The Dark Future of Over-the-Counter Contraception

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

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

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

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

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

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

While advocates of over-the-counter birth control claim that this move will reduce the abortion rate, the evidence suggests the opposite. Francis noted that the Opill approval is likely to lead to a higher rate of unintended pregnancies, which will lead to a higher abortion rate. The Guttmacher Institute, Planned Parenthood’s research arm, has reported that about half of women procuring abortions were using a form of contraception the month they became pregnant. Dr. Michael New of the Charlotte Lozier Institute concurs, noting that the available research shows “programs designed to promote contraceptive use have a very poor track record of reducing either abortion rates or unintended-pregnancy rates.” It is more likely that the approval of an over-the-counter pill, which can be acquired without a doctor visit or counseling, and has a high rate of failure if not taken precisely, will lead to more abortions rather than fewer.

This “new chapter in reproductive health” is thus likely to be a grim one. It is already easy for teens to access birth control; now it will be easier for them to do so while keeping their parents and family physicians in the dark, eliminating the possibility of essential conversations about health and sexuality. An increase in risky sexual behavior will result in more unwanted pregnancies and the destruction of more pre-born children. Government approval of over-the-counter birth control will also contribute to our culture's “contraceptive mindset,” encouraging the belief that men and women—and boys and girls—can use one another without consequence, and that healthy fertility is a condition to be treated.

Fortunately, there has been a recent renaissance of feminist intellectuals rejecting both the mindset and hormonal birth control itself—for a wide range of reasons. Mary Harrington’s Reactionary Feminism, Louise Perry’s The Case Against the Sexual Revolution, and Erika Bachiochi’s The Rights of Women are examples. They just might be the beginning of a wider backlash against the cultural assumption that for women to be liberated, their bodies must function like that of men. That would be a welcome chapter indeed.

Jonathon Van Maren is the author of Patriots: The Untold Story of Ireland’s Pro-Life Movement. 

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