Where's the opposition to over-the-counter birth control?

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At a time when reproductive health can feel increasingly politicized and polarized in American society, a landmark change may be around the corner without a big, flashy debate: over-the-counter birth control pills.

Last week, one of the Food and Drug Administration’s advisory committees voted unanimously to support making one type of birth control medication available over-the-counter, switching away from prescription-only status. It’s taken “Free the Pill” advocates nearly two decades to get here. And many of them did not expect the FDA to consider this change against the backdrop of an intense abortion debate.

“There are so many hostile attacks on sexual reproductive health care. So, as an advocate, it’s surprising when we might actually be very close to a win,” Candace Gibson, of the National Latina Institute for Reproductive Justice, told me.

I found myself fascinated by why there is not more organized opposition. So, I started asking around.

It turns out that both Republicans and Democrats have come out in favor of making the pill available without a prescription. When I reached out to March for Life, an anti-abortion organization, I got a short email saying the group “doesn’t take a position on birth control.” Same with the conservative Massachusetts Family Institute.

Then I spoke to Elizabeth Janiak, a researcher at Harvard’s School of Public Health, who has been tracking the issue. She assured me that many people involved in grassroots organizing against abortion also oppose contraception — and they often oppose it “just as fervently.” But “they have not chosen to make their opposition to contraception a major political goal,” she quickly added.

She had a few explanations for why. She said some conservatives — who oppose the Affordable Care Act requirement that insurance companies cover the cost of certain preventative health services — think of over-the-counter birth control as a “free market” alternative. It is seen as evidence that not all people need health insurance since there are other ways to access preventive care.

Another explanation for the lack of opposition, Janiak said, is that the pill is just too common — it’s taken daily by millions in the U.S.

“Because it’s so widely used and because it has been used for so long, pretty much everyone either has used the pill or knows someone who has. And so we can all say from our own personal experience, ‘Yeah, this drug seems perfectly safe,’ ” Janiak said.

Of course, there’s the religious perspective to consider, too. The Catholic Church is opposed to hormonal contraception and has been the main opposition to taking the pill over-the-counter. But evangelical groups that have been a driving force in efforts to ban abortion often don’t oppose contraception.

I spoke with some evangelical activists who said the pill is widely used within their circles. Some of them said the community is slowly waking up to “moral problems with the pill,” but — currently — there is no large-scale opposition.

This lack of consensus within conservative religious groups, some observers surmise, is keeping many grassroots organizations from taking a strong stance on the topic. (As I mentioned in a newsletter last summer, evangelical groups have said there should be an age restriction if the pill becomes available without a prescription.)

Even if the politics of the pill and abortion are very different, Janiak warned that nothing is happening in a silo. She said where things land in the legal battle over the abortion medication mifepristone — and what the case signals about whether judges can overrule FDA decisions — could make a difference for potential future legal challenges to an FDA decision on the pill. But first, the FDA has to make the switch official. That decision is expected this summer.

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