Association of over-the-counter birth control pill use and contraceptive autonomy among oral contraceptive users

To evaluate the association between individuals' experiences with healthcare and over-the-counter (OTC) pill use.

We conducted a cross-sectional online baseline survey of individuals aged 15-45 obtaining oral contraception (OTC or by prescription) for pregnancy prevention in a convenience sample across the United States (US). We collected demographic information, clinical information, and measured contraceptive autonomy using three validated measures: Contraceptive Agency Scale (CAS), the Person-Centered Contraceptive Care (PCCC) measure, and the Discrimination in Medical Settings (DMS) survey. We compared these characteristics between people using prescription and OTC pills and built logistic regression models to evaluate the association between OTC pill use and each of these three measures.

Our sample included 497 individuals (OTC 22.5%, n = 112; prescription 77.5%, n = 385) who received contraceptive counseling within the past year. Compared to participants with a prescription, users of OTC pills were older, more commonly uninsured (18.8% vs. 2.9%, p < 0.001), on Medicaid (24.1% vs. 10.1%, p < 0.001), and more likely to be Black (18.8% vs. 5.7%, p < 0.001). Less than half of OTC pill users were already using a more effective method of contraception prior to survey completion, compared to the majority of prescription users (47.3% vs. 82.9%, p < 0.001). Based on adjusted multivariable models, key autonomy outcomes of low contraceptive agency and non person-contraceptive care were both associated with increased probability of OTC pill use.

The OTC pill may fill an important gap in improving contraception access, particularly among individuals with past negative healthcare interactions.

Our study suggests that individuals reporting lower contraceptive agency and less person-centered care are more likely to use over-the-counter than prescription oral contraception. Expanding over-the-counter access may reduce barriers for marginalized populations with poor healthcare interactions, supporting more equitable contraceptive access across diverse demographic and insurance groups in the U.S.