By L.A. Williams
Christian Action League
January 26, 2024
Within the next few months, North Carolina women and even young girls will be able to buy birth control pills without a prescription at local stores. At least that’s the expectation of Perrigo, the company that makes Opill, a progestin-only daily contraceptive approved by the FDA for over-the-counter sales last summer. Perrigo says Opill, a .075mg oral norgestrel tablet, will hit local shelves during the first quarter of this year.
While increasing the availability of birth control is heralded by some as a means of lowering the rate of unintended pregnancy and as a result, reducing the abortion rate, the issue is more complicated than it may seem, says the Rev. Mark Creech, executive director of the Christian Action League.
“Already, in North Carolina, as a result of House Bill 96 that passed in 2021, pharmacists can provide oral and transdermal hormone birth control to women 18 and older without a doctor visit and even to minors with parental consent,” Creech said. “Fortunately, that law requires the pharmacist to talk with patients about preventative care, well visits, sexually transmitted infections and other important issues. That’s not the case with this OTC pill.”
According to NC Health News, more than 1,300 pharmacists in 91 counties across the state have trained over the past two years to prescribe hormonal contraception. Once Opill, also called POP or mini-pills, arrives, purchasers will be able to buy it without the benefit of medical advice, which many see as a problem.
Registered nurse Sharon Sullivan, who researches issues for the North Carolina Family Policy Council, says that counseling should be required.
“As a member of the medical community, I strongly believe there should be an obligation to counsel women and adolescents before they begin taking hormone birth control; particularly given the serious health risks that are of concern. With Opill, these include breast cancer, depression, ectopic pregnancy and the possibility of Opill acting as an abortifacient,” Sullivan wrote in a recent Family Policy Council op-ed.
She described instructions and warnings on many OTC medications as “complicated and difficult to read,” not to mention that they don’t offer a chance for the user to ask questions.
Sullivan also pointed out that allowing minors to buy birth control over the counter cuts parents out of the process.
“Parents are essential to adequately guide, direct, and educate children on the dangers of sex outside of marriage and the risks that accompany these medications,” she wrote. “The FDA is not a substitute for a child’s parent, and we must fight back against the consistent push by our culture to eliminate parents from decision-making in the lives of their children.”
Taking its opposition a step further, the Catholic Review called the approval of the OTC mini-pill “a victory for the culture of death.”
In her CR commentary, Samantha Stephenson highlighted the relationship between hormonal contraceptives, which are not always effective, and abortion.
“It is more accurate to say that contraceptives ‘lessen the likelihood’ of pregnancy. Even a failure rate as low as 1 percent each month compounds to an unintended pregnancy rate of 70 percent over 10 years — and that is for standard contraceptives. The mini-pill has an even narrower margin for error,” she wrote, pointing out that more than half of the 600,000 to 1 million annual abortions in the United States occur after failed contraceptive use.
“This is one reason that this issue is so complex. Making contraception more available without any medical or parental advice cannot guarantee a decrease in unintended pregnancies,” Creech said. “Easy access may encourage women to opt for this mini-pill, which is not the most effective form of birth control.”
In fact, according to Health.com, the commonly prescribed pill which contains progestin and estrogen, even if taken as directed, ranks seventh in effectiveness behind the implant, male sterilization, hormonal IUD, female sterilization, copper IUD and hormone injection. The progestin-only Opill may be even less effective because it has a narrow margin of error.
“The drug must be taken every single day and at the same time, or the effectiveness is reduced and pregnancy may occur,” the FDA warns. “In real world use, nonprescription norgestrel is expected to be less effective than prescription norgestrel used in clinical trials that led to its initial approval.”
Above and beyond the potential for an inflated failure rate are concerns about side effects, which can be serious, Creech said.
In an interview for The Daily Beast, Poppy Daniels, an obstetrician-gynecologist with more than 20 years of experience, called OTC birth control without doctor involvement “ridiculous” and “absurd.”
Dr. Daniels, who treats many patients with blood-clotting disorders that only became apparent after taking hormonal birth control, says the disorders are often related to a gene mutation that affects roughly 2 in 5 people. She will prescribe hormonal contraception only after evaluating the risks for each patient, including exploring their family history for blood clots, strokes and heart attacks.
“My concern is that you’re basically taking women who have no counseling, no family history, no risk assessment, and they’re just getting [hormonal birth control] with no guidance,” Daniels said. “Why would you take that risk?”