Today, Explained - Lip gloss, gum, and the Pill

Episode Date: March 14, 2024

Soon you can buy them all at your local drugstore. The FDA approved an over-the-counter birth control pill that will be available later this month. Journalist Lux Alptraum and Megan Kavanaugh of the Guttmacher Institute explain why available doesn’t necessarily mean more accessible. This episode was produced by Victoria Chamberlin, edited by Amina Al-Sadi, fact-checked by Laura Bullard, engineered by David Herman, and guest-hosted by Alana Casanova-Burgess. Transcript at vox.com/todayexplained Support Today, Explained by making a financial contribution to Vox! bit.ly/givepodcasts Learn more about your ad choices. Visit podcastchoices.com/adchoices

Big news in the birth control aisle. For the first time ever in the history of modern birth control, Americans can buy birth control pills over the counter. It's called Opil, and it's been around for a few decades now. What's really interesting is that the big new news in birth control has absolutely nothing to do with some scientific breakthrough or some medical breakthrough. It is more of a social breakthrough. It was approved by the FDA last year, and now, later this month, you can buy

them online. Somebody can buy them and give them out for free. You don't have to see a doctor. You don't have to show ID. You can just buy them the same way that you buy Tylenol. But does making birth control more available mean it's also more accessible? That's ahead on Today Explained. the GTA from Real Canadian Superstore with PC Express. Shop online for super prices and super savings. Try it today and get up to $75 in PC Optimum Points. Visit superstore.ca to get started. It's Today Explained. I'm Alana Casanova-Burgess, filling in as host today, and I'm talking to Lux Alptrom. I am a freelance journalist who specializes in a range of sex-related topics, sex tech, sexual health. Because for the first time ever, there's going to be an over-the-counter birth control pill available in the U.S.

It's expected to hit store shelves around the end of the month or early April. You can get it without a prescription at major pharmacies, including CVS and Walgreens. Its retail price is about $20 for a one-month supply. And Lux says this is different from the birth control pills we're mostly familiar with. So most of the birth control pills that people in the U.S. take, like OrthoTriCyclin or Yaz or Sprintek or a lot of the really popular brands. Like all pills, Yaz is effective at preventing pregnancy and can give you shorter, lighter periods. Those are combination estrogen progestin pills. So there's three weeks

of quote-unquote active pills that are what are really preventing you from getting pregnant, and then you have a one week of placebo pills, which is where you get your period. The idea was when people came up with hormonal birth control is they thought, you know, this is a way of mimicking the body's natural cycle. People will feel more comfortable if they're getting a regular period, and that's the way that a lot of us think of the pill working, right? Progestin-only pills don't work that way. There's no placebo week where you have a period. They're just four straight weeks of hormonal pills. So that means you don't have that withdrawal week where you get a period. And, you know, I want to note a lot of birth control methods are progestin only. The Depovera shot is progestin only. Hormonal IUDs tend to use

progestin. Implants tend to use progestin. So this isn't, again, this is not a new thing. It's just, it's not the way that we think of the birth control pill as working. How effective is the O-pill? With perfect use, it's about 98, 99% effective. And with typical use, it goes down to about 92% effective, which is still incredibly effective. The thing about O-pill that makes it a little bit different from combined estrogen progestin pills is that you have to take it at the same time every day. So there's about a three-hour window, I think, where you can take it and have it at peak efficacy. If you are taking it at the wrong time some days, or if you are forgetting a pill, as people tend to do in real-world use, that's when you're going to start to see the effectiveness

drop. And what do we know about how, that's when you're going to start to see the effectiveness drop. And what do we know about how much it's going to cost? So Parago, which is the company that is distributing Opel, they have announced that their suggested retail price is $19.99 for one month's supply and $49.99 for a three month's supply. Now that's what they are telling telling Target and CVS and all of these drugstores to sell it for. That doesn't necessarily mean that we're not going to see some slightly higher or, in the case of retailers like Amazon, slightly lower prices, but that's about what we're expecting to see it at. We know that opil.com, which is the direct-to-consumer website, that's going to be

selling it for $49.99 for a three-month supply and $89.99 for a six-month supply. So I saw a map of the globe and there are over a hundred other countries that have had birth control pills available without a prescription. So why did it take so long for the U.S. to get on board? It's not because there weren't pills. As you noted, in over 100 other countries, there's over-the-counter birth control pills, and we know that they are being used safely and effectively. But what I think it is, is that in the U.S., there is a really extreme lack of trust around reproductive health. There's just a really ingrained belief that people cannot be trusted to manage their own reproductive health and that doctors need to be involved. And that has held back a lot of innovation that has held back a lot of access. And I think it's really,

really, really intense stigma that we are still battling. And, you know, I come from a sex education space, and I can tell you the arguments in my head. I had a period where I was very skeptical about over-the-counter birth control, when I was much less educated about the fact that it had been safely implemented in many other parts of the world. And with estrogen and with combined estrogen and progestin pills, there are health risks. There's always been concern that the new generation birth control, like Yaz, Yasmin, B-Yaz, maybe increases the risk of developing a blood clot slightly over the old generation. Two popular kinds of birth control pills have been linked to the deaths of almost two dozen women, many of them under the age of 30. The pills are called... And so I had it in my head,

you know, birth control has some dangerous side effects. You need to be properly screened. And so it must be gatekept because of a doctor. Like that was what I believed. And then I stopped believing that because I realized that people can be trusted to make decisions for themselves and that medications like Tylenol are also incredibly dangerous. And yet we have no qualms about them being available over the counter. And we trust people to make the right decisions for themselves if we give them the correct information about how to take these medications. Right. Like I'm an older millennial. I've had decades of this conditioning about these issues that you're describing, these issues around the combination birth control pill,

this intense fear that it raises the risk of blood clots. You know, do you have a migraine with aura, without aura? So if those concerns were warranted, do you think that that changed attitudes about this other kind of birth control pill, the over-the-counter one with progestin only? One of the primary reasons we got energy and enthusiasm and excitement behind over-the-counter birth control was that we had already gotten over-the-counter emergency contraception. And over-the-counter emergency contraception was a much easier argument for people to make. With Plan B, you have 72 hours, really, to take Plan B and have it work as well as it possibly can. Right. You don't have time to get to the doctor. You've got to get to the pharmacy.

Exactly. And so if Plan B requires a prescription, which it did when I was in college, then you have a massive barrier. And people can understand like, oh, wait, if I have unprotected sex on a Friday and I can't talk to my doctor until Monday, that's a huge problem. Like I might be completely out of the window. I have a really important to-do list that starts with not getting pregnant. I have a flight in a few hours, so I think we could both agree that makes mine a way more urgent situation. My boyfriend lives in the back of a pet store. I need it.

So I think with Plan B, we had an easier time being like, this needs to be over-the-counter, otherwise it's not as effective as it could possibly be. But even then, I mean, there was pushback to Plan B being over the counter. There was all of this, like, it's actually an abortion pill. The whole point of the morning after pill is to abort a fertilized egg, i.e. a zygote, which is already a unique human being. So I do think that's the same as abortion. That if you put Plan B over the counter, it would be used irresponsibly. There was, you know, age restriction where you had to show an ID to get it because

there was all this panic. And again, none of this is rooted in reality. It's rooted in this idea that like if you allow teenagers to get access to emergency contraception, then they're going to have sex. And teenagers are already having sex. Not all of them, but the ones who want to have sex generally are having sex. And withholding stuff just means they're not having sex as safely as they can. Has there been that kind of pushback with Opal? I have not really heard as much. I mean, I think the fact that we have people getting birth control through telemedicine and sometimes through asynchronous telemedicine where they're just filling out a form and they're not talking to a doctor. I think that all of that has kind of combined to raise people's comfort with birth control pills being over the counter. illegal in parts of the country and heavily restricted in much of the country has made people see over-the-counter birth control as a way of ameliorating that, a way of making it less bad

because it's like, well, okay, it's harder for you to get an abortion, but it's easier for you to get birth control pills, so hopefully you won't need an abortion. And unfortunately, it's not that simple, but I do think there's that mental calculus there for people where there were just a variety of factors that combined to make over-the-counter birth control seem more acceptable than it was 20 years ago when this campaign began. So we've been waiting for this since the 70s. All these other countries already had it. As someone who's reporting on this and thinking about sex ed and access to reproductive health, what's left in this sort of pharmaceutical space that we don't

have access to that we should have more access to? You really want to think of the ideal as there's a range of methods so that every person can find the right method for them. And we have to recognize not only is everybody different, but individuals change over their lifetimes. Everybody needs to have the ability to have control over their own reproductive health and reproductive destiny. So there are a lot of gaps. It's much better than it used to be. But what a perfect system would look like is everybody, no matter their body, no matter if they're in a city or in a rural environment, at any point in their life would be able to find a birth control method that is right for them and that they can access very easily.

Lux Alptrom is a freelance journalist who covers sexual health and is a former sex health educator. Coming up, so how's it looking for all the prescription birth control? Support for Today Explained comes from Ramp. Ramp is the corporate card and spend management software designed to help you save time and put money back in your pocket. Ramp says they give finance teams unprecedented control and insight into company spend. With Ramp, you're able to issue cards to every employee with limits and restrictions and automate expense reporting so you can stop wasting time at the end of every month. And now you can get $250 when you join Ramp. You can go to ramp.com slash explained ramp.com slash explained R A M P.com slash explained cards issued by Sutton Bank member FDIC terms and conditions apply. BetMGM, authorized gaming partner of the NBA, has your back all season long.

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to speak to an advisor free of charge. BetMGM operates pursuant to an operating agreement with iGaming Ontario. Support for this show comes from the ACLU. The ACLU knows exactly what threats a second Donald Trump term presents, and they are ready with a battle-tested playbook. The ACLU took legal action

against the first Trump administration 434 times, and they will do it again to protect immigrants' rights, defend reproductive freedom, fight discrimination, and fight for all of our fundamental rights and freedoms. This Giving Tuesday, you can support the ACLU. With your help, they can stop the extreme Project 2025 agenda. Join the ACLU at aclu.org today. It's Today Explained. I'm Alana Casanova-Burgess, filling in as host today. My name is Megan Kavanaugh. I am a principal research scientist at the Guttmacher Institute in New York City, and we are an institute that focuses on policy-relevant research related

to advancing sexual and reproductive health care access for all. So it's been a tumultuous time these last couple years for reproductive health in the United States. What's contraception access like in 2024? So this is an interesting time for contraceptive access. On one hand, we know there is broad support for contraception. There's wide recognition that most people use contraception at some point in their lives. There's broad talking about contraception. There are so many methods that are available on

the market. Right. We're talking condoms, IUDs, the birth control pill. There's so many now. And with O-Pill going over the counter, you don't even need a prescriptions, the birth control pill. There's so many now. And with O-Pill going over the counter, you don't even need a prescription to get a birth control pill. This is a huge milestone for contraceptive access. And yet I sense something else is coming. And on the other hand, there are still many barriers that remain to people being able to get the contraceptive methods that they want. And one of those key barriers is affordability.

We just know that cost is a huge barrier to people being able to get the methods that they want to use most. So one study that I can point to that really draws on national-level data of reproductive age women found that about 40% of reproductive age women who were living with low incomes, they said that they would want to use a different birth control method or they wanted to start using a birth control method if they didn't have to take cost into consideration in their choice of a method. So in other words, 40% of low-income women aren't happy with the contraception that they're using, they would change if they could afford it. And how does health insurance come into play with that?

So in that same study that I was just describing, we found that people who did not have health insurance coverage were more likely to say that they wanted to either switch their contraceptive method or start using a new method than people who already had health insurance coverage like public health insurance coverage or private. And what are the other accessibility barriers? What else did people talk to you about? So a lot of those barriers have to do with having to go to a healthcare provider to get a prescription. Some of those barriers are things like not having a usual healthcare provider that you go to for sexual and reproductive healthcare. These are all like convenience-related factors that people have to navigate just to get in the door to a healthcare provider. And all of us have had those experiences of not being able to get an appointment when you want to get an appointment with your provider, and so being delayed and trying to get in to get the care that you want. And that has ramifications when we're thinking about wanting to use a method of birth control to prevent pregnancy.

As you said, you study access to birth control in the U.S. So when the Dobbs decision came down, overturning Roe versus Wade, what did you expect that would mean or might mean for access? We were concerned that potentially this might impact people's ability to get contraceptive care. So we looked at changes in overall contraceptive use. So did people use contraception or did they not? And then we also looked at specific method use. So we looked at use of IUDs, use of permanent methods, use of pills, use of each specific method that people could report using. What we did find was changes in people's actual access to contraception. People reported higher

levels of delays and trouble in accessing the methods that they wanted to use after the Dobbs decision as compared to before the Dobbs decision. For those folks who were actually able to get contraceptive care, they reported the actual care was lower quality after the Dobbs decision compared to how they described the quality of that care from before the Dobbs decision. Oh, wow. Okay, so how do you understand that? Like, why or how would reduced access to contraceptive care follow from reduced access to abortion care? So it's very dependent on the sort of method that people are starting to focus on, the method that they want to use. So after the Dobbs decision, what we think is happening is that it may be the case that health care centers that used to provide both abortion and contraception

care, some of them have closed, and some of them have had to decrease the services that they are able to offer. And this is because they are no longer legally allowed to provide abortion care, and that has impacts for their ability to provide any other type of care, like contraception. We heard earlier that the OPIL cost is around $20 a month, which seems lower than out-of-pocket costs for many prescription drugs, but is that still unaffordable based on your research? The research indicates that the majority of folks say that it's about $10 a month that is the maximum that they are able and willing to pay for an over-the-counter birth control pill. So that's a real difference there. And that's where the focus really needs to be in terms of

what are the next steps to make sure that O-Pill being made available over-the-counter is being made available over-the-counter to everyone who wants to be able to use it. Can you talk about the Affordable Care Act and how it factors into all of this? Because we've had it for over a decade, and I wonder what that has done to people's access for contraceptive care. The Affordable Care Act was, again, another important milestone along the road towards increasing access to contraceptive access was that within the contraceptive coverage guarantee, all FDA-approved methods that are available by prescription have to be made available without cost-sharing to the consumer. And that's a lot of jargon. Yeah. And that's a lot of jargon, but what it essentially means is that insurance plans in the ACA marketplace have to cover all methods of contraception.

So that's all deductibles, all co-pays. There are zero out-of-pocket costs for the person who holds that insurance coverage. The ACA really did impact people's out-of-pocket costs such that those went down quite a lot. They really decreased after the ACA went into effect. I sense a but coming. There is a but, and that's because there are several loopholes that still remain within the ACA in terms of really truly making contraception accessible and affordable to everybody who has coverage. So there are many different birth control pill options available. Jolessa, Yasmin, Loestrin, OrthoTricycline, Yaz, Introvale, Reva, and Sprintest. And what the ACA didn't necessarily say was that every single formulation and every single brand

name pill is covered at the same way. And so that's an important loophole because for some people, they need to use a particular formulation of birth control pill because that works best for them. There are several other loopholes about grandfathered plans and certain plans don't have to cover other methods. There've been several attempts to try to really reduce these loopholes. And I wanna talk about one important one

that is really relevant to what we're talking about as it relates to O-Pill going over the counter. So there's been an effort by several senators to introduce a bill called the Affordability is Access Act. The Affordability is Access Act will make sure that once the FDA determines an over-the-counter option to be safe and effective for use without a prescription, that pill is fully covered by insurance, just like every other FDA-approved birth control. This is really important in the context of O-Pill. When we were talking about that cost differential between what the suggested retail price is and what consumers themselves are saying they would be willing or able to pay,

this particular Affordability as Access Act would help to bridge that gap for those people who have insurance coverage through the marketplace so that their cost sharing would again be zero for OPIL because it's available over the counter. What's the next step, in your opinion, in getting closer to a system where everyone in the United States has easy, affordable access to contraception? It requires recognizing that policies aimed at restricting access to one aspect of sexual and reproductive health care, like abortion bans and restrictions, also trickle out to impact other aspects of people's sexual and reproductive health care and their broader lives. In this conversation, it's really important to not frame increasing access to contraception and the importance of doing that as a fix to the broken abortion access that we have in our country and the state of abortion access today. Abortion care and contraceptive care are each critical forms of broader sexual reproductive health care that people need to access to be able to realize their reproductive goals. And I think kind of more broadly, we just

have to build systems that put people who need and want to use contraception at the center so that the programs themselves are responsive to and reflective of people's own needs and their lives. And I think if we shift to doing that, we'll be much better set up to have systems that are actually meeting people's needs where they say they are. Megan Kavanaugh is a principal research scientist at the Guttmacher Institute in New York City.

Today's show was produced by Victoria Chamberlain, edited by Amina Alsadi, fact-checked by Laura Bullard, and engineered by David Herman. The rest of the team includes Avishai Artsy, Jesse Alejandro-Cotro, Miles Bryant, Hadi Mouagdi, Amanda Llewellyn, Halima Shah, and Rob Byers. Our supervising editor is Matt Collette. Our executive producer is Miranda Kennedy. We use music by Break Master Cylinder. I'm Alana Casanova-Burgess, filling in for Noelle King and Sean Romswaram. Today Explained is distributed by WNYC. This show is a part of Vox, which is totally free, thanks in part to contributions from our listeners. If you're feeling generous, you can contribute too at vox.com slash give. Thank you.