When Dyvia Huitron asked her parents if she could go on birth control for the first time, the sexually active 16-year-old from McAllen, Texas was promptly grounded. Though it was unsurprising—she grew up in a religious community where sex is discouraged until marriage—she was frustrated. Years later, she revisited the conversation, but the pandemic complicated the process, and gynecologists weren’t taking new patients. Now 19 years old and a student at the University of Alabama, she still isn’t on the pill.
“I was anxious, especially when I was younger,” Huitron told ELLE.com. “No matter how correctly I use condoms, something could still go wrong, and I would not have the same safety net as being on the pill.” Huitron’s biggest barrier: historically, in order to obtain the birth control pill in the United States, a patient had to be prescribed the medication. But on Thursday, in a watershed moment, the U.S. Food and Drug Administration approved Opill, a form of birth control, for over-the-counter sales with no age restrictions.
The decision marks the first time that Americans will be able to purchase oral contraception without a prescription since it was first approved in 1960, and comes after years of advocacy from those in favor of increasing its accessibility. “This gives me the chance to just walk into a store and access birth control in a quick and easy way,” Huitron said after the FDA’s approval. “It’ll let me take charge of my health the way I would with many other aspects of my life.”
Despite its efficacy and safety, the pill has been stigmatized in the U.S. for decades, in part because of societal norms around sex and sexual health, religious beliefs, and gender stereotypes.”
Opill will likely hit pharmacy shelves in early 2024, making the U.S. the latest country to offer some form of over-the-counter oral contraceptives. (The birth control pill is already available over the counter in more than 100 other countries, mostly in Latin and South America, Africa, and Asia.) Despite its efficacy and safety, the pill has been stigmatized in the U.S. for decades, in part because of societal norms around sex and sexual health, religious beliefs, and gender stereotypes. As a result, many young people across America, like Huitron, have struggled to access it.
The FDA’s decision came after Huitron and five other young people involved with the #FreethePill Youth Council, a group focused on making oral contraception available without a prescription for Americans of all ages, brought together by the sexual advocacy organization Advocates for Youth, testified to an FDA advisory committee in May, painting a powerful picture of how over-the-counter birth control would make a tangible impact on the lives of many young Americans.
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️ #FreeThePill rally at The White House: check!
Tune in TOMORROW for the first ever FDA hearing to bring birth control pills over-the-counter and improve access for EVERYONE! pic.twitter.com/Zpj5POyzev
— Advocates for Youth (@AdvocatesTweets) May 8, 2023
With their testimony, the advocates described the barriers young people often face while trying to obtain birth control: parental permission can be difficult to get; doctors are at times hesitant to prescribe it; and there are circumstantial obstacles to the pill depending on where you live and what type of insurance you have. Though most insurance plans should cover the cost of prescription contraceptives thanks to the Affordable Care Act, a Kaiser Family Foundation study found that 41 percent of females ages 18–49 are not aware of that requirement, and 25 percent of those females with private insurance reported paying for at least a portion of the cost of the contraceptive themselves.
“I [couldn’t] access it because my parents…their belief system is a little bit different,” Huitron said. “But there are people who can’t access it because of transportation reasons, because of health insurance reasons, because of so many other things. And I think it would have made everyone’s life easier, and they probably would have felt a million times safer, had they had the chance to just go to a CVS or Walgreens and pick up a pack of birth control—the way they would pick up a pack of Advil—on their own time, at their own discretion, and be in charge of their health.”
For some, like Beau Nelson, 20, birth control has been a lifeline, even before they were sexually active. Nelson grew up in Sarasota, Florida, and was 12 years old when they first got their period, a cycle that came with intense pain—cramping so badly they could barely walk and would have to miss school. Nelson knew birth control could be used to manage and lighten one’s period, but when they first tried to get a prescription at 13, they said doctors were “uncomfortable” prescribing birth control to someone so young. “Basically, they didn’t want a 13-year-old having sex,” Nelson told ELLE.com. “They were afraid of that possibility.”
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When giving their testimony to the FDA advisory committee, Nelson explained that it took three doctors’ visits to find a “non-judgmental” nurse practitioner when they were 14. “Birth control completely changed my life,” they said. “It managed my heavy periods. It let me finish high school without the stress of teen pregnancy, and now in college, it’s allowing me to achieve my career goals of becoming a reproductive health provider.”
Nearly 1,000 miles north of Nelson, Bex Heimbrock, 20, described a similar scenario.
Growing up in a religious community in rural Appalachia, Heimbrock started to experience painful periods as soon as they started menstruating. After once bleeding through a tampon in their sixth grade science class, Heimbrock visited a family doctor, the only doctor in town.
In the course of the visit, Heimbrock was told that if they were to take birth control, they were “more likely to become sexually active,” they told ELLE.com. “Which is not true.”
They were not prescribed birth control and continued to experience agonizing periods. Years later, Heimbrock moved closer to Washington, D.C. and visited a local gynecologist who diagnosed them with endometriosis and polycystic ovarian syndrome. Endometriosis can cause heavy menstrual bleeding, and polycystic ovarian syndrome can cause irregular periods. Hormonal contraception can be used to manage both conditions.
Through the entire thing, it was so hard to talk to people about what I was experiencing, because if I talked to my friends in middle and high school, they’d be like, ‘Why are you on the pill? Are you having sex?’”
In their own testimony to the FDA advisory committee, Heimbrock emphasized the disparities between rural and urban health care and the way over-the-counter birth control could change the lives of young Americans in more isolated communities.
“Rural teens are more likely to experience teen pregnancy and report higher barriers to accessing birth control,” Heimbrock told the committee. Stigma can also impact young people navigating their sexual and reproductive health in these communities. “Through the entire thing, it was so hard to talk to people about what I was experiencing, because if I talked to my friends in middle and high school, they’d be like, ‘Why are you on the pill? Are you having sex?’” Heimbrock said.
“If Opill were available over the counter, rural youth could access this life-changing care online with ease, reducing unintended pregnancies and changing the course of their lives,” they said before the FDA’s decision. After the FDA approved Opill, Heimbrock told ELLE.com that “the fight to make birth control truly accessible isn’t over yet.” They continued: “I remain focused on ensuring affordable, easy access to over-the-counter birth control. If the pill isn’t affordable, it isn’t accessible.” (The price for the over-the-counter oral contraceptive has yet to be determined.)
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With her testimony, Lauren Schenk, a 21-year-old who grew up in a religious community in Oak Ridge, Tennessee, offered yet another example of the barriers rural youth can face when trying to secure health care. When she was 16 years old, she had to drive 30 minutes to the county’s only health clinic to obtain birth control. “I had to go on the one day of the week where I wasn’t working, because it was only open 9 A.M. to 5 P.M.,” she told ELLE.com. “I told my mom that day I was still going to work so she wouldn’t be dubious of me driving out to get birth control.”
Schenk, who attended a Catholic high school with abstinence-only education, said, “Sex wasn’t something we even talked about.” When she arrived at the clinic that day, she described her situation, and the nurse on duty worked with her to ensure the medication wouldn’t show up on her insurance or bank statements, an experience Schenk knows was unique.
“I was very lucky that I had a car, had the time, and ability to go to the clinic, and that the nurse who helped me was kind and worked with me to find a way to have birth control, but I am not a common example,” she told the FDA advisory committee. “We should not live in a reality where one of the best-case scenarios is a young girl driving out of her way with her limited time to have access to health care.”
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The FDA’s independent, evidence-based action to approve a safe, daily contraceptive for over-the-counter use will make it easier for women to access birth control without a prescription.
This announcement will help more Americans to decide their own futures.
— Vice President Kamala Harris (@VP) July 14, 2023
The push for over-the-counter birth control was also supported by the American College of Obstetricians and Gynecologists as well as the American Medical Association, and prior to the Supreme Court’s decision to overturn Roe v. Wade, nearly 60 members of Congress wrote a letter to the FDA suggesting that birth control be made accessible over the counter.
After the fall of Roe in June 2022, over-the-counter birth control advocates insisted that making the pill more accessible was essential. Meanwhile, the same anti-abortion activists and politicians who pushed to overturn Roe have been working to limit sexual education and, in some cases, reduce funding for contraceptive methods like birth control. Take Florida for example, where this year, Republicans moved to restrict sexual education in public schools, and last year, Republican Gov. Ron DeSantis vetoed funding that would’ve helped low-income Floridians get their hands on long-acting contraception like IUDs. Outside legislatures, anti-abortion activists have also posted misinformation about risks and side effects of birth control to drum up support for their cause. On the contrary, advocates with the #FreeThePill Youth Council have spread awareness on social media about the efficacy and safety of the pill as well as the potential for the FDA to approve an over-the-counter option.
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Using her platform on TikTok, Sriha Srinivasan (known to her nearly 200,000 followers as @sexedu) works every day to destigmatize sexual health and has publicly dispelled myths about contraception while advocating for over-the-counter birth control. In a post this spring, Srinivassan clarified whether or not birth control can cause cancer, a topic often elevated by anti-pill activists. In a “Get Ready With Me” video, she tackled arguments against over-the-counter birth control, such as the suggestion that people would misuse the medication or can easily access a health care provider.
Srinivasan then posted a video crying “happy tears” on the day the FDA decided to make birth control available over the counter. “I’ve never cried in front of the camera before,” she said in the video. “I just feel like it’s worth it, because they just freed the pill.”
“I’m thinking today of all the stories I’ve heard from young people, all the lived experiences brought on by barriers to access that have been shifted by this change in the status quo,” she told ELLE.com. “I know my younger self would be so happy, and I’m grateful to have been a part of this movement and for the activists before me that paved the road.”
Writer
Rachel Janfaza is a journalist covering youth political culture. Most recently, she started ‘The Up and Up,’ a newsletter focused on Gen Z’s political zeitgeist: how young Americans are organizing, mobilizing and participating in civic life and politics – or, how and why they’re not. She also freelances, with bylines in Teen Vogue, Glamour, Elle, and Bustle. Previously, she was an associate writer on the CNN Politics team covering young voters, campaigns, and breaking news.
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