More people are turning to over-the-counter birth control pills

Two years after approval, the first over-the-counter birth control in the United States has expanded contraception access to people who may not have had it before, according to a survey.

Over-the-counter contraceptive pills may improve access for uninsured, rural populations, the survey in JAMA Network Open concluded. Among 986 participants who used either over-the-counter or prescription oral contraceptives, the researchers found that people taking the over-the-counter pill were 41% more likely to have transitioned from less-effective methods like condoms or Plan B. Compared to those taking the prescription pill, those using the over-the-counter pill were also 32% more likely to have not used any contraception in the past.

The researchers at the Oregon Health & Science University Center for Women’s Health who conducted the survey declined to comment due to clinical scheduling, but said in a press release that “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.”

Opill, the first birth control pill approved by the FDA that does not require a prescription, was released by manufacturer Perrigo in 2023 as a progestin-only oral contraceptive. Its over-the-counter status makes it accessible to more individuals that may be susceptible to unintended pregnancies, the FDA said at the time of its approval.

The expansion of Opill access shown by the study “shows that the promise of over-the-counter contraception is real and this is the data to back that up,” said Dana Singiser, co-founder of the non-profit Contraception Access Initiative, who was not involved in the study. 

Although the researchers cite limitations in fully capturing the differences in health care engagement or contraceptive preferences in their study, they claim their findings demonstrate reasons to push for affordability and improved community awareness moving forward.

Educating young people and community providers on contraception options would improve Opill’s reach, said Cynthia Harper, a professor of obstetrics, gynecology, and reproductive sciences at the University of California, San Francisco, who was not involved in the study. 

“There’s been a lot of confusion, a lot more silence and stigma,” Harper said. 

Another hurdle is cost. While Opill costs about $20 per cycle, Harper said young people and those without insurance may be reluctant to spring for the pill. A 2022 survey found that 11% of women would not be willing or able to pay anything for an over-the-counter option and another 39% they would only pay up to $10 a month.

North Carolina and California are among states that have moved to cover the costs of Opill under Medicaid, but Harper said that states with abortion bans are typically the slowest to move toward these policies.

The study found that states like Arkansas, Kentucky, Louisiana and Oklahoma that have banned abortions saw more Opill use. 

Daniel Grossman, the director of Advancing New Standards in Reproductive Health at the University of California, San Francisco, said that while access to over the counter birth control is growing, there is more work to be done to combat concerns around affordability and misinformation in these states.

“Expanding access to contraception now is really important, because people face barriers to accessing contraception and the consequences of having an unintended pregnancy can be even more dire for people who are living in states where abortion access is so constrained,” Grossman told Scienceline.

The survey’s researchers urge health departments and officials to remove prescription requirements for all daily oral contraceptives. With an over-the-counter combination progestin and estrogen pill in development, Singiser said policymakers should prioritize what is best for their communities. 

“When policy makers are working to make contraception harder, they are clearly working against their constituents,” Singiser said.