Over-the-Counter Oral Contraceptive Use and Initiation of Contraception

Area of Science:

• Reproductive Health
• Public Health Policy
• Contraception Access

Background:

• The US FDA approved the first over-the-counter (OTC) oral contraceptive pill (OCP) in 2023.
• Assessing the impact of OTC OCPs on individuals facing systemic barriers to care is crucial.

Purpose of the Study:

• To evaluate if the OTC progestin-only OCP reaches individuals not previously using contraception.
• To assess if OTC OCPs reach those relying on less-effective contraceptive methods.

Main Methods:

• Cross-sectional study using baseline data from a national prospective US cohort (April 2024-February 2025).
• Included individuals aged 15-45 obtaining OCPs (prescription or OTC) for contraceptive use.
• Used multivariable logistic regression to analyze outcomes.

Main Results:

• 32.5% of participants used OTC OCPs.
• OTC users were more likely to be uninsured and reside in rural areas.
• OTC access increased initiation of contraception by 31.8% and transition from less-effective methods by 41.0%.

Conclusions:

• Many individuals using no method or less-effective contraception accessed OTC OCPs.
• OTC availability of oral contraceptives may enhance equitable access.
• Findings support the public health impact of expanded contraceptive access.