Opponents of OTC access to oral contraception

Overview

In 2024, “Opill,” a progestin-only pill often called the “mini-pill,” arrived on store shelves without a prescription, marking a major milestone in contraceptive access. Now, a second pill, “Zena,” a formulation with two hormones used by over 90% of birth control pill users, is in the final stages of the FDA research process for over-the-counter status and is expected to go through the final review process within a few years.

Opponents of the pill over-the-counter

In spite of robust support for over-the-counter access to the birth control pill among leading medical experts and a strong bipartisan majority of U.S. voters, an organized opposition persists. This is occurring amidst a backdrop where opponents of contraception and abortion have been targeting the Food and Drug Administration, attempting to interfere in its decision-making on reproductive health products.

Three groups are at the helm of opposing the pill over the counter: religious-based medical associations, the Catholic Church lobby and anti-abortion leadership, in particular Students for Life Action.

These groups are commonly defined as anti-abortion, yet they are also firmly anti-contraception. Students for Life of America promotes anti-birth control messaging, such as “birth control disrespects women” and “birth control is degrading to women.” SFLA President Kristin Hawkins told MSNBC’s Joy Reid, “in my ideal world, yes,” both the pill and IUDs should be illegal.

SFLA makes their stance on over-the-counter birth control, which they falsely label an “abortifacient” capable of ending an existing pregnancy, explicitly known on their website:

In July 2023, Students for Life of America President Kristan Hawkins posted on X (fka Twitter),

“I guess everyone who is pro-choice will join me in calling for an end to legal abortion now that any woman, girl, or rapist can get birth control pills over the counter. Right? I've heard this time and time again that if we just had more easily accessed birth control, then we wouldn't need abortion.”

In May 2023, Hawkins called an FDA Advisory Committee’s recommendation for over-the-counter distribution of contraception “a feckless decision that empowers abusers.” Hawkins made the following statement, published in an SFLA press release:

“The abortion lobby has trained many in our culture to see pregnancy as the enemy of women, ignoring all the factors at play when you abandon young women with the sole message of ‘don’t be pregnant.’ Pregnancy is not a disease cured by abortion. And importantly, over the counter birth control and Online, No Test Distribution of Chemical Abortion Pills puts the power in the hands of abusers and sex traffickers.

Prior to the FDA Advisory Committee’s recommendation of over-the-counter birth control, SFLA put out the following statement:

“Making it easy for abusers to cover up their sexual abuse and statutory rape crimes with Online, No Test Chemical Abortion Pills or over-the-counter birth control sales is negligent public policy.

The FDA ignores the impact of their policies on minors, including failing to show what the exact long-term impact of such early exposure on young women might be. It’s astounding that an agency established to keep women safe when using any substances is more interested in a quick sale than patient safety.

President Biden’s FDA must stop prioritizing the goals of the abortion lobby and put women and young girls first. As I travel on campuses across the country, I find that young women – both pro-life and pro-choice – agree that hormonal birth control causes women many terrible problems.

Outside of Washington D.C., young women are very worried about such drugs. As a mother, I also am offended by the FDA’s reported decision in light of the current epidemic of sexually transmitted disease. But the bottom line is that there should be bipartisan agreement that making it easier for predators to hide their sexual abuse of minors is bad public policy.”

One prominent voice in the Catholic Church lobby, Michael J. New (senior associate scholar at the Charlotte Lozier Institute, the research branch of Susan B Anthony Pro Life America) opposed the pill over-the-counter in an op-ed for the National Review:

“Indeed, the FDA’s decision to approve Opill received almost uniformly positive coverage from mainstream media outlets. That said, plenty of data show that the contraceptive culture has done considerable damage to both families and public health. Conservatives should oppose the FDA’s approval of Opill and ask future Republican presidential administrations to revoke the FDA approval for Opill and other over-the-counter contraceptives.”

Religious-based medical associations

Religiously affiliated medical associations have been actively lobbying to disrupt the FDA’s ability to make decisions about reproductive health products. Two groups are leading in this area: the Catholic Medical Association (CMA) and the American Association of Pro-Life Obstetricians and Gynecologists (AAPLOG).

CMA, with 2,400 members, is a founding partner of the Alliance for Hippocratic Medicine, who brought the lawsuit against the FDA’s decision-making authority related to medication abortion. The American Association of Pro-Life Obstetricians and Gynecologists (AAPLOG), and American College of Pediatricians and Christian Medical & Dental Associations also joined the lawsuit. 11 U.S. Senators and 58 members of the U.S. House of Representatives also endorsed interfering in FDA’s authority to approve drugs.

CMA said in regard to Judge Kacsmaryk’s ruling in favor of Alliance, “The FDA’s approval of these dangerous chemical abortion drugs stands in direct violation of the right to life and inherit [sic] dignity each of us has from the moment of conception.”

CMA also pressured the FDA to not approve over-the-counter status for oral contraception, including a joint letter to the FDA and a quiet letter-writing campaign among its members.

Catholic institutions

Catholic leaders have issued a joint letter to the FDA — including the Catholic Medical Association, United States Conference of Catholic Bishops (USCCB) and the National Association of Catholic Nurses. Each of these institutions has a history of campaigning against access to contraception:

The Catholic Medical Association opposed the Right to Contraception Act in 2022. They oppose emergency contraception even in cases of rape and have a long history of opposing access to oral contraception.
The USCCB is firmly opposed to artificial contraception, including the birth control pill, and regularly campaigns against access to the pill, condoms and other forms of contraception. The USCCB does not consider Natural Family Planning to be contraception.
The National Association of Catholic Nurses is aligned with the Catholic Church opposition to artificial contraception and advocacy for Natural Family Planning.
A subset of the Catholic-affiliated opposition is Natural Family Planning advocates such as Natural Womanhood, with a history of asking the FDA to curb access to contraception. These groups often advance the non-medical assertion that contraception such as the pill is equivalent to abortion.

COORDINATED FDA COMMENTS

In the fall of 2022, a flurry of opposing comments were submitted to the FDA public comment portal regarding Opill’s application for over-the-counter status. The comments displayed striking similarities in content and tone and appeared to have been coordinated. The authors affiliated with a Catholic or anti-abortion group rarely self-identified these affiliations, instead focusing only on medical concerns.

Approximately 28% of comments submitted via the FDA portal were in opposition to the “mini- pill” receiving OTC status. Of those opposition comments:

28% of comments that oppose over-the-counter status were anonymous; in contrast, only 10% of the comments in support of the pill OTC were anonymous.

84% were from people aligned with opposition campaigns, largely rooted in a Christian belief system that generally opposes “artificial contraception.

48% were from self-identified medical providers. Among those medical providers, 91% of those opposing the pill OTC could be identified as either religiously or generally motivated in their opposition to contraception.

Only six medical providers who have not been identified as a part of an advocacy campaign submitted opposition content using their identity (rather than anonymously).

Advocates for Natural Family Planning made up 11% of opposition comments.