What is the future of birth control in America?

Over-the-counter birth control may soon be available for the first time in the United States. A Food and Drug Administration panel this week will consider a request from a French company to let pharmacies distribute Opill without a prescription, The Washington Post reports. Maybe that shouldn't be so revolutionary: More than 100 countries already allow over-the-counter purchases of contraceptive medicine.

But the Opill application arises nearly a year after the U.S. Supreme Court overturned Roe v. Wade, upending reproductive rights. Some observers believe that anti-abortion conservatives will also try to narrow access to birth control. Indeed, ABC News reports that several Catholic groups — including the U.S. Conference of Bishops — are arguing against over-the-counter access to contraceptives, arguing that teens shouldn't be able to obtain the pills without parental notification or health provider supervision. "The results could be catastrophic," the groups said in a written objection to the FDA proposal. Other anti-abortion groups are declining to weigh in.

And states may not wait for the feds' approval. New York Gov. Kathy Hochul (D) last week signed a law allowing patients to bypass doctors and obtain birth control directly from pharmacists. "We're going to do everything in our power to stop the backslide while expanding reproductive rights here in our state," she said. This might not be a simple right-versus-left story, though: Red states like Indiana, Oklahoma, and Iowa have also recently passed legislation expanding or guaranteeing the availability of birth control. Will the future give Americans greater ability to obtain contraceptives? Or are more restrictions coming?

What are commentators saying?

"Birth control pills should be available without a prescription for people of all ages," U.C. San Francisco's Daniel Grossman writes for the Los Angeles Times. But allowing over-the-counter pills should just be the beginning: The next step is to make them affordable. Ideally, Congress would pass legislation that would require insurers to pay for the pills without requiring patients to pay any out-of-pocket costs. And if Congress doesn't act, states should step in and impose the requirement. "It's up to state legislators across the country to ensure contraceptive access is a reality for all," Grossman writes, and adds: "It's really time to free the pill."

There might be obstacles. "Conservatives are not coming for birth control next," Christina Cauterucci writes for Slate. "They're coming for birth control now." Republicans last year refused to sign onto a federal bill guaranteeing birth control access. And though Iowa just approved over-the-counter access for adults, the state's attorney general just suspended payments for emergency contraception for sexual assault victims. Some opponents are even campaigning against "side effects and risks of hormonal contraception." Those conservatives might end up following the game plan used to reverse Roe. "It's worked for them before."

On the other hand: "Pro-life can mean pro-birth control," Kimberly Ross writes for the Washington Examiner, pointing to GOP presidential candidate Nikki Haley. Yes, contraception is a "sensitive, divisive topic" on the right. But contraception "does not go against the pro-life mission." Pro-lifers may not lend support to drugs that induce miscarriages, but there are ways to prevent pregnancies instead of ending them — including condoms, diaphragms, and some birth control pills. Not all pro-life people will feel personally comfortable with those methods. But "if the goal is fewer abortions, making contraception widely available is key."

What's next?

Over-the-counter pills might be just the first step to an expanded birth control universe. The Atlantic reports that a "contraceptive vaccine" for women is in early trials, one that prevents pregnancy without the "messy, sometimes dangerous side effects, such as weight gain, mood swings, and rare but risky blood clots and strokes." Will it work? It's too early to say. The concept is "devilishly difficult in execution, both scientifically and socially."

Men may also have options soon. NPR reports that researchers have developed a compound that turns off the sperm's "on-switch," which has proved promising when used on mice. (The drug was originally developed to treat eye disorders.) If the work bears out, an "on-demand male contraceptive" could one day be available to men who now often rely on women to carry the burden of preventing pregnancies.

As for Opill, the Washington Post reports the FDA could decide whether to allow over-the-counter use by the end of summer 2023. The agency is reportedly being "extremely cautious" in its review, aware of the fragile politics surrounding its decision. But advocates say the rationale for approval is simple. "Women who are not seeking to be pregnant," says one expert, "should have the ability to prevent it."

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