considering the maternal mortality crisis and abortion bans?

Anu Manchikanti Gómez of the University of California, Berkeley: Providing people the opportunity to be unpregnant is always important, but more important than ever because of these additional crises. Abortion bans have many effects, obviously, on people’s ability to access abortion . But [bans are also] having a chilling effect on health care providers in some states. Maybe they are leaving those states where abortion is banned, or not coming [to those states] in the first place. Those are generally the same providers who might be doing contraceptive counseling or providing pap smears or prenatal care, [so] there can be less access to this care. Birth control can’t solve those issues, but there may be ways that more access is going to be particularly helpful when access is being lost in other ways.

Logan: It feels like we’re in a very critical moment where reproductive autonomy is definitely under threat. So this could mean extending options to people who otherwise may not have an option or a way to obtain a method of birth control that works for them. Being able to walk into a store and pick something off of the shelf that you can use and is very safe and effective is life changing.

SN : What do we know about the historical impact of prescription birth control?

Gómez: The availability of hormonal birth control has been transformative for, historically, cis gender women’s participation in the world, in the workforce, in their ability to engage in education . Being able to control your fertility is such an important part about being able to control your destiny. There are many things that can affect our ability to live the lives that we want, but if you are a person who can become pregnant, [it’s] really important to have the option of deciding if, when and how you want to become pregnant or remain pregnant.

SN : When choosing a birth control method, what does it mean to take a person-centered contraceptive care approach?

Gómez: A person-centered approach, if we’re talking about contraceptive access, means … actually support[ing] the person in making the decision that’s best for them versus what someone else thinks they should be doing. There’s a long history of birth control abuse and coercion in the United States, from forced sterilization to aggressive promotion of certain methods toward Black communities and people who are poor. Even though there are different levels of effectiveness of different types of methods, that doesn’t make one more medically appropriate.

For some people, they don’t like something that they can’t stop using without going to see a health care provider [such as an implant or other long-acting reversible contraception]. You may feel that you’re losing bodily autonomy through using a method that you can’t stop using on your own. That’s a very real concern for some people, and it’s definitely grounded in some of the historical abuses and racism and ongoing experiences of low-quality care that some people, too many people, experience.

Logan: [A person-centered approach] is being OK with people saying, “no,  I don’t want to use that method,” and saying, “that’s fine,” as opposed to [providers] feeling like it’s their job to convince people to get on a method or to use a particular method. [It’s] showing people that you care about them using what feels right and best for them. We’re aligning people’s preferences with methods that are available.

SN : Does the over-the-counter availability of hormonal birth control assist with this approach?

Logan: Yes. It gives people the power that they need without these constraints that are really only hurdles. This is in no way to replace routine preventative care. It is to reduce barriers to methods that we know are safe and effective that people can use independently. I think the health care system is already very strained. Is it a good thing that we’re moving some services that we know to be safe and effective outside of the health care system? I would say yes.

Gómez: [Easier access] can make a huge difference for people. Being able to start using [a birth control pill] without seeing a provider, that removes many layers of barriers. All of those can reduce people’s ability to use it at all or to use it continuously. Not everyone wants to use the pill, [but for those who do] having over-the-counter access is really going to help people.

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Understanding the Side Effects of Birth Control: a Comprehensive Overview

This essay is about the side effects of birth control and how they impact users. It explains the various side effects associated with hormonal methods like pills, patches, injections, and IUDs, such as nausea, weight gain, mood swings, and the risk of blood clots. The essay also covers non-hormonal methods like copper IUDs, condoms, and diaphragms, noting potential issues like heavier menstrual bleeding and allergic reactions. It highlights the importance of personalized medical advice and careful consideration of individual health histories when choosing a birth control method. The essay emphasizes that while side effects exist, many people use birth control without significant problems.

How it works

Contraception, also referred to as birth control, has transformed the landscape of reproductive health, empowering individuals to exert greater autonomy over their fertility and family planning endeavors. Nevertheless, akin to any pharmaceutical intervention, birth control methodologies harbor potential side effects. It is imperative to comprehend these conceivable repercussions to facilitate judicious decision-making regarding contraceptive utilization. This discourse furnishes an exposition on the side effects associated with diverse birth control modalities, accentuating the indispensability of tailored medical counsel.

Hormonal contraceptive modalities, encompassing pills, patches, injections, and intrauterine devices (IUDs), rank amongst the preeminent contraceptive methodologies.

These modalities operate by modulating the body’s hormonal milieu to thwart ovulation. Despite their efficacy, they engender an array of side effects. For instance, many women encounter manifestations such as nausea, breast tenderness, and headaches upon commencement of hormonal contraceptive pill regimens. These manifestations typically ameliorate subsequent to several months as the body acclimates. However, certain individuals may manifest more pronounced reactions, such as mood fluctuations, weight gain, and diminished libido, which can markedly impinge upon their quality of life.

The birth control patch and injection entail commensurate side effects to the pill, albeit their administration modalities can exacerbate specific issues. The patch, for instance, can precipitate cutaneous irritation at the site of application. The injection, administered tri-monthly, has been correlated with weight gain and osteoporosis with protracted usage. It is imperative for individuals contemplating these alternatives to engage in comprehensive discussions regarding their medical history and lifestyle preferences with a healthcare professional to discern the optimal modality.

Non-hormonal birth control modalities, inclusive of copper IUDs, condoms, and diaphragms, proffer alternatives for individuals either contraindicated or disinclined to employ hormonal contraception. Copper IUDs, notwithstanding their efficacy, may incite augmented menstrual hemorrhage and intensified cramping, particularly in the initial months post-insertion. Condoms and diaphragms lack systemic side effects but can elicit allergic reactions or irritation in select users. Additionally, their efficacy is contingent upon meticulous adherence to correct usage, constituting a caveat for certain individuals.

An eminent concern with hormonal birth control pertains to the heightened propensity for thromboembolic phenomena. Estrogen-containing contraceptives, encompassing combination pills and select patches, can augment the peril of deep vein thrombosis (DVT) and pulmonary embolism (PE). Although the overall incidence is relatively modest, it escalates within specific demographics, such as smokers and women exceeding 35 years of age. Progestin-only modalities, such as the mini-pill or hormonal IUDs, portend a diminished risk of thromboembolic events and may thus represent a safer alternative for those predisposed to risk factors.

An additional pivotal consideration is the ramifications of birth control on mental well-being. Certain users delineate mood fluctuations, depression, or anxiety concomitant with hormonal contraceptives. Inquiry into this realm remains ongoing, and while empirical evidence is disparate, it underscores the exigency for individuals to monitor their mental well-being vigilantly and articulate any concerns to their healthcare provider. Transitioning to an alternative contraceptive modality may sometimes assuage these manifestations.

Prolonged utilization of birth control precipitates queries regarding its repercussions on fertility and overall health. Generally, fertility rebounds to baseline expeditiously following discontinuation of hormonal contraceptives, albeit some individuals may necessitate several months for resumption. Scrutiny concerning cancer susceptibility has also been extensive. Hormonal contraception has evinced a propensity to abate the hazard of ovarian and endometrial cancers whilst marginally amplifying the peril of breast and cervical malignancies. These perils and benefits warrant meticulous consideration and discourse with a healthcare practitioner.

It is imperative to underscore that notwithstanding the possibility of side effects, myriad individuals avail themselves of birth control sans significant complications. The advantages of averting unintended pregnancies and mitigating menstrual-related maladies frequently outweigh the conceivable drawbacks for numerous users. Nevertheless, experiences may vary substantially from individual to individual, accentuating the necessity to approach birth control as an individualized health decision.

In summation, cognizance of birth control side effects constitutes a linchpin in effectuating enlightened decisions regarding contraception. Hormonal and non-hormonal methodologies each harbor distinctive potential side effects, ranging from benign and transient to more grave concerns. Tailored medical counsel is indispensable in navigating these alternatives, ensuring individuals can ascertain the most suitable and efficacious modality commensurate with their requisites. Transparent communication with healthcare providers and sustained abreastment with the latest research can empower individuals to manage and ameliorate side effects, thereby fostering enhanced health outcomes and heightened contentment with their elected mode of birth control.

Kindly bear in mind that this essay serves as a launchpad for further introspection and investigation. For bespoke guidance and adherence to academic conventions, contemplate soliciting the services of professionals at EduBirdie.

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Stop Shouting Down the Women Going Off the Pill

As over-the-counter birth control hits shelves, more people are also expressing skepticism about hormonal contraceptives. They should be heard.

Listen to this article

Produced by ElevenLabs and News Over Audio (NOA) using AI narration.

P erhaps you’ve noticed something new at your local market. Opill, the first oral contraceptive approved by the FDA for over-the-counter use, began shipping to U.S. stores in March. It has no age restrictions and does not require a physician’s sign-off; you can now buy a three-month supply at Walmart or Target the same way you might pick up Tylenol or tampons or a six-pack of seltzer.

This is, without a doubt, a momentous development in the realm of reproductive health. In the post- Dobbs environment, in which access to abortion care has been severely restricted across the United States, easier access to contraceptives is significant. Yet Opill also debuts as more and more women, in public forums and in their physicians’ offices, are raising concerns about the effects of hormonal birth control on their physical and mental well-being—and are pushing back against the idea that pharmaceuticals are their best options for trying to prevent pregnancy.

For the past few years, the “Why women are going off the pill ” essay has become a staple of lifestyle journalism . A search for birth control on TikTok yields thousands of videos, many taking a negative stance on hormonal methods. Side effects are a common complaint: mood changes , headaches, irregular bleeding , lower libido —or, in some instances, more dangerous complications, such as blood clots . Many of the critiques note that women’s concerns have a history of being overlooked or dismissed by the medical establishment, and that women are still waiting for an improvement on the birth-control status quo.

Read: The Coming Birth-Control Revolution

In many spaces, this upsurge in discussion has been treated not with curiosity, but with contempt. Those airing dissatisfaction, or simply describing potential side effects, have been called antifeminist or accused of threatening other women’s birth-control access . Commentary critical of the pill has been dismissed as misinformation by mainstream news outlets—not always unfairly, as much of the material on social media can’t exactly be called reliable. (“Wellness” figures hawking fertility-awareness “coaching” abound, as do right-wing influencers with barely concealed agendas.)

But at the same time, many people online are recounting real stories of real symptoms, and expressing legitimate qualms about the options they’ve been given. Their distrust is not unfounded. Kate Clancy, a biological anthropologist and professor at the University of Illinois at Urbana-Champaign, and the author of Period: The Real Story of Menstruation , told me that women “are very often subject to medical betrayal—to having really awful experiences in a medical context.” Clancy said she was “glad there’s improved access.” But if you already harbor mistrust, “if you already have reasons to say, ‘Wow, these pharmaceuticals were not really made for me,’ then over time I understand why people arrive at a place where they are dissatisfied with current options.”

This is where the tenor and content of the discourse can be vexing: The public takedowns of skeptical women risk silencing the important conversations people ought to be able to have in service of meeting their health-care needs. If women’s overall betterment is the goal, then narrowly prioritizing access—celebrating a development such as Opill while shouting down the women simply trying to talk about their experiences—is counterproductive. To address reproductive health in full, taking into account questions about rights, responsibilities, and the physical and social ramifications of pharmaceutical solutions, requires a wider lens.

A few years ago , I was prescribed an oral contraceptive after a conversation with my doctor that could most generously be described as extremely brief. In the month I took the pill, I was overtaken by a debilitating brain fog that felt like a loss of self. I was irritable, snappish. I made my living as a professional columnist, yet suddenly I felt bad at writing—not in the sense of the usual scribbler’s procrastination, but in that I genuinely couldn’t generate ideas or string together words. I contemplated leaving my job . I cried a lot.

I realized the cause of this identity shift only after my prescription ran out and my regular personality snapped back into place, seemingly overnight. I hadn’t turned into a failure. Hormonal birth control had derailed me.

The pill is something of a catchall term, used to describe a variety of oral contraceptives that make the uterus inhospitable to pregnancy and often prevent ovulation. “Combination” pills, the most common type—and the kind I was prescribed—contain synthetic estrogen and progestin (a synthetic version of the hormone progesterone); “mini-pills,” of which Opill is one, contain progestin alone. Early versions of oral contraceptives had extremely high doses of both hormones, leading to sometimes severe side effects. Newer versions, with more carefully calibrated doses, have lessened, though not eliminated, those risks.

Today, oral contraceptives are the second-most popular birth-control method for women in the United States, after permanent sterilization . Fourteen percent of girls and women ages 15 to 49 use them, according to a federal survey from 2017 to 2019 , the latest data available; nearly one in five American girls between the ages of 15 and 19 is on the pill. Over the decades, several studies have found that many people who start taking the pill will eventually go off it because the side effects are so intolerable. Concerns about side effects are also frequently named as a reason women resist taking their “preferred contraceptive method” in the first place.

It is not a stretch to imagine that young women taking an over-the-counter pill, unmonitored, could be left dealing with symptoms they might not be prepared for—without the recourse or the wherewithal to ask questions, or without the knowledge that what they’re experiencing is worthy of concern. Sarah E. Hill, a psychology professor at Texas Christian University and the author of This Is Your Brain on Birth Control: How the Pill Changes Everything , told me she’s in favor of removing barriers to access and supports Opill coming to market. But “I worry about it,” she said. “For everybody, but I worry about it most intensely for adolescents, whose brains are still developing.” Recent studies have found evidence of an increased risk of depression in some of the youngest users of hormonal birth control, and Hill said it troubles her to think about “young women who are most vulnerable to getting these kinds of side effects going on this medication and not being watched.”

Nearly all medications come with potential negative side effects, and we still use them as tools. You can get liver damage from taking too much Tylenol, but in the right amounts, the drug can lower a worrying fever. And in the case of birth control, of course, any adverse effects must be weighed against the life-changing alternative: becoming pregnant, one of the riskiest undertakings many women will ever experience. Forty-six percent of pregnancies in the U.S. are unintended , one of the highest rates among wealthy nations, and the rate tends to be highest among low-income populations and younger women. Those are the same populations most likely to take advantage of a pill that has no age restrictions and does not require a visit with a health-care provider for a prescription and subsequent renewals.

My own disturbing experience was, I know, not a universal one (though there is at least one high-quality study, of more than 1 million Danish women and girls, suggesting a linkage between hormonal birth control— especially progestin-only formulations —and higher rates of depression). And some people decide that even significant side effects are worth it when they desperately want to prevent pregnancy and hormonal birth control is the only, or the most readily accessible, option. Here is where Opill could be transformative—imagine a woman being pressured into pregnancy who can now buy birth control without alerting her partner, or a working mother who doesn’t have the time or resources to meet with a prescribing doctor but can walk to the nearest CVS.

But I do wonder: If I had started taking hormonal birth control unsupervised, as a teen or a young adult, would I have spent my entire adulthood believing my personality to be different than it was? What would that have meant for me—and the trajectory of my life?

I t would be an understatement to say that women have put up with a lot in the name of reproductive health, including many discomforts and inconveniences that men have refused to endure, and that the conventions of medical research have allowed them to avoid. This is not to say that efforts have not been made to get men to do their part.

Andrea Tone, a medical historian and professor at McGill University, told me that in the 1960s and early ’70s, “activists clamored for a contraceptive pill for men so that they, too, could share its responsibilities and risks.” Clinical trials for male hormonal birth control began as early as the 1970s . But a 2016 study noted that a trial for a hormonal injection was canceled after men reported side effects , including acne and depression—never mind that for decades, women have endured these afflictions and worse.

Read: New Male Contraceptives Could Be Infuriatingly Pain-Free and Easy

In a recent Atlantic article , my colleague Katherine J. Wu detailed current research and potential innovations in male-managed birth control, noting that although the list of contraceptive options available to women has lengthened since the introduction of the pill 64 years ago, most of the changes have been incremental, and women are still left to deal with a wide variety of side effects and inconveniences. In contrast, the medical system seems to bend over backwards to ensure male users are comfortable: Experts have said they doubt that the side effects typical of the female contraceptives on the market would be deemed acceptable by evaluators of the clinical trials of male birth-control methods.

Easier access to the pill eliminates real barriers. But in a medical industry that has long centered male comfort when it comes to reproductive health, an undue burden will always be placed on the people capable of becoming pregnant. As Tone put it, “Making pill-based hormonal contraception available OTC normalizes birth control as a female responsibility and, possibly, even an expectation.”

That expectation may very well continue to serve as an excuse for overprescribing, for overlooking women’s concerns, and for failing to hold accountable a health-care system that has historically not served women well. Ease of access is “a really good thing,” Clancy, the University of Illinois professor, told me. “But there are things in addition to contraception we need to be doing to improve the lives of people who can get pregnant, like broader social infrastructure to improve their care.” Instead, she said, “we just choose to kick the can down to the microsolution and make it about individuals making decisions.”

This is where the knee-jerk pushback to discussion of hormonal birth control’s potential downsides becomes harmful. To support individuals, we need more conversation, not less. It should be possible to celebrate increased access to birth control and to validate women’s negative experiences. It should be possible to praise Opill and to push back against the unfair assumption that women must bear the material and physical costs of contraception.

In a 2023 survey of people assigned female at birth, conducted by the reproductive-justice nonprofit Power to Decide, almost a quarter of respondents ages 15 to 19 said that they lacked sufficient information to decide which birth-control method was right for them—a gap that speaks to a larger problem with the American approach to reproductive health. In an ideal world, the health-care providers I spoke with told me, doctors would spend more time with patients, health literacy would be higher, and reproductive responsibility would be shared between women and men. To create such a world would require not only a cultural shift but also a remaking of the American way of providing care—a not-impossible task, but a much heavier lift than selling a pill.

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• Health Care

Private Programs Provide Access to Birth Control. They Can Also Deprive Women of Choice

I f you’re an undocumented immigrant in Tennessee, you don’t have a lot of options when it comes to birth control. You can’t get an abortion—it’s been banned with very limited exceptions since 2022. You can’t get services from state public-health clinics, which lost federal funding with the abortion ban. The state has backfilled the funding, but a Tennessee law prohibits that money from being used for family-planning services for people without legal status.

One thing you can do is reach out to a nonprofit called A Step Ahead, which will pay for you to get a long-acting reversible contraceptive (LARC), like an intrauterine device (IUD) or an implant that goes into your arm. But there’s a problem, some reproductive justice advocates say. In many regions of the state, including Memphis and Nashville, A Step Ahead will only pay for an implant or IUD, not for birth-control pills or other short-acting methods of contraception. That means many women have a stark choice to make if they are uninsured and want contraception: They can get a LARC from A Step Ahead—devices that they will need to get a doctor to remove when they are ready to have children—or they can go without birth control. 

There appear to have been instances of A Step Ahead paying for LARCs for undocumented women who didn’t speak English, at times without a translator present, says Della Winters, a professor at California State University, Stanislaus, who wrote her dissertation on the use of LARCs in Tennessee. “I’m not sure my clients really understood or even consented,” one provider, an employee of a federally-qualified health center, told Winters, about the large number of Latina clients that appeared to be getting LARCs but who did not speak English. (Winters completed her work in 2019 and 2020, before the U.S. Supreme Court’s Dobbs decision. A spokeswoman for A Step Ahead East Tennessee, which serves majority Latina clients, says that the group’s call center coordinator is bilingual and the group makes sure a translator is available whenever necessary.) 

The role of A Step Ahead in Tennessee illustrates how private programs have stepped in to provide ways for women to access birth control methods in the absence of state and federal funding. It also shows how those programs can push women into a specific method of contraception, depriving them of choice. “It is absolutely coercive to only pay for one class of methods and not another,” says Christine Dehlendorf, a researcher and ob-gyn at the University of California, San Francisco.

Read More: Women Say They Were Pressured Into Long-Term Birth Control .

There are other ways that Tennessee policies can limit womens’ choices. In 2017, a Tennessee judge began offering reduced sentences to women who agreed to get birth-control implants inserted in their arms. Though the judge later rescinded the order after pushback, more than 32 women received implants in the two months the order was in effect. As recently as 2020, the state was pushing LARCs on women in prison, says Winters, who interviewed the Tennessee Department of Health about a program that visited jails, showed women videos of babies experiencing withdrawal from drugs they were exposed to in utero, and asked them to sign up for LARCs. “The thing that these states will tout is, ‘Look how much money we saved by not paying for these babies on Medicaid or mothers on public assistance,” Winters says. (The Tennessee Department of Health did not return multiple requests for comment.) 

There is a patchwork system of birth-control access across the country. Though the Affordable Care Act mandated that private insurance plans cover FDA-approved contraceptives without cost sharing, there are many women who still can’t access affordable birth control. This is especially true in states like Tennessee that have not accepted the federal Medicaid expansion. Around 95,000 uninsured adults in the state have an income too high to qualify for Medicaid but too low to qualify for financial assistance in the Affordable Care Act marketplace, according to the Center on Budget and Policy Priorities. States in the Southeast, including Tennessee, Mississippi, Alabama, Georgia, South Carolina, and Florida, make up the majority of states that haven’t accepted the Medicaid expansion . 

In some of these states, private organizations have stepped in to provide access to birth control and LARCs. In South Carolina, a privately-funded nonprofit called New Morning partners with clinics and healthcare providers to offer free or low-cost birth control methods. New Morning initially found that many clinics in the state couldn’t afford to stock IUDs and implants, and helped pay for them to do so. But New Morning is very deliberate about providing access to eight separate methods of birth control, including the patch, the pill, and condoms, says Bonnie Kapp, New Morning’s president and CEO. The group also trained providers on “person-centered counseling,” essentially making sure doctors listened to what patients wanted when it came to birth control. “We really wanted to create an environment where every woman would have a choice of methods,” she says. “We're very committed to making sure that we don't do anything to add to the history of stigma and coercion that the state has and the South has.”

This tension between providing access to birth control but also not pushing women to choose one method over another is present in many groups that have stepped in to provide access, including A Step Ahead. The organization was founded in 2011 by Claudia Halton, a former Tennessee juvenile-court magistrate who was troubled by the number of women who came before her who had difficulties with housing or other issues and who didn’t have childcare options for their children. The magistrate would ask women who were on the pill whether they had taken it before appearing in court, but not a single woman had, says Nikki Gibbs, the current executive director of A Step Ahead Foundation, who worked as a state investigator at the time. “We saw firsthand what happened,” Gibbs says, “when a woman had too many babies before she was financially ready for them.” 

A Step Ahead Foundation, the Memphis branch, primarily serves Black and Latina women. Through radio and TV ads and events in low-income communities, it seeks to teach women about the most effective contraceptive methods and how using contraception can help women get “a step ahead” in life. The organization will pay for the LARC and the procedure to insert it, as well as transportation to the doctor’s appointment. It does not offer short-acting methods of birth control, Gibbs says, because LARCs are the most effective form of contraception, and because, she says, women can easily get the pill elsewhere for free.

Read More: Why Health Care For Mothers Is Underpaid .

But even some of A Step Ahead’s affiliates believe it is coercive to choose a woman’s method of birth control. A Step Ahead has expanded to five other locations since 2011, and the Knoxville, Chattanooga, and Johnson City locations now provide free short-acting methods of birth control like the pill and do not promote one form of birth control over another. “That would be coercive,” says Taylor Phipps, the executive director of A Step Ahead East Tennessee, which is based in Knoxville. “Our organizational values relative to contraceptive access do not fully align.”

A Step Ahead East Tennessee had no choice but to just provide LARCs when it was first launched, Phipps says. That’s because it received funding from A Step Ahead Foundation, the original organization based in Memphis, and that funding had a stipulation: New affiliates must pledge to only offer LARCs for the term of their affiliate agreement. The affiliate agreement of A Step Ahead East Tennessee ended in 2019, and the group decided to start providing access to the pill and other short-acting birth-control methods in 2022, after the Dobbs decision and the pandemic. It now partners with a telehealth clinic, which opens up options for women, who can get short-acting methods mailed to them. “Given how the reproductive health landscape is changing in Tennessee,” says Phipps, “we felt that it was our mission to provide as much information as possible so that women can make their own decisions about their own bodies.”

Limiting birth control access to LARCs could cut off access for some women, like those who can’t get transportation to come into a clinic but could do a telehealth appointment for the pill, Phipps says. Other women prefer the Depo-Provera shot because it’s not noticeable by a woman’s husband or partner, who might not want her to be on birth control. “If we could provide short-acting methods to our clients without transportation or cost barriers, it was a no-brainer,” Phipps says.  

Still, the Memphis and Nashville branches of A Step Ahead, which only provide LARCs, are thriving. The Nashville nonprofit said in 2023 that it was expanding to serve 11 more surrounding counties , bringing the total to 29. Charitable contributions to the Nashville A Step Ahead grew 80% between 2021 and 2022, to $1.2 million, and the Memphis group saw charitable contributions grow 8% to $2.3 million in the same time period according to a TIME analysis of the groups’ tax forms. 

The Dobbs decision and subsequent abortion ban in Tennessee has created a huge boost in need for the services of A Step Ahead East Tennessee, Phipps says. In 2022, the group provided around 250 contraceptive prescriptions a year; it now provides around 750. But in contrast to the Nashville and Memphis affiliates, she says, “we are struggling.”

This article was produced as a part of a project for the USC Annenberg Center for Health Journalism’s 2023 Impact Fund for Reporting on Health Equity and Health Systems.

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The Pill Makes Some Women Miserable. But Are They Really Quitting It en Masse?

The internet is awash with stories of women throwing out their oral contraception. New data suggests a different narrative.

Credit... Eric Helgas for The New York Times

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By Alisha Haridasani Gupta

• May 16, 2024

The woman in the video looks resolute, and a little sad, as she cuts up a pack of birth control pills. “These silly little pills have literally ruined me as a person,” reads the caption. The clip , which is on TikTok, has 1.1 million likes. It’s one of thousands that have proliferated on social media in recent years with virtually the same message: The pill causes terrible, sometimes irreversible side effects, and women should free themselves from it.

Anecdotal reports from news outlets have suggested that women are quitting the pill in large numbers because of this type of online post. “We’ve known for a long time that people really rely on their social circles to help them with medical decision making as it relates to contraception,” said Dr. Deborah Bartz, an obstetrician-gynecologist at Brigham and Women’s Hospital. Against a backdrop of increasingly restrictive abortion access, the idea that women might be giving up a reliable form of contraception because of social media hype has concerned researchers and doctors.

But, according to initial data, prescriptions for the birth control pill are not actually declining at all. An analysis by Trilliant Health, an analytics firm that provides health care companies with industry insights, found that usage has been steadily trending upward in the United States; 10 percent of women had prescriptions in 2023, up from 7.1 percent in 2018. The analysis looked at prescriptions for the pill that were written and picked up. Even among those aged 15 to 34, who would be most likely to see negative social media posts, Trilliant found prescriptions had increased.

The analysis was done at the request of The New York Times, and drew on Trilliant’s database of medical and pharmacy claims. It looked at a nationally representative sample of roughly 40 million women, aged 15 to 44, who used either Medicaid or commercial insurance. It doesn’t account for people who might get their birth control from telehealth providers that don’t take insurance, but that group most likely represents a small slice of the American population, said Sanjula Jain, chief research officer at Trilliant. Several of those telehealth companies also reported double-digit increases in birth control pill purchases in the past two years. The data also doesn’t include sales of the over-the-counter birth control pill, Opill , which has been available in stores in the U.S. since March .

Ten percent of women had prescriptions for the pill in 2023, up from 7.1 percent in 2018. Source: Trilliant Health

The pill has a reputation as a reliable, if flawed, form of birth control. Its known side effects — including blood clots, weight gain, a loss of libido and mood disruptions — have in fact been the main reason that some women do eventually quit the pill, Dr. Bartz said. When patients raise those concerns with physicians, they are often dismissed, she added, which can erode people’s trust in their doctors, and in health care institutions.

Online, that mistrust has bloomed. In two separate papers, published in 2021 and 2024 , Dr. Bartz analyzed the tone of birth control-related posts on Twitter. In the first study, researchers found that almost a third of posts about the pill from 2006 to 2019 were negative. In the second study, the team found that one of the major focus points of posts about the pill was its side effects. Another analysis from 2023 found that 74 percent of a sample of YouTube videos posted between 2019 and 2021 discussed discontinuing hormonal birth control methods because of side effects.

But the side effects of the pill don’t override its utility for many women. It is often seen as an easy point of entry for people newly considering continuous birth control because it can be started and stopped at any point, rather than requiring a painful procedure , said Dr. Cherise Felix, an obstetrician and gynecologist at Planned Parenthood’s south, east and north Florida chapters.

It is also more than 90 percent effective at preventing pregnancies, and can be used to help manage a range of health conditions, like endometriosis and polycystic ovarian syndrome.

What the analysis from Trilliant also underscores is that perhaps women are not so easily swayed by what they see online, said Dr. Felix, who reviewed the findings but was not involved in the analysis. If anything, they end up discussing it with their doctors to make more informed decisions. “I have not once had a patient start a conversation with ‘I stopped using my birth control because I saw this on TikTok,’” Dr. Felix said. “But I can tell you that just over the course of my career, I am having better-quality discussions with my patients.”

Nine states with some of the most restrictive abortion laws had bigger-than-average growth in pill prescriptions. Source: Trilliant Health

Several experts also pointed to increasingly restrictive abortion laws as a reason for the pill’s staying power. Trilliant’s analysis found that nine states with some of the most restrictive abortion laws saw bigger-than-average growth in prescriptions. For example, in Alabama, where abortion is completely banned with few exceptions, and South Carolina, which restricts abortions after six weeks, prescriptions increased by almost 5 percentage points between 2018 and 2023, compared with a national increase of 3 percentage points in that same time frame.

Women began stocking up on the birth control pill after the June 2022 Supreme Court ruling that ended the constitutional right to abortion, said Julia Strasser, director of the Jacobs Institute of Women’s Health at George Washington University and co-author of a recent study looking at contraception use. In 2019, roughly 32 percent of initial prescriptions were for more than one month; by 2022, more than half of initial prescriptions were for a greater supply of “two months, three months, six months and sometimes even 12,” Dr. Strasser said.

So if more women are relying on the pill, why does social media seem to tell a different story? One explanation, Dr. Bartz said, is what’s known as a negativity bias. Consumers are “much more inclined to complain and say ‘oh my gosh, let me tell you about all this bleeding that I’m having on my pill’ or ‘let me tell you about my weight gain,’ ” she said, and far less likely to post positive reviews.

She’s seen something very different in her clinical practice: Patients valuing their birth control options more than ever. “Post-Dobbs,” Dr. Bartz said, “there has been a heightened recognition of the need to be very proactive in preventing pregnancy.”

Alisha Haridasani Gupta is a Times reporter covering women’s health and health inequities. More about Alisha Haridasani Gupta

Birth Control Methods

The internet is awash with stories of women throwing out their birth control pills. New data suggests a different narrative .

A new device, designed as an alternative to a widely used one, called a tenaculum, which looks like a pair of scissors tipped with hooks, attempts to reduce the pain of IUD placement. Does it work ?

A medication called Opill will soon become the most effective birth control method  available over the counter . Here’s what to know .

Seven gynecologists and reproductive health experts told us about the types of contraceptives currently available  and the risks they carry.

The birth control pill is known for having ushered in a sexual revolution. But for some, it can dampen libido .

The hormonal implant called Nexplanon, a long-acting reversible contraceptive, is an increasingly popular choice among teenagers. How does it work ?

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A promising approach to develop a birth control pill for men

by Baylor College of Medicine

The world's population has increased by more than 2.6-fold in the last 60 years. The growing trend continues—projections indicate that the number of people living on our planet will grow to 9 billion by 2037 from 8 billion in 2022. These numbers underscore the need for considering family planning; however, there have been limited breakthroughs in contraception in recent decades. Specifically for men, there are no oral contraceptive pills available.

In a study published in the journal Science , researchers at Baylor College of Medicine and collaborating institutions show in animal models that a novel, non-hormonal sperm-specific approach offers a promising option for reversible human male contraception.

"Although researchers have been investigating several strategies to develop male contraceptives, we still do not have a birth control pill for men," said corresponding author Dr. Martin Matzuk, director of the Center for Drug Discovery and chair of the Department of Pathology and Immunology at Baylor.

"In this study we focused on a novel approach—identifying a small molecule that would inhibit serine/threonine kinase 33 (STK33), a protein that is specifically required for fertility in both men and mice."

Previous research has shown that STK33 is enriched in the testis and is specifically required for the formation of functional sperm. In mice, knocking out the Stk33 gene renders the mice sterile due to abnormal sperm and poor sperm motility. In men, having a mutation in the STK33 gene leads to infertility caused by the same sperm defects found in the Stk33 knockout mice . Most importantly, mice and men with these mutations have no other defects and even have normal testis size.

"STK33 is therefore considered a viable target with minimal safety concerns for contraception in men," said Matzuk, who has been on faculty at Baylor for 30 years and is Baylor's Stuart A. Wallace Chair and Robert L. Moody, Sr. Chair of Pathology and Immunology. "STK33 inhibitors have been described but none are STK33-specific or potent for chemically disrupting STK33 function in living organisms."

Finding an effective STK33 inhibitor

"We used DNA-Encoded Chemistry Technology (DEC-Tec) to screen our multi-billion compound collection to discover potent STK33 inhibitors," said first author Dr. Angela Ku, staff scientist in the Matzuk lab. "Our group and others have used this approach before to uncover potent and selective kinase inhibitors."

The researchers uncovered potent STK33-specific inhibitors, from which they successfully generated modified versions to make them more stable, potent and selective. "Among these modified versions, compound CDD-2807 turned out to be the most effective," Ku said.

"Next, we tested the efficacy of CDD-2807 in our mouse model ," said co-author Dr. Courtney M. Sutton, postdoctoral fellow in the Matzuk lab. "We evaluated several doses and treatment schedules and then determined sperm motility and number in the mice as well as their ability to fertilize females."

Compound CDD-2807 effectively crossed the blood-testis barrier and reduced sperm motility and numbers and mice fertility at low doses. "We were pleased to see that the mice did not show signs of toxicity from CDD-2807 treatment, that the compound did not accumulate in the brain, and that the treatment did not alter testis size, similar to the Stk33 knockout mice and the men with the STK33 mutation," Sutton said.

"Importantly, the contraceptive effect was reversible. After a period without compound CDD-2807, the mice recovered sperm motility and numbers and were fertile again."

"In our paper, we also present the first crystal structure for STK33," said co-author Dr. Choel Kim, associate professor of biochemistry and molecular pharmacology and member of the Dan L Duncan Comprehensive Cancer Center at Baylor.

"Our crystal structure showed how one of our potent inhibitors interacts with STK33 kinase in three dimensions. This enabled us to model and design our final compound, CDD-2807, for better drug-like properties."

"This study was a tour de force by our team in the Center for Drug Discovery at Baylor and our collaborators," said co-author Dr. Mingxing Teng, assistant professor of pathology and immunology and of biochemistry and molecular pharmacology at Baylor. Teng also is a Cancer Prevention Research Institute of Texas Scholar and a member of the Dan L Duncan Comprehensive Cancer Center at Baylor.

"Starting with a genetically validated contraceptive target, we were able to show that STK33 is also a chemically validated contraceptive target."

"In the next few years, our goal is to further evaluate this STK33 inhibitor and compounds similar to CDD-2807 in primates to determine their effectiveness as reversible male contraceptives," Matzuk said.

Jerrett Holdaway et al, An emerging target for male contraception, Science (2024). DOI: 10.1126/science.adp6432 , www.science.org/doi/10.1126/science.adp6432

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