OTC oral contraceptives linked to increased initiation among women with barriers to care

OTC oral contraceptives linked to increased initiation among women with barriers to care | Image Credit: © Antonioguillem - stock.adobe.com.

The availability of an over-the-counter (OTC) oral contraceptive pill in the United States is significantly improving contraceptive access, particularly among individuals who previously used no method or relied on less-effective options, according to new research published in JAMA Network Open.

The cross-sectional study, led by Maria Rodriguez, MD, MPH, professor of obstetrics and gynecology at Oregon Health & Science University (OHSU), evaluated data from 986 individuals across 44 states who obtained oral contraceptives either through a prescription or directly OTC between April 2024 and February 2025. The analysis focused on whether OTC access reached populations with systemic barriers to care, including adolescents, uninsured individuals, and those living in rural communities.

Study design and population

Participants were aged 15 to 45 years and biologically capable of pregnancy. Among them, 320 individuals (32.5%) accessed the pill OTC, either in pharmacies or online. The OTC group had higher proportions of adolescents, uninsured individuals, and those residing in rural areas compared with prescription users. Specifically, 31.6% of OTC users were uninsured, compared with 3.5% of prescription users, and 14.4% of OTC users lived in rural areas, compared with 8.4% of prescription users.

The majority of study participants expressed strong preferences for pregnancy prevention. Among OTC users, more than three-quarters reported that avoiding pregnancy was “extremely important” to them, despite many having used no contraceptive method or a less-effective method immediately before initiating OTC oral contraceptives.

Key findings

The researchers found a 31.8 percentage point increase in individuals moving from nonuse of contraception to using the OTC pill, compared with prescription users. Similarly, there was a 41.0 percentage point increase in transitions from less-effective methods, such as condoms or emergency contraception, to the OTC pill.

“These findings suggest 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,” the authors concluded.

Rodriguez emphasized that the study demonstrates the public health value of nonprescription availability. “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,” she said in the press release. She added, “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.”

Context and public health implications

The study findings are particularly relevant in the context of declining reproductive health access following the 2022 US Supreme Court decision to overturn constitutional protections for abortion. Rodriguez noted that decreased access to abortion and contraception disproportionately affects populations already at higher risk for maternal morbidity and mortality. The uptake of OTC oral contraceptives may partially address these gaps by providing an alternative pathway for those unable to access clinical services.

Geographic trends revealed greater OTC use in southern states, where structural barriers to reproductive health services are often pronounced. OTC users were also more likely to have a history of pregnancy and childbirth, suggesting the method is serving individuals at elevated risk of unintended pregnancy.

Cost and coverage considerations

Despite the benefits of OTC availability, cost remains a barrier. The study noted that a 3-month supply of the OTC pill costs approximately $50. Federal law currently requires most private insurers and Medicaid to cover FDA-approved contraceptives without cost-sharing, but it is unclear how broadly this extends to OTC products. While several states mandate coverage of OTC contraception without a prescription, inconsistent reimbursement mechanisms persist, raising concerns about equitable implementation.

Conclusion

The availability of OTC oral contraceptives in the United States is associated with significant increases in contraceptive initiation among populations with limited health care access. The study highlights the potential for nonprescription access to reduce disparities in reproductive health and support reproductive autonomy.

“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,” the authors concluded.

References:

1. Oregon Health & Science University. Over-the-counter pill boosts access to contraception, OHSU study finds. Eurekalert. August 18, 2025. Accessed August 19, 2025. https://www.eurekalert.org/news-releases/1094806
2. Rodriguez MI, Burns H, Sheridan R, Edelman AB. Over-the-Counter Oral Contraceptive Use and Initiation of Contraception. JAMA Netw Open. 2025;8(8):e2527438. doi:10.1001/jamanetworkopen.2025.27438