Over-the-Counter Birth Control in the U.S.: Who’s Using It?

 

More than a year after the U.S. Food and Drug Administration approved the first over-the-counter birth control pill, new research reveals that the medication is reaching populations who previously had limited access to contraception. A study published in JAMA Network Open found that 26.2% of people using over-the-counter oral contraceptives had not been using any modern method of birth control before.

The study highlights that individuals who rely on nonprescription birth control are more likely to be uninsured, adolescents, or residents of rural areas. These findings suggest that removing prescription requirements is helping to overcome structural barriers that have historically limited access to reproductive healthcare.

FDA Approval and Accessibility of Opill

The FDA approved Opill as the first over-the-counter birth control pill in July 2023. By March 2024, shipments reached distributors and major retail pharmacies such as CVS, Walgreens, and Walmart. Pricing ranges from $19.99 for a one-month supply to $89.99 for a six-month pack, making it more affordable for people who face obstacles in obtaining healthcare appointments or prescriptions.

“This pill is reaching exactly the populations that need it most,” said Dr. Maria Rodriguez, lead author of the study and director of the OHSU Center for Women’s Health. “These are people with structural barriers to healthcare, and those at greatest risk for unintended pregnancies, in a country already facing a maternal health crisis.”

The study surveyed 986 individuals aged 15 to 45 across 49 states, asking about their contraceptive use between April 2024 and February 2025. Researchers found that 32.5% of participants had used over-the-counter birth control pills, with 31.8% switching from using no contraception after gaining access to the nonprescription option.

Why Over-the-Counter Access Matters

One of the most common reasons cited for choosing over-the-counter birth control was avoiding the need for a doctor’s appointment. Lack of insurance and rural residence were major factors that limited access to prescription contraception. “Not having insurance makes it harder to afford clinic visits for preventive care,” Rodriguez explained. “In rural areas, options for reproductive healthcare are often limited, compounded by clinic closures, workforce shortages, and providers leaving states after recent legal changes.”

Opill, a progestin-only “mini-pill,” works differently from combination hormonal pills containing both progestin and estrogen. It is FDA-approved for all reproductive-age users and has been shown to be 98% effective at preventing pregnancy when taken correctly. The pill’s formulation makes it safer for people with certain health conditions that might make combination pills risky, such as uncontrolled hypertension or clotting risks for smokers over 35.

Addressing Contraceptive Deserts

Public health experts predicted that rural residents would particularly benefit from over-the-counter access. Dr. Anne-Marie Amies Oelschlager, a professor at the University of Washington School of Medicine, described these areas as “contraceptive deserts,” where individuals must travel long distances to reach reproductive healthcare providers.

Expanding access through pharmacies and online options increases individuals’ control over their reproductive health and choices. Megan Kavanaugh, principal research scientist at the Guttmacher Institute, emphasized that Opill’s availability represents a major milestone in reproductive healthcare access, helping people manage their fertility more independently.

The study provides an early look at how nonprescription birth control is being adopted in the United States. As the first year of availability concludes, researchers note that ongoing studies will be essential to understand long-term trends, usage patterns, and potential effects on unintended pregnancy rates.