« The Weeds

A new era for birth control

2023-08-02

For the first time ever in America, a birth control pill will be available over the counter. In July 2023, the Food and Drug Administration approved Opill, a progestin-only form of daily oral contraception. This move could open the doors to millions of people who need, and want, to use birth control. To understand the court rulings that got us here, the potential obstacles to equal access, and what Opill means for the future of contraceptives in the US, host Jonquilyn Hill speaks with Dr. Raegan McDonald-Mosley, an OBGYN and the CEO of Power to Decide, and Khiara M. Bridges, a professor of law at UC Berkeley School of Law.

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This is an unofficial transcript meant for reference. Accuracy is not guaranteed.
- This comes from Planned Parenthood. It's hard to imagine a world where we leave future generations with fewer rights and freedoms. Since the Supreme Court's decision to overturn Roe v. Wade, politicians in nearly every state have introduced bills aimed at blocking people from getting the essential sexual and reproductive care they need, including abortion. Planned Parenthood believes everyone deserves access to care. And with supporters like you, they can reclaim our rights and protect and expand access to abortion care. Visit plannedparenthood.org/future to learn more and support their cause. Hi! We're visible. We're the wireless company with nothing to hide. Seriously. Hidden fees? We don't have them. Annual contracts? Not our thing. Great wireless on just one line? Now that's more like it. Get unlimited 5G data powered by Verizon for just $25 a month. Taxes and fees included. That's right, $25 a month, every month. Sorry hidden fees, we're just not that into you. Sometimes the choice is made.
Is just visible. Switch today at visible.com. Great with service on The Visible Plan. For additional terms and network management practices, see visible.com. It's the weeds. I'm John Glenn Hill. Everyone has a comfort TV show. You know, the kind Maybe you fall asleep to it or have it on while you're doing a task that doesn't require all that much brain power. It's usually something like Friends or The Office or Living Single. But one of mine is a little old school. It's The Mary Tyler Moore Show. She's a 30 something unmarried woman working as an associate producer at a local TV station, making her way through life in the 1970s. The fact that the show takes place in the 70s plays-- a major role in a lot of the jokes. It was a time with tremendous social change, and there's this joke in one episode that's always kind of stuck with me.
While her dad stays behind. As her mother is leaving, she's leaving. She stops and says, - Don't forget to take your pill. - I won't. - Though the reminder was meant for her. Father, Mary also replies, because the joke is, Mary is on the pill. She's a single woman using birth control. And while that's not a whole lot to blink at now, at the time, it was revolutionary. Today, people using contraception is pretty commonplace, but a few... Weeks ago, the FDA made a call that a lot of advocates consider revolutionary today. Time ever in America, the pill will be available over the counter.
That there were no restrictions, such as an age restriction, put on the final decision. But I was also not entirely surprised, right? This is something that the field has been working on for over 20 years. -That's Dr. Reagan. And McDonald-Mosely. She's an OBGYN and the CEO of Power to Decide, an organization that advocates for sexual and reproductive health. This is something that I myself have been really excited about and working closely on for over a decade as a part of the Free the Pill steering committee.
That the science and literature supports over-the-counter access to the pill, particularly the progestin-only pill. So while I was super excited, I wasn't surprised and grateful that the FDA followed the science. - I would love for you to tell us about the kind of current challenges that exist for people trying to access birth control. What are the hoops that exist right now that make the over-counter pill? Something that people really want. I really appreciate that question because I'm often, you know, at dinner parties or hanging out with people and they ask like, why is this such an important issue? Why is your work so critical? And I think it's because so many people are just out of touch with the realities of, you know, the average and in America and all that they face with accessing basic healthcare services, including birth control. And the fact that for in particular for people
Of color, people with lower incomes, people who rely on Medicaid or government-funded programs, it can be extraordinarily difficult to just get an appointment. So I've worked with some place-based groups, including one in Dallas, that have been working on contraceptive access and increasing access specifically for young people in Dallas. And they've reported that it can take two to three months for a young person to get a basic birth control appointment. And if someone wants a more advanced method, like an intrauterine device or a contraceptive implant, they may have to wait six or seven months. And that's just not access, right? And of course, that these are in parts of the country where if someone does face an unintended pregnancy, access to abortion has been completely obliqued. So not only is there just getting an appointment, you also then have to think about do they have appointments if I'm a young person and I go to school or I'm in community college, do they have appointments outside of when I'm working or going to school on nights and weekends and many places do not. You have to think about transportation and how far someone has to travel to get an appointment.
Care, et cetera. And so when you add up all of these barriers, it gives you a better understanding of why being able to just go to the local drugstore or order it online will increase access significantly, people who have significant barriers and are now not adequately served by the health care system. - I think of so many women I know who are on the pill and even if they have access to insurance and a doctor, continual, like, gotta go back and get this prescription refilled, like have to... Does that factor into this as well? It totally does, right? So let's say somebody actually has surmounted all of the hoops, made the appointment, saw the provider, organized childcare. Transportation, got there, got there on time, so they weren't turned away, got their prescription, then they still have to fight with the pharmacist every month to like get the refill. And there have been advocates.
And organizations working on passing laws state by state that require insurance companies to cover 12 months worth of contraception at a time. So I was a part of Such an effort here in Maryland where I live and work. But it still means that the actual pharmacists have to be aware of this, that the insurance companies have to be aware of this. And so there's still a lot of logistical barriers to making that a reality, even in states where it is the law. And I've experienced that myself personally. And research shows that even when people have navigated the incredible journey of getting a, you know, to see a provider getting a prescription, that 30% of those people in the course of a year reported missing a pill because they weren't able. To get a refill of their supply. - So we're having this conversation about access and I know you mentioned the wait times for young people in Dallas, but I would love for you to tell us about contraception deserts.
I know there's something like 19 million women who live in one. What is a contraception desert? And how does that happen? Because it feels like, you know, you can see a CVS, you can see a Walgreens, like on every corner. You're right that roughly 19 million women in need of publicly funded family planning live in contraceptive deserts, which we define as counties where they lack reasonable access Of birth control methods. So that's recognizing that birth control pills are one, but there are so many other methods too. The contraceptive patch, the ring, injectables, intrauterine devices, and implants. And for most people, birth control is a journey. Most people do not start on one method and continue it for the rest of their life.
Lives. And people generally are using birth control for decades. When you think about their reproductive life course, when someone gets their period on average, the number of children people have, you know, which is a little bit less than two now in this country, the fact that people don't go through menopause until around 50, that's decades of preventing pregnancy potentially. And so what happens is people often will start with something like the pill, but then maybe decide that it's not working for their lifestyle to have to take it every day, move on to a different method. And maybe that causes them some side effects and they don't like it. And so they move on to a different method and maybe that third method is the one that works for them, but it's a journey. And that's why people need to have access to the full range of birth control methods. And the reality is that for folks who operate with lower incomes and rely on publicly funded family planning, their access is really, really limited in many places throughout our country. And it's not just in rural places. There are places in urban areas as well. I want to get into the science of how OPL works because
This is the pill, but it's not the combination birth control pill that I think a lot of people think of when they think of, you know, capital P, the. Pill. So what's the difference and how does this work? When most people think of the birth control pill, they're thinking of the pill that has both estrogen and progestin in it. That's the pill that's used by over 90% of pill users in the United States. There There is another type of pill called the progestin-only pill that is widely utilized in other parts of the world and is utilized here in the United States generally for people who have what we call contraindications or medical reasons that they shouldn't use the combined pill. And some of those commonly are people who've just recently had a baby or are breastfeeding, people who have medical issues like a history of blood clots or a family history of blood clots, people with hypertension, people with heart disease.
People over 35 who spoke, people who have migraines with visual symptoms, there are a number of things that would make it unsafe for someone to use a combined pill. And so providers generally will prescribe a progestin-only pill if someone falls into those categories, because there are very few medical reasons why someone shouldn't use a progestin pill, namely breast cancer, active breast cancer, or history of breast cancer, or severe medical problems like liver failure or heart failure. But the other contraindications that I named for the combined pill do not apply for the progestin-only pill. There are other differences, including the side effect profile. So with the progestin-only pill, someone takes active pills every single day. The traditional combined pill, people take active pills for three weeks, and then for the last week, they take placebo pills where they'll have a withdrawal bleed. But with the progestin-only pill, they take the same.
Pill every day. It doesn't change throughout the month. Some people experience some spotting with the progestin-only pill. And for most people, it's not super bothersome, but it's something that they should know about going into taking the pill. And it may not happen every month, it may only happen every few months. Why are progestin-only pills not recommended for people with breast cancer? So most breast cancers are sensitive to hormones. There's been some clinical research to show that exposure to progestins can increase someone's risk of breast cancer slightly. If someone has an average risk of breast cancer, that may not be a consideration at all for them. If they have a strong family history of breast cancer, it might be something that they want to talk to their provider about before starting any hormonal method of contraception. How does O-PIL actually work? Do anything with ovulation, fertilization? How does this particular pill work? So the progestin...
So, definitely methods in general work by thickening the cervical mucus and blocking the sperm from entering the genital tract. So the sperm and the egg never meet. Ideally, there's no fertilization, etc. How do combined birth control pills work? How's that different? The combined pills because they contain both progestin and estrogen, also thickens cervical but they also generally block ovulation more reliably than just the progestin only pill. And so that way, when someone has. The cycle every month, they don't release an egg, right? Their ovaries are quiet and they're not responding to the hormones from releasing eggs. And so since there's no egg released, then there's less. Risk of a pregnancy. I mean, no matter what, you should be good about taking your medicine, particularly the pill. But the pedestrian only pill in particular, right? Because I know with the combination pills, sometimes it's like, Oh, I forgot. Time to take two tomorrow. And you can't.
Not really do that with the progesterone only pill, can you? That's a really good point. So because the progesterone only pill has only has progestin and not estrogen, the time window within which you have to take get is much narrower. And the general medical advice is you have to take it within a three hour window. So let's say someone takes it every morning. At 8 a.m. when they eat breakfast, then if they forget to take it by 11 a.m., then that means they would either need to use a backup method for a couple of days or abstain from sex. So that's another important difference that people should know about. So like you-- before, for many people finding the right kind of birth control can be this. And Admittedly somewhat frustrating trial and error. I'm wondering how the pill being over the counter will impact that. Again, it's still really important that people have access to all methods. And so it's important to again recognize that.
The pill is just one of them. You know, more than likely the way I see this working is that folks who either have already used the pill understand it, know that it's safe for them, and are comfortable accessing it without talking to a provider, will go and be able to get it over the counter and, take it for as long as they want to, if they want to stop taking it for a little while or restart it, they'll have access to that pill. And for people who want to switch from one method to another, they'll have access to that pill over the counter and will make it much easier for them. The important point of having the pill available over the counter is that it's breaking down barrier to this really effective method of contraception. I mean, this will now be the most effective method of contraception available over the counter. Like that's amazing. But we also have to strengthen the traditional medical system to make sure Don't have unnecessary barriers to all of the other methods that they may want to use. Is there a concern at all, especially since, you know, people will be getting this over the counter, they won't be going to the doctor, that, you know, just things like that, things that...
That you learn from your pharmacist or from your doctor in a perfect scenario, which our scenarios are far from perfect. Is there any concern where it's like, ooh, is this gonna do what we need it to do? - Another concern that comes up about access to over-the-counter birth control pills is if it will prevent people from going to the doctor for other things, right? Like screenings for sexually transmitted infections, pap smears, breast cancer screenings. And there was a study done in border communities in the United States where people had access to over-the-counter birth control pills in Mexico. And that study showed of U.S. women that even though that they could go to Mexico and got birth control pills over the counter, they had similar rates of going to a provider for pap smear screening, STI screening, and breast cancer screening. People who went to a provider and people who got it over the counter had similar rates of screening. So all that to say, there's research to suggest that even when someone has access to the pill over the counter, that they still see a provider for other things.
Things. That's really important to know. And again, having the pill available over the counter does not prevent people from contacting a provider and saying like, how does this work or you know, this doesn't work for me, I want to switch to something else, etc. But in the same way that people can say like, I have allergies. I need to go and get allergy medication over the counter and I know that it's safe for me to do so. I know I have allergies. Then for someone who's perhaps taken the birth control pill already, they understand how to use it. They should be able to go and get that over the counter. So it's really exciting that that's finally going to be an option here in the United States and has been an option in many countries for a very long time. Time. So this pill is scheduled to be available next year and I'm wondering what can we expect in terms of access? Like who will be able to get this? Where can they find it?
Do we know the cost? Like, how will this change access? - Yeah, I mean, this could change access enormously, right? I think the most traditional setting. That people will probably get it will be like in the drugstore, the same place that people can go to get emergency contraception and condoms and gels and other types of over the counter birth control methods. But communities have been doing really innovative things to increase access to emergency contraception, for example, that will now be applicable for over the counter pills, like increasing access in barber shops and beauty suit salons and religious organizations, community organizations. We've partnered with some place based organizations who've done that work to make it more accessible, particularly.
To young people. It will also increase access online, right, where you can just like order it from an online drug store or pharmacist, think Amazon, and have it delivered to your house. Also vending machines. There are some college campuses now that have emergency contraception vending machines. So this could really revolutionize access to the birth control pill. Do you think we're going to see access to other forms of birth control over the counter in the future or that these things will just become easier over time? I hope so. I mean, I hope this is one of many, right? So I do know that there's another company that's working to bring a combined pill over the counter and because As of the contraindications or medical concerns that we talked about earlier in our conversation,
longer for them to do the research and show that people can safely identify if they can take it or not. But hopefully there'll be a combined pill over the counter eventually. And once there's one combined method, you know, that opens the door to other combined methods being made over the counter, such as the contraceptive patch, the ring, and even there's a potential for. Contractible contraception to be available over the counter in the future. There are many providers now that are training patients to give themselves their own subcutaneous injections of Depropervera. So that's another method that could be available over the counter in the future. Future. When you think of your ideal contraception future, what does that look like? Like what does access look like? It, describe it to us your your dream contraception landscape? Oh, I love this question.
And so if I had a magic wand and could be the reproductive well-being fairy and wave it around, what access to contraception would look like is like you really wouldn't even have to think about it, right? In the same way that people And so much mental energy right now, thinking about like going to get a provider, what do I have to do to prevent pregnancy, switching between methods, where there are. Are very person-centered methods available that are designed with the ideal lack of side effect profile and efficacy in mind that people can have access. To those methods in their own community in a way that makes sense for them from a trusted provider if it needs to involve a provider that is available without. Any financial barriers, ideally completely free, that people can start and stop methods without having to jump through hoops.
And most importantly, that none of this is stigmatized, right? That this is talked about openly and that, you know, birth control and access to contraception is thought of just the general part of someone's well-being in life. Dr. Reagan McDonald-Moseley, thank you so much for joining us on The Weeds. Dr. Reagan McDonald-Moseley Thank you so much for having me. A really fun conversation. So That's the outlook from a medical professional. Next, we'll take a look at the legal landscape that got us here. Support for this podcast comes from Planned Parenthood. Is your own. That's why Planned Parenthood is committed to ensuring that everyone has the information and resources they need to make their own decisions about their bodies, including abortion care. Today, lawmakers who
To oppose abortion are challenging Planned Parenthood. Affordable, high quality, basic healthcare for more than two million people is at stake. Believes that healthcare is a basic human right. That's why they fight every day to push for common sense policies that protect our right to control our own bodies. They also work tirelessly to oppose the... In the next generation can decide their own futures. The organization needs your support now more than ever. With supporters like you, they can help you. And reclaim our rights and protect and expand access to abortion care. Visit plannedparenthood.org/future to learn more and support their cause. you Podcast comes from Planned Parenthood.
Is your own. That's why Planned Parenthood is committed to ensuring that everyone has the information and resources they need to make their own decisions about their bodies, including abortion care. Today, lawmakers who To oppose abortion are challenging Planned Parenthood. Affordable, high quality, basic healthcare for more than two million people is at stake. Leaves that healthcare is a basic human right. That's why they fight every day to push for common sense policies that protect our right to control our own bodies. They also work tirelessly to oppose the... In the next generation can decide their own futures. The organization needs your support now more than ever. With supporters like you, they can help you. now more than ever. With supporters like you, they can help you.
And reclaim our rights and protect and expand access to abortion care. Visit plannedparenthood.org/future to learn more and support their cause. - This is the weeds. I'm John Quilin Hill. Before the break, we talked about the science behind O-Pill, the birth control pill that recently got FDA approval for over-the-counter use. But it's impossible to ignore the legalities here too. Last summer, the Supreme Court struck down Roe v. Wade, leaving abortion access up to the states. Support for abortion access tends to fall down the party line, but the over-the-counter birth control pill has gotten bipartisan support. I wanted to talk about this along with the history of controversy.
Of reception access in the US. So I called someone who could tell me. - My name is Kiara Bridges. I'm a professor of law at UC Berkeley School of Law. - So I wanna hop in our time machine and go back to 1965 and talk about Griswold v. Connecticut. Can you tell us about this case and also tell us its significance when it comes to reproductive rights? - So Griswold v. Connecticut. Even for legal scholars, it's kind of where it all begins in terms of the court being willing to interpret the Constitution to protect a right to privacy and a right to privacy that was broad enough to... To encompass rights to things concerning family formation. So the right to have a family, the right to not have a family. So Griswold versus Connecticut. It arose after a physician prescribed a contraceptive. contraceptive.
To a married couple. And it was against the law in Connecticut. It's generally we're against the law. And so they said, you know, surely the constitution prohibits states from. Denying us the ability to use a contraceptive and avoid pregnancy. And the court agreed with them. And so it was in 1965 that the court first began interpreting the Constitution to protect her right to access contraceptive. For married people. In 1972, in a case called Eisenstadt v. Baird, the court expanded its holding such that the right to access contraceptives was available to people who were unmarried as well. And so then it's, you know, not at all coincidentally, the next year in 1973, the court decided Roe vs Wade, in which they even, you know, brought in even further that law
that if a person has the right to avoid becoming pregnant in the first instance, a person has the right to terminate. Pregnancy in order to avoid parenthood. But I think it's really, you know, really important to understand the logic. Behind these laws that prohibited or criminalized the use of contraceptives? Yeah, that was, as I was reading through the Griswold case, I mean, the first thought that came to mind is, Is the legal argument behind this? Like, why would this be something that's illegal in the first place? - So Connecticut. Believed, and many other states at the time believed, that it was immoral to have sex without the possibility of reproduction.
Connecticut and half of the states in the US at the time believed that, again, sex for pleasure, like non-procreative sex, sex that did not lead to... A fetus and then a baby, that that was immoral. And so Connecticut was trying to protect the morality of its population by essentially mandating that every time you have sex, you should face the possibility. Of procreation. And so in a blue state in 2023 with my sort of values and beliefs and commitments, it seems outlandish that a state would more. In that sense, that, you know, that they care so much about what happens in my home that they want-- Every single time I have sexual intercourse, that we might become-- pregnant. But that's exactly what was happening in 1965, exactly what was happening in 1972, when and the Massachusetts--
Law in the book, that's where Eisenstadt versus Baird arose when the Massachusetts law was on the book and they're like, okay, so married people might be able to avoid pregnancy. But unmarried people, absolutely not. So again, the court has a pushback against states' mandate. Their own moral codes around sex. - Looking at Eisenstadt, how did that change access to birth control? Like once that case came down, did we see, you know, people in all 50 states finding access? What did we see with the implementation of Eisenstadt v. Baird? - We have to keep in mind that these rights that the court would protect. And Griswold versus Connecticut and Eisenstadt versus Barrett, as well as Roe versus Wade, these were all negative rights, meaning that all they did was prevent the state from prescribing activity. What they did not do was...
Obligate the state to ensure that people had access to these things, whether it be contraceptives or abortion. That's a long way of saying if you're poor. These rights are meaningless, right? If you don't have access to a physician who will prescribe you the contraceptive, you know, these rights are meaningless. If you don't have transportation to get to the physician or to get to the pharmacy, these rights are meaningless. So these rights become incredibly meaningful, worth fighting for, for those with class privilege, and they become sort of that exist only in theory alone for those without the means to buy these, you know, goods in the market. Since that 1970s The 2022 Eisenstadt decision. Have there been any significant moments in the expansion of access to birth control? What are some other things we've seen through the years?
I mean, the thing that immediately comes to mind for me is the Affordable Care Act. That was huge in terms of expansion of access to birth control. With the ACA, you know, now health insurance companies were required to pick up some of these costs. They were no longer permitted to offload the costs on to individual folks, folks who might not have been able to. To afford it. And so the ACA is huge in my view in terms of expanded access to contraceptives. Back through time and looked at, you know, to the two major cases that gave us access to contraception. But I also... Want to talk about where we are now. And I think maybe for folks
weren't necessarily looking at this on a regular basis, the bipartisan support for over-the-counter birth control might be surprising. Why did it get bipartisan? Support? It's a complicated question. I think that we have to pay attention to the timing of this thing. I think most people are aware that Roe vs Wade was overturned last summer. To criminalize abortion, to do all that they can to make abortion inaccessible to as many people as possible. So it was a huge win for the Republican Party. It's been, you know, a major platform.
A major item on their platform for many decades. And so I think in terms of the Democrats, they needed to win and expanded access to. Contraceptives is definitely a win. The question then becomes, okay, so why weren't Republicans opposed? To it, right? Why was this bipartisan support? I think in terms of two things. One, Republicans have not, are not done with the abortion fight. The fight has moved to the States. Republicans are trying to pass abortion bans in states. They're trying to make abortion inaccessible. Oh, you threw abortion pills and the like. So there's still a lot of energy being spent on the abortion fight. Have energy to fight over-the-counter contraceptives right now. The other piece of it is the...
Astronomical political popularity of contraceptives. I would say like the vast majority... Of Americans support access to contraception. Whether you are against abortion or in favor of abortion rights, like sort of contraceptive access is something that... Everybody is on board with. And so for the Republican Party to make a political issue, fighting people's ability to access contraception, it seems like a loser. It seems like something that they might, they might be able to convince their party. That contraception are bad, but it would take, again, a lot of energy. And right now it's just politically unpopular to fight against expanded access to contraception. So I think that's where we get the bipartisan support, support from the Democrats, and then just an unwillingness to oppose.
Pose it from the Republicans. -If we were living in a world where Roe v. Wade still existed, would -- we still see this over-the-counter measure happen? I am skeptical, but I am interested in your thoughts. - My sense is that they would not, because of the political unpopularity of that. Position. So after Dobbs was handed down and Clarence Thomas authored that concurring opinion where he was basically like, let me tell you what's coming next. We're going to overturn our holding, protecting the right to same-sex marriage. We're going to overturn that whole... Holding, protecting the right to be free from criminalization when you engage in same-sex activity. And also, we're coming after your...
Contraceptives, right? And there was a lot of conversation last summer about like, should we be scared about this? And my sense last summer was we should only be scared about this if the Republican Party wants it. I mean, the court has been telegraphing to the Republican Party what it is interested in, what arguments it wants to hear, what arguments it thinks Compelling. And so the question isn't whether there's a majority on the court who would be willing to overturn the precedent protecting a right to access contraception. The question for me is whether the Republican Party thinks it's a winner. And I just don't think that they think it's winner. I'm glad that you brought up that Clarence Thomas concurrence because he wrote quote in future cases we should reconsider all of this court's substantive due process precedents including Griswold, Lawrence and Obergefell because any substantive...
Due process decision is quote, dismontorably erroneous. And you know, everyone's ears kind of perked up when. Happened because I think you know a lot of us thought like okay so we know what's coming next but you're saying you like no it's actually the activist court signaling to the politicians versus politicians signaling to the court and it just feels is that unprecedented it feels maybe it's not It just feels not typical. - Yeah. Oh yeah. Like we are living through some very atypical days. Um, I I have understood the past couple of terms in the Supreme Court as the Supreme Court saying to the GOP, what do you want? What do you want? We'll give it to you.
Second Amendment rights to bear arms. You want open carry. Like, what do you want? We'll give it to you. You want voting restrictions? We'll give that to you. You want no more affirmative action. You don't like that anymore. We'll give that. So the court has essentially been saying, What do you want? And so the question for me becomes, Okay, so then what does the Republican Party want? And I just don't think that the Republican Party wants right now to limit access to contraceptives. I think for a lot of people, it is inconsistent to prohibit abortion and then make it.
Hard for people to access contraception. I just think that in 2023, most people think like, all right, you can limit access to abortion, but at least expand the means to avoid unwanted pregnancy in the first instance. - So that's how over-the-counter birth control became a bipartisan effort. After the break, what this could mean for the future of reproductive health. The port for the weeds comes from hydro. Finding the time to exercise can be hard, but with the HydroRower, finding time for a 20-minute full body workout can be a piece of cake.
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Hi, we're Visible. We're the wireless company with nothing to hide. Seriously, hidden fees? We don't have 'em. Annual contracts? Great wireless on just one line? Now that's more like it. Get unlimited 5G data powered by Verizon for just $25 a month. Taxes and fees included. That's right, $25 a month, every month. Sorry hidden fees, we're just not that into you. Sometimes the choice is made. Is just visible. Switch today at visible.com. Rate with service on the Visible plan. For additional terms and network management practices, see visible.com. This is the weeds and we're back. While the FDA has now approved an over-the-counter birth control pill, in many states, it's been a long time since the COVID-19 pandemic started. Access to abortion is steadily being rolled back. I asked Kiara how reproductive justice advocates are thinking of that trade-off. - As a reproductive justice. Or like somebody who thinks within this framework, it's not really a trade-off.
That anybody's willing to make. Like it's not reproductive justice. Reproductive justice consists of three rights, the right to avoid pregnancy, the right to become pregnant and the right to... Carry a pregnancy to term and to raise the child that you bear. And you can't have like one-- Like you can't have two out of three of those rights and call it reproductive justice. And so reproductive justice understands, like, it's really important to be able to access contraceptives and to avoid pregnancy in the first instance. And it's also super important to be able to terminate a pregnancy if you don't... Have the means or desire to carry the pregnancy to term and to raise the child. So simply because we are gaining sort of like one facet of reproductive justice by having expanded access to contraception, it doesn't make folks operating within the reproductive justice framework.
Work satisfied because we're still missing an incredibly important facet of reproductive justice, which is the ability to access abortion care. Talked in the beginning about, you know, the way that people used to, or sometimes still do think about sex. Like the purpose of this, it's like two straight cis people haven't And the reason that they are hanging out right now is to make a baby. Like that is the purpose. I'm curious how you see the narrative we have around both birth control and sex changing, not just from the past, because I think that's Obviously changed, but even in our present moment, what shifts are we seeing? I don't know. I wonder if we are kind of witnessing a shift.
I'm thinking out loud, like I'm questioning whether there have been shifts around sex and contraceptives. And the reason like it sort of gives me pause the question, because in one sense, like there's a part of me that says Well, now because we don't have like a federal right to an abortion, people recognize the importance of contraception. And ever since Roe vs Wade was reversed, you know, people support access to contraception. I don't think that's necessarily true. I think that people have... Articulated the importance of accessing contraception and the importance of a right to an abortion. I don't think that those two issues are connected in the minds of a lot of folks. I think that their support for contraception exists independently.
Of their sense that abortion is available or not, or their sense of whether abortion is morally, you know, defensible or not. So I just wonder about whether in sort of recent years, there have been shifts around thinking around sex and contraceptives. I mean, I do know that if we look like a sort of long view, Talking about half a century, there's been incredible amount of shifting around sex and contraceptives, just go on Instagram. And you'll see a whole, stuff that we wouldn't have seen in 1965 around the comfort. Around sex and sex for pleasure particularly. But when we narrow that period of time to a decade or five years or two years, I'm curious about how much shifting we're actually seeing.
I remember being a little kid in the 90s and hearing the phrase, Babies are having babies, and teen pregnancy was treated like the worst thing that could ever happened to you. There's a growing problem being left on the doorstep of every American. Last year, nearly half a million babies were born to teenage girls. And then, you know, rates went down. We also saw like the increase in long acting birth control. And yeah, it just feels like such In a way, like a major shift, even in my lifetime. You know, I remember, like, the purity culture of it all, when everyone had a purity ring and it was like, Please wait for marriage. Do not have a baby. Do not have sex, you know? So I totally agree with you. I think perhaps in my head.
I am dichotomizing like adults having sex versus, you know, young people having sex. I absolutely a thousand percent believe that there is. Still stigma associated with young people having sex, there absolutely is demonization. Involved around teenage pregnancy and young parenthood. People still do conceptualize. You know, teen pregnancy as like a social problem that we need to fix, as opposed to looking at the fact that folks who become parents at young people are Young aged are marginalized and vulnerable before they become pregnant in the first instance. So it's not necessarily the pregnancy. That marginalizes them, but rather the conditions in which they're existing before their pregnancy that marginalizes them. Marginalizes them. So, you know, we still have very, in my view, regressive conversations around teen pregnancy.
Or young parenthood. And so there, and I do believe, I haven't been hanging out with young people recently, but I do think that there might still be some stigma associated with young people having sex. Is all gendered, of course, right? And not everybody is stigmatized because they're in high school having sex, right? Some people get high fives, you know, cis men get high fives when they have sex in high school, while cis women, you know, get, there's a multitude of names associated with, you know, young cis women who are having sex. So I don't think that that has shifted. In 2023, when we're talking about the availability of the over-the-counter contraceptives, Was some dialogue around who's going to be able to access this. Is it going to be young people? You know, young women, are they going to go out and have sex now that they can access this pill? And that was like an argument against the pill.
Changed at all. I think what has changed has been the Republican Party's interest in sort of leveraging the stigma associated with young people having sex into a political position to oppose the over-the-counter pill. Am curious about that accessibility question, because I think when people hear over the counter pill, they're like, oh, so everyone will get it quite easily. But I know that that still may not necessarily be the case. Can you talk about access for a bit? - I think one of the biggest questions. Around the over-the-counter pill is how much is it gonna cost. And drug pricing is, like, such a black box to me. I think it's also a black box to pharmaceutical companies. Um... Everybody's waiting to see how much this over-the-counter pill is going to cost, and that's going to determine
And whether this pill actually is a game changer for vulnerable populations. It could mean that a young person. Low income person might be able to foot the cost of the contraceptive. However, if the pill costs as much as it used to cost me. When my insurance wasn't covering it, and I'm talking about like $100 a pack, then young people, low-income people, you know, vulnerable. People are not going to be able to afford it. And so that kind of brings me to the Affordable Care Act. Why wouldn't the Affordable Care Act just automatically cover this new pill? And that's because the... Care Act covers prescription contraception. This is the innovation of the over-the-counter... Is that it's not prescription. So we have to figure out what... They're going to amend the ACA such that it covers the over-the-counter pill, maybe health insurance companies.
Will voluntarily cover the medication. And so all of these questions about how much is it gonna cost, is health insurance gonna cover it? And so forth. Those are all like sort of essential questions that need answered before we know. Whether this pill will actually expand access to contraception. I want to talk about one of the things you do. Touched on earlier when you were talking about these tenets of reproductive justice. And that's the right to carry a child to term. The fact that we are two Black women having this conversation is not lost on me. And, you know, I have friends who are having kids, trying to have kids. And I know that there's this real fear of like, okay, am I going to be able to do this?
Going to make it through childbirth? Are me and my baby going to make it? And I also think of the complicated history of reproductive coercion that a lot of people faced in this country. You know, in the 20th century, over-- 70,000 people had forced sterilizations performed on them. It's common knowledge that the founder-- Was a eugenicist and the man who is considered the father of gynecology, experimented on enslaved women. I mean, that's how James Marion Sims invented the speculum, which we still use today. And that history is so sticky. And it can be and often is used as a political tool. And I just, I wonder. I wonder how you think of Opal in that context. I am very much
Familiar with the history of reproductive coercion in this country. I'm very familiar with the history of reproductive coercion against Black people in this country. I was going for a run earlier this morning, and I do a lot of my best thinking when I'm running. And I was thinking to myself, like, is it possible for anything that is developed in a context of anti-blackness, xenophobia, ableism, cisnormativity, transphobia, is it possible for anything developed in those contexts to be free from anti-blackness and cisnormativity Xenophobia and ableism. You know, it was only a two mile run, so I didn't arrive at an answer. But what I do know is that I'm not at all surprised that contraception has been affiliated,
cousins with anti-blackness. I'm not at all surprised that contraception is... Very intimately associated with ableism and cisnormativity. Like I'm not, you know, given, it would be surprising given the context in which these things were created if they weren't. If they didn't have hints of all of these horrible forms of violence, you know, kind of associated with them. So in light of the horrible history of the violence, I think it's really important to think about the history of the violence. And I think that's really important to think about the history of the violence. And I think that's really important to think about the history of the violence. Of reproductive coercion against vulnerable people that we have in this country, you know, like, how should we understand OPL, right? How should we understand the over-the-counter pill? You know, I'm sort of leaning on the scholarship of Dorothy Roberts right now. For those who don't know, she's brilliant. Scholar who has helped to sort of articulate the reproductive justice framework.
And she talks about a distinction between autonomy and... and Compulsion, right? And taking a pill could be an act of violence if you are compelled to do it. Having an abortion can be an act of violence if somebody is forcing you to terminate that pregnancy. Same vein, taking a pill, taking an over-the-counter contraceptive could be an act of liberation, right? An act of self-actualization, if it is actually a product. Of, you know, one's agency, you know, one's autonomy. You know, same thing with terminating a pregnancy. Is that what you're thinking of as you think of Opal's place in reproductive-- justice going forward, like, you know, in 50 years when whoever is hosting the weeds
Interviews, you know, a legal scholar about whatever is going on. Will this, you know, will this be up there with Griswold? Griswold was like game changer. Chris, well, I was like, next level. I think this is incredibly significant. Will I be teaching this? Like, will this be on the syllabus? Of reproductive justice seminars in the future, like the day that Opel was approved, I'm not sure. I think a lot of it is gonna turn on. Accessibility. I think a lot of it is going to turn on whether vulnerable people can actually access it. I think it's going to be funny though. When I am twice my age right now and I'm talking to young people and I'm gonna be like back in the day, you used to have to go to the doctor and they had to write you a prescription and
Like, you know, when I tell the story about how we used to access, you know, oral contraception, you know, and the young folks are going to shake their head and be like, That was crazy. But, you know, like this pill is going to be like... Available on Amazon. Like this pill is going to be in grocery stores. And so... We're creating a landscape in which, you know, contraception is kind of a banality. And that, you know, that might be, you know, a game changer. Kiara Bridges, thank you so much for joining us. Thank you for having me. Yeah. Thank you to Dr. Reagan McDonald-Moseley and Kiara Bridges for joining me. This episode was produced by Caitlin-
and Sophie Lalonde. Krishna Ayala engineered this episode. Serena Solon and Elizabeth Crane fact-checked it. The Weeds is part of the Vox Media podcast. The Weeds is part of the Vox Media podcast. The weeds is part of the Vox Media podcast. Network. Hi. We're visible. We're the wireless company with nothing to hide. Seriously. Hidden fees? We don't have them. Annual contracts? Not our thing.
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Transcript generated on 2024-05-19.