Over-the-counter birth control pills have been available in the US for over a year. Here's who's using them

CNN

2 days ago

About two years after the US Food and Drug Administration approved the first over-the-counter birth control pill in the United States, a new study suggests that many people who may not have had access to contraception before are now using the over-the-counter option.
More than a quarter – 26.2% – of people now using over-the-counter oral contraceptives were using no modern method of birth control before, according to the study published Monday in the medical journal JAMA Network Open.
People relying on the over-the-counter birth control pill, which requires no prescription, are more likely to be uninsured, adolescents and living in rural areas, the study found.
Not having health insurance and residing in rural areas are two of the main barriers for people trying to access any health care, said the study's lead author, Dr. Maria Rodriguez, professor of obstetrics and gynecology at Oregon Health & Science University in Portland and director of the OHSU Center for Women's Health.
In July 2023, the FDA approved the birth control pill Opill to be available over-the-counter, making it the first nonprescription birth control pill available in the United States.
In March 2024, the first shipments of Opill were sent to distributors, major drug stores and pharmacies. The pills became available in many retail pharmacy chains such as CVS, Walgreens and Walmart, costing $19.99 for a one-month supply, $49.99 for a three-month supply and $89.99 for a six-month pack.
'This pill is basically reaching the exact populations that need it the most, people with structural barriers to health care, and people that are at the greatest risk for the harms that come along with unintended pregnancy, in a country where we have a maternal health crisis and access to safe abortion is limited,' Rodriguez said.
Rodriguez and her OHSU colleagues surveyed 986 people, ages 15 to 45, using an online questionnaire, asking specifically about their contraceptive use. The study participants were from 49 states, Rodriguez said, and they had obtained some form of oral contraceptive pills at pharmacy stores or online between April 2024 and February 2025.
The researchers found that 32.5% of the study participants had used over-the-counter birth control pills. The survey data showed that having access to over-the-counter birth control pills was associated with an increase of 31.8 percentage points in switching to using the over-the-counter pill after using no contraception.
'Giving that choice to people who can become pregnant, to control their own access to contraception, I think is really powerful,' Rodriguez said. 'It's also something that is done around the globe. The US is really delayed in making a form of oral contraception available over the counter. Over 30 countries around the world have had this available for use for many years, and we know that it's safe and effective.'
The survey data also revealed that one of the most common reasons why the study participants said they were using the over-the-counter birth control pill was because it did not require a doctor's appointment to get a prescription.
'Not having insurance makes it a lot harder to be able to afford to get into a clinic to get any kind of care that's preventative,' Rodriguez said, adding that people living in rural areas often have limited options for reproductive health care. 'We're seeing that with labor and delivery units closing due to costs, a shrinking of the contraceptive workforce, and then there's the suggestion that we also are seeing some providers leaving states post-Dobbs too, all of which is impacting contraceptive access for people.'
The researchers wrote that their study provides a 'first look' at who is using over-the-counter oral contraceptive pills, 'as the method has been available in the US for only approximately a year.'
And while the study estimates what the early uptake of over-the-counter birth control pills has been in the past year, more research is needed to assess how that uptake may change over time and what impact it may have on unintended pregnancy rates.
Opill was approved by the FDA without age restrictions and is 'suitable for most people of reproductive age to use to prevent pregnancy,' according to its website. Opill works as a 'mini-pill,' using only the hormone progestin to prevent pregnancy. It's a different formulation than what is in combination hormonal birth control pills, which contain both progestin and estrogen.
Combined birth control pills may carry risks for people with uncontrolled hypertension or blood clot risks for smokers older than 35. Contraindications for progestin-only pills include conditions such as breast cancer or liver disease, or the use of certain medications.
When taken as directed at the same time every day, Opill has been found to be 98% effective at preventing pregnancy, according to Perrigo, the company behind the product. Most birth control pills are up to 99% effective at preventing pregnancy if taken as instructed every day.
Last year, when Opill first became available, public health experts anticipated that it would benefit women living in remote rural areas, Dr. Anne-Marie Amies Oelschlager, professor of obstetrics and gynecology at the University of Washington School of Medicine, who specializes in adolescent care, said at the time.
'The biggest population that will benefit from this are those who have limited access to contraception in the first place,' Oelschlager said last year. 'There are a lot of people in our country that live in what we would call contraceptive deserts, and these are areas where they have limited to no access to a reproductive health care provider, meaning they'd have to drive really far away to be able to access a provider.'
The more avenues through which people can access contraception – whether it's over the counter in a store or online – the more control they can have over their reproductive health and choices, Megan Kavanaugh, a principal research scientist at the Guttmacher Institute, a nonprofit that has been tracking the rollout of Opill, said last year.
'It's a huge milestone that Opill is available over the counter,' she said last year. 'And I think we should really celebrate the milestone, and we should situate this milestone on this trajectory of always wanting to move towards increased access for all people.'