Two years after the FDA approved the first over-the-counter birth control pill in the United States, a comprehensive nationwide study reveals the policy change has dramatically improved contraceptive access among the most vulnerable populations. The research, published today in JAMA Network Open by Oregon Health & Science University, demonstrates that over-the-counter availability is reaching exactly the people it was designed to help.
Significant Increase in Contraceptive Use
The study surveyed 986 people across 49 states who obtained the OTC pill either online or at pharmacies, comparing outcomes with prescription users. Researchers found a striking 31.8 percentage point increase in people who shifted to using the pill after previously using no contraceptive method at all.
"This is one of the first studies to show that over-the-counter birth control pills are reaching the very people they're meant to help — those who face the greatest barriers to care," said lead author Maria Rodriguez, M.D., M.P.H., professor of obstetrics and gynecology in the OHSU School of Medicine and director of the OHSU Center for Women's Health.
The majority of OTC pill users were either not using any method of contraception or relying on much less effective methods, despite reporting that avoiding pregnancy was extremely important to them.
Addressing Health Disparities
The research revealed that over-the-counter access particularly benefited populations historically underserved by the healthcare system. Among those accessing oral contraceptives over the counter, researchers documented higher rates of use among racial and ethnic minority groups, adolescents, the uninsured, and Medicaid recipients.
"At a time when pregnancy is becoming even more dangerous in the United States — especially for people of color, those with low incomes, and those living in rural communities — our findings underscore that OTC contraception is a powerful tool for reproductive autonomy," Rodriguez explained.
Policy Impact in Changing Healthcare Landscape
The study's findings take on additional significance given recent changes in reproductive healthcare access. Rodriguez noted that the U.S. Supreme Court's 2022 decision to overturn constitutional protection for abortion access has decreased availability of both abortion and contraception services, particularly affecting populations at highest risk for maternal injury or death.
The over-the-counter pill, which costs approximately $50 for a three-month supply, appears to be filling critical gaps in contraceptive access for these vulnerable populations.
Current Limitations and Future Potential
Currently, only one type of birth control pill is available over the counter: Opill, which uses only progesterone to control fertility. This represents a small fraction of the birth control pill market, as Dana Singiser from the Contraception Access Initiative noted: "While having Opill over the counter is historic and important, and this study shows the potential impact for increasing availability, it still leaves more than 90% of birth control pill users out of the equation."
Many users prefer combination pills containing both progesterone and estrogen, which have different effectiveness profiles and side effects. Advocates are pushing for additional over-the-counter options to serve a broader range of contraceptive needs.
Research Implications
Kimi Chernoby from the National Women's Law Center emphasized the study's significance: "It's not often that we get such clear data about the effects of a policy change." The research provides concrete evidence supporting the expansion of over-the-counter contraceptive access.
The study authors conclude that "removing prescription requirements for [the oral contraceptive pill] can expand contraceptive access, particularly for underserved populations, such as the uninsured and those in rural areas." They note that "as reproductive health care access faces growing threats, [over-the-counter] contraception offers a promising strategy to support reproductive autonomy and reduce disparities in contraceptive use."
