For the first time, U.S. regulators have approved over-the-counter sales of an oral contraceptive, joining more than 100 other countries in allowing women to access the popular and safe birth control method without a prescription.
What’s Canada waiting for to make “The Pill” more accessible?
In early 2024, a 28-pill pack of Opill will be available in many American drug stores, corner stores and big-box retailers alongside condoms, spermicides, and lubricants.
At a time when reproductive rights are under unprecedented attack, this is a rare victory for broader, more equitable access.
The debate about making birth control pills an over-the-counter (OTC) medication is also informative, one that Canada can learn from, and hopefully use to act swiftly.
Almost three-quarters of Canadian women use hormonal contraceptives at some point during their reproductive lives – and about one in eight at any given time.
Yet, to access the drug, you need a prescription from a doctor, a nurse practitioner or, in some provinces, a pharmacist.
Generally, that involves making a medical appointment (if you can get one), taking time off work or school, getting childcare, taking transit or paying for parking, and more. Some doctors still insist on a physical, or pelvic exam, which is usually unnecessary.
It’s a little easier in the seven provinces where pharmacists can prescribe oral contraceptives – B.C., Alberta, Saskatchewan, Quebec, New Brunswick, Nova Scotia and PEI.
The pill has been around for more than six decades. It’s quite a safe drug, and has become safer over time as levels of hormones in the pills have decreased. It’s also easy to use: Take one pill daily at roughly the same time.
Opill, the birth control pill approved for OTC sales in the U.S. contains only the synthetic hormone progestin. Most oral contraceptives contain both estrogen and progestin, which have more side effects.
Women can safely use oral contraceptives until menopause but, if they smoke or have high blood pressure, different birth control methods are recommended, especially after age 35. Users also need to be aware that other drugs like those used to treat seizures, HIV and high blood pressure can interfere with the effectiveness of hormonal contraceptives.
But there are similar contraindications for other OTC drugs. It’s something most consumers can handle.
As the U.S. regulator concluded, the potential risks of the pill are greatly outweighed by the benefit of preventing a large number of unwanted pregnancies. Especially since most of those unwanted pregnancies happen in teenagers, racialized, and low-income groups – those who have the worst access to medical care, and usually the lowest risk of side effects from the medication.
Calls for easier access to oral contraceptives date back decades. The slow and overly cautious response of regulators and legislators is part of a pattern of paternalism and misogyny when it comes to women’s reproductive health.
In Canada, birth control was criminalized until 1969. (Oral contraceptives were approved as a prescription drug in 1960, but only to regulate menstrual cycles.)
It took many years for Plan B, the “morning-after pill,” to be approved and sold in Canada. It is now available in pharmacies without a prescription and paid for by provincial health plans in every province except Quebec.
Abortion was not fully decriminalized in Canada until 1988, two decades after birth control, and it took a Supreme Court ruling to do so.
Canada’s history with the abortion pill is the most shameful of all. It took almost three decades between the time Mifegymiso was approved in France in 1988 to the time it was approved in Canada in 2017, and there are still barriers to access in some provinces.
But there are glimmers of hope on the reproductive rights front, most notably in B.C., where earlier this year the province’s NDP government made access to many forms of contraception (including oral contraceptives) cost-free and universal.
Affordability is an important part of the access question, one that has been a key part of the U.S. debate about the OTC status of Opill.
Under the U.S. Affordable Care Act, all insurers must cover prescription birth control. But they don’t have to cover non-prescription drugs. The same is true of many public and private drug plans in Canada.
Paradoxically, that could make the pill less available to some. The cost of $20-30 monthly can be a barrier for many. (The manufacturer has yet to set a price for Opill, but OTC drugs are generally cheaper than prescription versions.)
The answer, of course, is to make birth control more accessible both practically and financially, an equitable solution that provides the best return on investment.
Editor’s note: A previous version of this article incorrectly stated the number of provinces in which pharmacists can prescribe oral contraceptives. This version has been corrected.
André Picard