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A new JAMA Network Open study highlights how over-the-counter oral contraceptives can reduce barriers to care, especially for uninsured, rural, and adolescent populations, amid shifting federal policies on reproductive health.
In 2023, the FDA approved the first over-the-counter (OTC) birth control pill for use in the United States, with Opill becoming available for purchasing in stores and online in April 2024.
Oral contraceptive pills (OCP)—those that are progestin-only and combined—are considered effective, and safe, along with simple to use.1 Having the convenience of OTC availability is a way to increase access to contraceptives; making them available over the counter can expand access by reducing barriers to starting, continuing, and correctly using these products, steps that may help lower unintended pregnancy rates.
OCPs are considered the most common form of reversible contraception that is used in the US. This includes the birth control pill, with almost 80% of US reproductive aged females who ever had sexual intercourse with a male partner having used one. OTC OCPs are also available in more than 100 countries worldwide.
Currently, access to contraception takes on an even greater importance, as potential changes to Title X and Medicare under the Trump administration could restrict the availability of prescribed methods. This would signify that those without insurance and people in communities with limited health center access may face even greater barriers to contraceptive information and services. The administration has been active as of late, with the president also publishing an official memo last week directing the FDA to more strictly enforce existing regulations surrounding DTC advertisements, due to the believe that the advertisements are misleading.2
Keeping this in mind, a cross-sectional study published in JAMA Network Open1 sought to determine whether OTC OCP improves access for people seeking to prevent pregnancy who face structural barriers to care, including adolescents, uninsured individuals, and those living in rural areas.
The study pulled baseline data from a nation-wide US cohort that obtained OCPs—both online and in pharmacies—between the April 2024 and February 2025 timeframe. Participants were aged 15 to 45, and were qualified to join if they had gotten an OCP (via prescription or OTC) for contraceptive use and were biologically capable of becoming pregnant. Therefore, those who were using the pill for non-contraceptive reason or were not at risk of pregnancy were excluded from this particular study.
Multivariable logistic regression models with robust standard errors were used to calculate adjusted absolute probabilities and differences in outcomes expressed in percentage points.
Overall, the study consisted of a total of 986 individuals spanning 44 states, with those relying on OTC access being more likely than prescription users to be uninsured, adolescent, and living in rural areas. Having access to an OTC contraceptive produced a 31.8 percentage point boost in those switching from no contraceptive method at all to an active method.
Those who participated were mainly single (692 participants [70.2%]), while the largest proportion was aged 20 to 24 years (338 participants [34.3%]). Of the total, 721 individuals (73.1%) were White, 131 individuals (13.3%) were Asian, 116 individuals (11.8%) were Hispanic or Latina, 97 individuals (9.8%) were Black, 24 participants (2.4%) were American Indian or Alaska Native, 12 individuals (1.2%) were Native Hawaiian or Pacific Islander, and 1 participant (0.1%) was of unknown race and ethnicity.
“In this national cohort study, the OTC availability of a progestin-only OCP was associated with increased uptake among individuals at high risk of unintended pregnancy, including those who were previously nonusers or using less-effective methods,” concluded the study authors. “These findings suggest that removing prescription requirements for OCPs can expand contraceptive access, particularly for underserved populations, such as the uninsured and those in rural areas.
“As reproductive health care access faces growing threats, OTC contraception offers a promising strategy to support reproductive autonomy and reduce disparities in contraceptive use. Improving community awareness of this option and insurance reimbursement policies will be essential to ensure equitable access and sustained impact.”
References
1. 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
2. Hollan M. President Trump Targets Pharma DTC Advertising. Pharmaceutical Executive. September 10, 2025. Accessed September 15, 2025. https://www.pharmexec.com/view/trump-targets-pharma-dtc-advertising
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