Efficient being pregnant prevention is a cornerstone of reproductive autonomy. The event and approval of the primary contraception capsule and the 1965 Supreme Courtroom determination defending entry to it, Griswold vs. Connecticut, had been watershed moments for reproductive rights.
Final week, the Meals and Drug Administration made the progesterone-based Opill (norgestrel) the primary hormonal contraceptive authorised for over-the-counter sale. Many advocates are celebrating the choice as one other landmark triumph for reproductive rights. However in a rustic with numerous obstacles to abortion entry — together with complete or near-total abortion bans in 16 states — the appearance of a nonprescription contraception capsule is a hole victory.
Why? As a result of being pregnant prevention is rarely good.
No contraceptive methodology is 100% efficient, and the progesterone-based “minipill” — of which Opill is one formulation — just isn’t essentially the most dependable means obtainable. That distinction belongs to the etonogestrel implant, which requires an in-office insertion process, with a being pregnant prevention price of about 99.9% — even higher than tubal ligation or vasectomy.
That’s proper: Even surgical sterilization just isn’t a assure towards future being pregnant. I’ve carried out abortions for ladies who’ve had their tubes tied and for ladies whose solely companions had vasectomies. I had one pregnant affected person whose husband had undergone vasectomy twice!
With “good use” — which means the person takes the capsule day-after-day on the similar time — the minipill’s efficacy is about 99%. However we all know from years of real-world research {that a} extra significant metric for contraceptive efficacy is “typical use,” which accounts for the truth that many customers will make errors similar to lacking doses or failing to take their tablets on the similar time day-after-day. The minipill’s “typical use” efficacy is nearer to 91%.
Which means that over the course of a yr, 91 out of 100 girls utilizing the mini-pill for being pregnant will not get pregnant. On the threat of stating the apparent, the opposite 9 girls will grow to be pregnant.
Offered over-the-counter contraception is fairly priced, it can go a good distance towards mitigating disparities in entry for people who find themselves uninsured or in any other case unable to simply or safely get to a health care provider’s workplace. However framing over-the-counter contraception as one way or the other mitigating the disastrous results of the Supreme Courtroom’s reversal of abortion rights dangers enjoying into the outdated, unhelpful argument that contraception is the answer to the abortion “downside” — that no girl ought to have to terminate a being pregnant within the age of broadly obtainable oral contraceptives.
This ignores the 9 in 100 girls who, regardless of taking the minipill, will usually grow to be unintentionally pregnant inside a yr.
Prevention is not any answer and not using a backup plan. Once we tout simply accessible being pregnant prevention strategies however fail to supply authorized, obtainable abortion, we’re giving lip service to autonomy whereas setting girls up for failure.
Think about a metropolis that provides free hearth alarms to all residents however can solely assure that 91% of them work. And now think about that this metropolis doesn’t have a fireplace division.
A lady’s skill to regulate her life trajectory will depend on the choices obtainable when her contraception fails. Even with efficient, inexpensive, over-the-counter contraception, girls will wind up pregnant though they don’t wish to be and, in lots of states, be compelled to present delivery towards their will. As soon as your home is on hearth, your free hearth alarm is irrelevant.
Christine Henneberg is a doctor practising in California and the creator of “Boundless: An Abortion Physician Turns into a Mom.”
