OTC contraception access and patients of color

Interest in an over-the-counter (OTC) oral contraceptive pill (OCP) among Black, Indigenous, and people of color (BIPOC) is high, especially for those who have had trouble accessing prescription methods and those not currently using contraception, according to a study in Contraception.¹ The authors, therefore, recommend that OTC OCP availability and implementation strategies must consider access challenges these patients face.

Despite the popularity of birth control pills and their decades of safe use and research, said senior author Sarah Baum, people still face barriers to birth control pills. “These barriers fall hardest on young people and Black, Indigenous, and people of color.” She is a senior research scientist with Ibis Reproductive Health.

“This study is unique because we partnered with communities on the ground—groups such as Black Women for Wellness, Bold Futures, California Latinas for Reproductive Justice, the Native American Community Board, and the National Asian Pacific American Women's Forum—to survey more than 700 Black, Indigenous, and people of color in the United States,” Baum said. Among 727 respondents, the proportions who identified as Black or African-American, Latina/Latinx, or Asian American, Native Hawaiian, or Pacific Islander (AANHPI) were around 30% each; 13% identified as Indigenous.¹

“We found that interest in an OTC birth control pill was high in these communities, with 2/3 saying they would be likely to use an OTC pill. Interest was particularly high among young people and people who faced barriers to birth control, such as challenges getting to an appointment, cost, privacy concerns, and fear of judgement.” In multivariate analysis, respondents who experienced at least one such challenge in the past year had 69% higher odds of interest in OTC OCP use.

“In addition to interest in an OTC pill among young people and people who faced barriers,” Baum said, “interest was high among people who were not currently using a method. This means that moving a pill over the counter may help meet the needs of people who want to use birth control but are not currently using any method.”

The foregoing findings suggest that making OCPs available OTC can help bridge gaps in access among people of color who are facing barriers^2,3 and give people greater control over their reproductive health and lives, Baum said. It will be crucial that the rollout of any OTC OCP include a product that is priced affordably, fully covered by insurance, and available to people of all ages, she added.

In July 2022, HRA Pharma requested that the FDA allow OTC access to its prescription Opill (norgestrel 0.075 mg). If approved, Opill would become the first OTC OCP in the United States, although such pills are available worldwide including in the United Kingdom, Mexico, and other Latin American countries.⁴

“We expect the FDA to schedule an Advisory Committee meeting later this year,” said Baum, “and a decision would follow shortly after that. I trust they'll follow the decades of science and research showing that a progestin-only birth control pill is safe and effective for OTC use.”

REFERENCES:

1. Key K, Wollum A, Asetoyer C, et al. Challenges accessing contraceptive care and interest in over-the-counter oral contraceptive pill use among Black, Indigenous, and people of color: an online cross-sectional survey [published online ahead of print, 2023 Jan 11]. Contraception. 2023;109950. doi:10.1016/j.contraception.2023.109950

2. Dehlendorf C, Perritt J. Statewide contraceptive access initiatives: a critical perspective. Am J Public Health. 2022;112(S5):S490-S493. doi:10.2105/AJPH.2022.306930

3. Moniz MH, Spector-Bagdady K, Perritt JB, et al. Balancing enhanced contraceptive access with risk of reproductive injustice: a United States comparative case study. Contraception. 2022;113:88-94. doi:10.1016/j.contraception.2022.04.004

4. Aubrey A. Over-the-counter birth control pills are available worldwide. The US may be next. https://www.npr.org/sections/health-shots/2022/07/14/1111297318/over-the-counter-birth-control-pills. Published July 14, 2022. Accessed February 3, 2023.

DISCLOSURES:

Baum reports no relevant financial interests. The study was funded by Arnold Ventures, the Collaborative for Gender + Reproductive Equity, and the David and Lucile Packard Foundation, although funders had no role in study design or interpretation. Ibis Reproductive Health provided financial support for some of the research supporting HRA Pharma’s application for the Opill OTC switch, but Ibis receives no monetary compensation or ownership rights to the product.