Eradicating the Second Walk of Shame

A New Brand Aims to End Stigma Around Emergency Contraception

The FDA approved Opill for over-the-counter sale last week, as expected after an advisory committee voted unanimously in May to recommend the move. I wrote about Opill and that path to OTC approval when that decision came down. You can read it and see a pretty picture of Cecily the Cervical Mucus Fairy here.

As I said in that piece, I agree that we should have OTC birth control because more options and more access is always better, and I have some concerns about elevating the appeal of this method over others by making it available on store shelves. It’s a good birth control method, but there are a lot of contraceptive methods that are both more effective and require less effort to use. (And yes, the political reality is that none of these other methods have a chance at OTC approval anytime soon.)

I’ve been told this argument sounds a little patriarchal, but I prefer to look at it as a dialectic—two seemingly opposing ideas that can be simultaneously true. I am glad that Opill will be more easily available to anyone who wants/needs it, and it’s not a method I would want my daughters to rely on. (And yes, I know my daughters have privilege that other young women don’t, namely health insurance, money for copays, parents who will support their reproductive health decisions, and a mom who won’t shut up about birth control and condoms.)

I think the release of OPill needs to come with a metric s**t ton of information/education about hormonal contraceptives of all kinds. People need a better understanding about how these methods work and the differences between methods (including the difference between classic combination oral contraception that contain estrogen and progestin and Opill which is a progestin-only pill). They need to know what these methods do (prevent pregnancy) and don’t do (cause abortions). They need to know how to take them and what side effects users might expect. And, we need to combat the natural-is-everything-hormones-are-evil rhetoric that is constantly being spewed on social media.

One of our most immediate tasks, however, is to make sure that people know the difference between Opill, emergency contraception, and the mifepristone/misoprostol combination that is used for medical abortion. There’s misinformation about all of these methods swirling around already (some of it being deliberately spread), and it is likely to get worse with court decisions about mifepristone. We need to make sure people know what their options are and grab the right box.

Much of this education may fall to Perrigo as the maker of the newest product on the block, but when I say we, I really mean anyone who has the information, and I like to think that includes all Sex On Wednesday readers. Health care providers, pharmacists, advocacy groups, and sex educators all have a role, as do all parents and other adults who young people turn to for information.

The role of educator also falls to other reproductive health brands. from condom companies to the makers of pregnancy tests to pharmaceutical companies that make other hormonal methods. I recently had the opportunity to talk with the people behind one of those brands which is taking its responsibility as reproductive health educator very seriously.

Meet Julie, A New Name in Emergency Contraception

Julie is not actually a person. It’s a new company and brand of emergency contraception that came on the market in October and is currently available in Walgreens, CVS, and other major retailers. The product itself is the same as what we’re used to in Plan B and the generics, but the marketing behind it is different because the company’s goal is to educate consumers and take away stigma and shame. The CEO referred to Julie as a “content first pharmaceutical company.”  (You know I love me some sexual health content, and not just because writing it is how I pay the bills).  

The new company has a 1:1 donation policy in which they give one box away for every box purchased. It is also the first EC brand to market a two-pack—one for now, one for later.

I recently spoke to Amanda E/J Morrison, Julie’s co-founder and CEO and to Talia Halperin, Julie’s chief impact and innovation officer who is responsible for the brand’s donation partnerships. The two have very different backgrounds but a shared vision of what the women’s health marketplace needs now.

Amanda, who attended Howard University and then Harvard Business School, spent some time on Wall Street before becoming an entrepreneur when she co-founded Mented Cosmetics, “a pigment-first beauty brand celebrating women of all hues.” Talia went to NYU where she was a sexual health peer educator in the same program I participated in during graduate school (though there were, gulp, almost 20 years between our time there). She went on to get an MSW and worked with school based mental health clinics in the South Bronx and Harlem. After a few years of intense focus on somatic trauma, she made a big change by moving to BuzzFeed where she learned about “the emerging intersection between content and commerce.”

I talked with each of them separately over Zoom. Each conversation took over an hour and honestly could have gone on longer. Instead of doing a traditional Q & A, I’m going to pull some portions of the conversations in their words (edited slightly for clarity and length) and—because I can’t stay quiet for long—add a few words of my own.

Amanda on why she and her co-founders chose to start a new EC company:

What’s been interesting in this category is that you really had a monopoly ever since this became OTC. You have one leading brand and the generics, and the leading brand also makes the generics, so you’ve literally not had another voice and face in the category for 10 years.*

What's happened is that their silence has been filled with everybody else's opinion, and frankly, even some supporters didn’t really talk about it very well. There was all this shade and negativity thrown at EC pills with the basic message that it’s your fault that you’re in the position where you need this medication. We saw Julie as an opportunity to change the narrative.

Also, there was no real brand affinity or loyalty for the major brand that was out there. It's just what everybody said. You know, it's like Kleenex. Yes, say that brand name, but you might have actually purchased or were given the generic without really noticing. We realized there was a way to break through and talk about this thing differently and have people feel about it differently. That was the aha moment.

Emergency contraception is also a great conduit to having a ton of different conversations that we're excited to have. Some of them are about the science and the medicine, but not all. Some are going to be about how you feel that next morning. Some about whether you’re part of the generation that's not taking birth control and not going the doctor. We also want to talk about your dating and sex lives. It just allows us to go in so many directions.

*She’s had too much media training to name the competitor but she’s talking about Plan B which is the same formulation as Julie. There is also a brand called Ella which is a different drug. It’s only available by prescription but may work better for people with higher BMIs.

Talia on how Julie’s messages about EC are different than what we’ve heard in the past:

The conversation has been the same for over a decade. It’s felt really cold and clinical and shameful. People weren’t really talking about EC, and nobody knew the rules and regulations around whether it was legal or if you needed prescription or if there was an age requirement.

We felt like there was an opportunity for us to do a lot with the brand and make this more of a conversation. We want people to feel like they’re talking to family or friends about what this pill does so they can use it safely, and so we can reduce the shame and stigma associated with it. For us that meant a lot of testing and learning and a lot of playing with our marketing to find the happy medium where it’s educational but also relatable.

We have a lot of campaigns that are lighter; we’re not making a joke out of it but we are looking at the humorous side of these morning-after experiences when you're texting your friend with that “oh my god” moment. We have a billboard in LA that says something like “When you're not ready to be a mommy influencer,” and we have one in New York that says, “He gave you a New York minute now you need something for the next day.”

We don’t really care what happened before, we want to focus on what’s going to help you today.** We want to eradicate that second walk of shame*** in the pharmacy when you're trying not to make eye contact and you're not looking at the cashier.  

** This part was said in response to my complaints that previous campaigns to promote EC use both by the brand and by providers have too often included concepts like “the condom broke, don’t worry get EC.” The goal of the messaging was clear: let people fall back on an accident so they don’t feel guilty about needing EC. Unfortunately, the underlying message is still one of shame and suggests that condoms break a lot. (Spoiler alert: they don’t.)

*** I love this idea of the second walk of shame. Wait, I hate the idea of it, of course, but it’s a great turn of phrase.

Amanda on the education needed when Opill hits the market:

It will be interesting; the shelf is going to change in a very dramatic way. We are always having to clarify that birth control, EC, and the abortion pill are three distinct things and explain how each of them works. There’s a stat that 60% of people conflate the abortion pill with EC. If you listen to a birth control commercial, it's some woman running around in a field, while we hear about the side effects. Most people don't know exactly how the birth control works. So, we’re educating across the entire category.

The startling stat that only 17 states require sex education to be medically accurate is part of our guiding light for how we think about the content we're creating. We're filling in a real sex education gap. We see it in focus groups when people think that getting pregnant all happens in the uterus. We have to say, “Well, it doesn't just happen like that, let us break that down and explain literally how your body works.”****

The focus groups also told us that they didn’t want to hear from doctors in lab coats, that doctor’s offices can be intimidating, and that they don’t like it when an authority figure is telling them what to do. Instead, they want doctors sitting in their houses in regular clothes saying “Hey, I'm a doctor. Let me explain medically what's happening…” That content plays really well.

We shine on social where we can tell a story in ways that others can’t.

We’re also working very closer with retailers to figure out how we can make each product super distinct on shelf and make it clear what is what.   

****She’s too nice to scream, “That’s not how it f**king works.” I’m not.

Talia on their one-for-one donation program:

The donation program has been part of Julie since we launched. For every unit that we sell, we donate one to someone in need. Our first batch of donations, which happened last quarter, included over 200,000 units and we’re gearing up for more. We have over 70 donation partners in all 50 states. We have some national partners, and we have some really small partners that hand out Julie in nail salons and barber shops. We've diversified the program; our partners are federally qualified health centers, domestic violence shelters, sexual assault response and prevention programs, and street outreach teams that do harm reduction.  

One thing we’re really proud of is how we've been able to sort of flex our donation program up and flex it down depending on what's happening in the country. We can see which states need more help. Iowa just cut funding for EC for victims of sexual assault*****, so we’re working with partners there. I also try to focus on states where sex education isn’t medically accurate.

It's all about access. Just like we’re trying to expand retail access, we’re trying to expand access through our donation programs.

***** Sorry I missed this one back in April. It’s as horrifying as it sounds. The new attorney general suspended payments for EC to determine whether preventing pregnancy after rape was an “appropriate use of public funds.”

Amanda as a fierce advocate for emergency contraception:

Sometimes when I talk to people, even people who are pro-EC, they’ll say things like “Ideally, you’d want your company not to have to exist because if you educate people, they wouldn’t need to take EC anymore.”****** No, that's not what I'm saying. I'm saying there are no limits to the number of times you can take this medication. It does not affect your fertility, so if you are taking it correctly, I don't have a problem with you take it as many times as you need it. I am not here to judge how often you need to take this medication just like I wouldn’t judge how often a diabetes patient needs insulin. We need to reframe this discussion to take out the shame factor.  

***** She’s right, we fall into this trap often of letting antis develop the scripts we use, whether it’s saying that “abstinence is best,” but adolescents need condoms just in case” or saying “we’re just pro-choice, not pro-abortion” or looking for the sob story behind a woman’s decision to end a pregnancy. We can and should be bolder than that.

What’s Next for Julie?

When I asked them about the future of the brand, both women said they wanted to expand the reach of emergency contraception (I heard about colleges, bars, hotels, and vending machines as future possibilities) and look beyond EC to other issues that arise from sex and the morning after experience (they’re thinking a lot about STI testing right now).

Look for Julie in your local pharmacy. My CVS had it on the shelf the other day right next to condoms and one shelf up from a vibrating butt plug (a story for another day). And check out their website.