In many parts of the world, a person can walk into a drugstore and—without physician oversight or interference—buy a pack of birth control pills. Perhaps several packs. But not so in America, where the Food and Drug Administration (FDA) has been considering making oral contraceptives available over-the-counter (OTC) for more than twenty years. What's the hold up? Emergency contraception, a more potent dose of the same hormones that make up regular birth control pills, is now available without a prescription. There's no good medical justification for the differentiation, and no reason to tie the pill to yearly doctor's visits. Elizabeth Nolan Brown looks at why oral contraception in America remain stubbornly behind the pharmacy counter and behind the times.