Approximately two years after the US Food and Drug Administration approved the first over-the-counter contraceptive in the United States, new research suggests that many people who may not have access to contraceptives before are now using over-the-counter options.
A quarter of people currently using over-the-counter oral contraceptives – 26.2% – had not previously used modern methods of contraceptives, according to a study published Monday in Medical Jama Network Open.
People who rely on over-the-counter birth control pills that do not require a prescription are more likely to be uninsured and adolescents and live in rural areas, the study found.
Residents in rural areas without health insurance are two of the main barriers for those seeking access to healthcare, according to Dr. Maria Rodriguez, a professor of obstetrics and gynecology at Oregon Health & Science University in Portland and director of the OHSU Women’s Health Center.
In July 2023, the FDA approved opill contraceptives for over-the-counter availability, making it the first non-prescription contraceptive available in the United States.
In March 2024, Opil’s first shipment was sent to distributors, major drug stores and pharmacies. Pills are now available in many retail pharmacy chains CVS, Walgreens, Walmart and others cost $19.99 for a month’s supply, $49.99 for a three-month supply, and $89.99 for a six-month pack.
“The pills are basically reaching the exact population that need them the most. They are the people who have structural barriers to health care, and in countries where we have access to maternal health crisis and safe abortions, who are at the highest risk of harm associated with unintended pregnancy,” Rodriguez said.
Rodriguez and her OHSU colleagues used an online survey to survey 986 people aged 15-45, especially asking about their use of birth control pills. Study participants came from 49 states and between April 2024 and February 2025, Rodriguez said they obtained some form of oral contraceptives in pharmacy stores or online.
The researchers found that 32.5% of study participants used over-the-counter contraceptives. Survey data showed that access to over-the-counter contraceptives was associated with an increase of 31.8 percentage points when switching to over-the-counter medication use after using contraceptives.
“I think it’s really powerful to give those who can get pregnant that choice and control their access to birth control,” Rodriguez said. “It’s also what’s happening all over the world. The US is really late in creating the form of oral contraception available at the counter. It’s been available for use by over 30 countries around the world for many years and we can see it’s safe and effective.”
The survey data also stated that one of the most common reasons why study participants said they were using over-the-counter birth control pills was because they did not require the appointment of a physician to obtain a prescription.
“If you don’t have insurance, it’s much more difficult to afford to enter the clinic to receive all sorts of preventative care,” Rodriguez added that rural residents often have limited reproductive care options. “We see the labour and delivery units being closed due to reduced costs, contraceptive labor, and there are suggestions that some providers and providers who have left the state are affecting people’s access to birth control pills.”
The researchers wrote that their research provided “first look” for people using over-the-counter oral contraceptives.
The study also estimates what early intake of over-the-counter contraceptives is in the past year, but further research is needed to assess how the intake changes over time and how it may affect unintended pregnancy rates.
Opill is approved by the FDA without age restrictions and, according to its website, “it is suitable for most people of reproductive age to prevent pregnancy.” Opill acts as a “minipill” using only the hormone progestin to prevent pregnancy. This is a different formulation than that found in combinations of hormonal contraceptives that contain both progestins and estrogens.
Pills combined with contraceptives can pose a risk to people with uncontrolled hypertension or thrombotic risks by smokers over the age of 35. Contraindications for progestin-only tablets include conditions such as breast cancer or liver disease, or the use of certain drugs.
According to Perrigo, the company behind the product, Opill is known to be 98% effective in preventing pregnancy when it is indicated at the same time every day. Most contraceptives are up to 99% effective in preventing pregnancy if taken daily as directed.
When Opill first became available last year, public health experts expected it would benefit women living in remote rural areas. Dr. Anne-Marie Amies Oelschlager said she is a professor of obstetrics and gynecology at the University of Washington School of Medicine, specializing in adolescent care.
“The biggest population that will benefit from this is those who are limiting birth control in the first place,” Oelschlager said last year. “We have a lot of people in our country who live in what we call birth control pills. These are areas where we don’t have access to reproductive health providers, meaning we have to be really far away to have access to our providers.”
Megan Kavanaugh, a leading research scientist at Guttmacher Institute, a nonprofit that has tracked the rollout of Opill, said the more people have access to birth control, both at store counters and online, and the more control over their reproductive health and choices, the more they have.
“It’s a big milestone for opills to be available at the counter,” she said last year. “And I think we should really celebrate the milestone, and we should always position this milestone on this trajectory of wanting to move towards increasing access for all people.”
