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First over-the-counter birth control pill offers family planning amid Oklahoma’s abortion ban

Opill one- and three-month pill packets, available on the shelves of a Walgreens in Tulsa.
Jillian Taylor
StateImpact Oklahoma
Opill one- and three-month pill packets, available on the shelves of a Walgreens in Tulsa.

Kamryn Yanchick has experienced the benefits of birth control since she started taking pills in high school. For her, it wasn’t simply a preventative method. It helped her manage the symptoms that came with her menstrual cycle.

“I struggled with really, really heavy painful periods that would interfere with my ability to focus in school, and I would literally get fevers and be just so in pain that I would be sweating and feeling like I'm lightheaded and about to pass out,” Yanchick said.

The 24-year-old Tulsan said although her family wasn’t open about birth control, she didn’t face any opposition when she asked about it. That wasn’t the case for some of her friends.

“Even if they worked up the courage, which can be a total barrier in itself, just to work up the courage to have that conversation, even if they were able to do it, point blank, they would not be allowed to,” Yanchick said.

Yanchick represents people like her high school friends as a member of the FreeThePill Youth Council. The nonprofit has been working for decades to bring over-the-counter birth control pills to the U.S. so people of all ages can access what is already available in over 100 countries. Now, their efforts are becoming a reality.

Opill, which was approved by the FDA last July, is the nation’s first over-the-counter birth control pill, and it’s hitting pharmacy shelves now. Some Oklahomans believe its impact on reproductive health care could be significant. More than 200,000 Oklahomans grapple with limited access to birth control amid the state’s abortion ban, which cost it millions in federal family planning money.

What is Opill?

Opill is available at pharmacies like Walgreens and CVS in packets that last for one or three months. Packets that will last six months can be purchased online.

A one-month pack is $19.99, three-month packs are $49.99 and six-month packs are $89.99. A cost assistance program could cover months’ worth of Opill at no cost. Eligible Oklahomans include:

  • Medicaid and Medicare recipients
  • People with household incomes at or below 200% of the Federal Poverty Level, adjusted by household size

The 98% effective method isn’t age-restricted and is supported by the American College of Obstetrics and Gynecology (ACOG). Dr. Dana Stone, an ACOG member and obstetrician and gynecologist in Oklahoma City, said it’s most effective when taken at the same time every day. She recommends setting an alarm as a reminder.

If someone is over three hours late in taking their pill, they should take it as soon as possible and use backup contraception, like condoms, for the next two days.

The pill works by inhibiting ovulation and thickening the cervical mucus, making it harder for sperm to access the egg. Stone said the pill is safer than others because it only has the hormone progesterone in it – which results in weaker side effects than combination pills with estrogen. Opill might include symptoms like irregular bleeding and spotting.

“Progesterone-only makes it safer to take as an over-the-counter medication,” Stone said. “So, when you're taking something over the counter, you need to read the label, and you need to make sure that you aren't somebody that shouldn't take it.”

The main populations that should avoid taking Opill are Oklahomans with a history of breast cancer. She said years of data support that a person can evaluate a birth control method's side effects and determine if they can safely take birth control.

She said the outcomes of that choice are often a lot easier to manage than an unplanned pregnancy. From 2019-2021, Oklahoma’s maternal mortality rate was 31 Oklahomans per 100,000 live births.

“Women are much safer taking forms of birth control than they are being pregnant and delivering. There's a lot of complications with pregnancy, delivery and the postpartum period,” Stone said. “So being able to control when you want to become pregnant and making that more widely available to every woman, that's very important for health.”

Stone said Opill is great for Oklahomans in rural areas who can’t readily access a physician. Her main concern is people might not visit their provider for regular exams, which are important in preventing things like cervical cancer.

“What we don't want to see are women who say ‘Oh no, I don't have to go see a doctor, don't have to worry about getting that pap smear,’” Stone said.

‘Important timing’

The pill is becoming available as Oklahoma nears two years under an abortion ban that only makes exceptions to preserve a mother’s life. That same ban recently caused the state to lose over $4 million after it refused to let clinics federally funded by Title X provide information on abortion.

Title X is the only dedicated source of federal funding for family planning in the U.S. Its services supported confidential and low-cost family planning resources like birth control for all ages at over 90 sites in Oklahoma.

Only a few Title X sites remain in Oklahoma. When the state lost its Title X money, the federal government sent a $3.3 million share of the state’s funds to the Missouri Family Health Council. The nonprofit granted money to Oklahoma clinics under Planned Parenthood Great Plains, which also provides reproductive health care in Arkansas, Kansas and Missouri.

Planned Parenthood Great Plains President and CEO Emily Wales said the state’s four clinics primarily serve uninsured or underinsured people. Gaining money from the program means they can better serve that population.

It also means they have federal protections for minors who need contraception.

“We do encourage parental involvement. There are certain situations when minors may have concerns about their parents being involved, or often what we see is one parent who is fully supportive and another parent may not be in the picture or isn't consistently part of a minor’s life,” Wales said.

Take Control Initiative’s Executive Director Laura Bellis in its Tulsa office.
Jillian Taylor
StateImpact Oklahoma
Take Control Initiative’s Executive Director Laura Bellis in its Tulsa office.

Because fewer sites provide these services, and many of them are now solely located in urban areas, rural populations and teens are now facing additional barriers to accessing contraception. Laura Bellis, the executive director of the Take Control Initiative, works with her Tulsa nonprofit to provide free birth control locally. She said she’s witnessed these barriers to access.

“Especially not having Title X under state health department sites for rural communities, it is so important that there's another line of access to birth control for people,” Bellis said.

She said the timing of Opill heading to the market is important as Oklahomans navigate a reduction in family planning services, and it could be an option to help fill gaps in care.

“This might be a good method and even a bridge method for someone who goes, ‘I want birth control. I’m gonna be engaging in sex, and I don't want to be pregnant at this time,’ and so they go and get this one because it's the most readily available to them,” Bellis said. “It could be a good bridge that they could be on while they wait to get that health care appointment.”

Wales said Planned Parenthood Great Plains has seen a significant increase in contraception-related appointments across its service lines, especially following the Dobbs. v. Jackson Women’s Health Organization decision.

“We've been able to see a whole lot more contraception patients who are trying to be thoughtful and plan, and for those patients who do need abortion access, it has meant a lot of really tough conversations,” Wales said.

What are state lawmakers saying about birth control?

Oklahoma recently garnered national attention from House Bill 3216, authored by Rep. Kevin West (R-Moore). It stalled out in committee but could have restricted access to some contraceptive methods like IUDs and the morning-after pill.

In committee, West said he worked on the bill with the Christian law firm Alliance Defending Freedom, and the bill’s intent was to respond to the Oklahoma Supreme Court striking down recent anti-abortion laws.

Other Republican lawmakers, like Sen. Jessica Garvin (R-Duncan), say contraceptive access is an important topic in the pro-life conversation.

“I think that one of the biggest things that we can do to help protect life is by providing greater access to contraception for women who are not ready to be moms,” Garvin said.

Sen. Jessica Garvin (R-Duncan) at her desk at the Oklahoma State Capitol.
Jillian Taylor
StateImpact Oklahoma
Sen. Jessica Garvin (R-Duncan) at her desk at the Oklahoma State Capitol.

Garvin has written legislation over the past few sessions to allow pharmacists to prescribe birth control pills and protect access to contraception. Neither passed, but Garvin said she wants to continue advocating for legislation that “protects life in the state of Oklahoma.”

Wales said bills like HB 3216 are concerning and that, following the Dobbs decision, more women have elected to get long-term birth control methods like IUDs or implants.

“I think increasingly, folks were concerned about government overreach, (the) question of whether contraception would remain legal, what types of contraception might be affected,” Wales said.

Garvin said she heard similar concerns about losing access to birth control from one of her friends a few years ago. That conversation encouraged her to write legislation protecting contraception.

“We have a lot of those people in the building that really do prevent a lot of that more controversial policy from getting through, and I just believe that as long as we continue to elect competent people that are really policy-driven, and they're not pandering to one side or the other, I think we'll continue to be able to pass meaningful legislation that helps protect women and family choices, such as having an IUD or not having an IUD,” Garvin said.

Garvin said although she is thankful Opill will expand access to birth control, she still encourages people to see their providers. But as a working mom with three children, she said she could see someone like herself benefiting from the accessibility of Opill.

Oklahomans like Kamryn Yanchick said Opill is a win for reproductive health care, especially in a state where that care is limited.

“I was thinking about what it must be like to be a teenager after the Dobbs decision and how scary it must be to not have access, and to just to be in this state,” Yanchick said.

As the eldest in her family, Yanchick said she’s always talked with her younger siblings about contraception. Now, she looks forward to including Opill in those conversations.

Jillian Taylor has been StateImpact Oklahoma's health reporter since August 2023.