Women's attitudes toward over-the-counter oral contraceptive pills: A cross-sectional survey

To characterize women's attitudes toward the first FDA-approved over-the-counter (OTC) daily oral contraceptive (OCP) in the United States and identify demographic and clinical predictors of those attitudes.

We distributed a cross-sectional survey via patient portal to female patients aged 18-50 years at Mayo Clinic sites in Arizona, Minnesota, and Florida (August-December 2025), assessing attitudes across six domains: first-choice consideration, backup use, trust in safety, trust in effectiveness, willingness to re--, and policy support. We used multivariable logistic regression to examine predictors of agreement, adjusting for age, race/ethnicity, marital status, education, sexual orientation, and prior or current progestin-only pill use.

Among 4931 respondents, policy support was high (84.9%), but first-choice willingness (42.9%) and willingness to re-- (44.9%) were substantially lower. Trust in safety (59.9%) and effectiveness (57.4%) were moderate. Older respondents (35-50 years) showed higher odds of trust and willingness to re-- than 25-34 year-olds; 18-24 year-olds showed lower trust. Lower educational attainment was associated with reduced trust and support. Black non-Hispanic respondents had lower odds of trusting safety (aOR 0.54, 95% CI 0.36-0.83) and policy support (aOR 0.54, 95% CI 0.33-0.88).

Broad policy support for OTC OCPs does not uniformly translate to personal trust or willingness to use, with significant variation by demographics; however, findings are from a predominantly White, highly educated, portal-based sample and may not generalize to populations most likely to benefit from OTC access. Equity-oriented implementation should incorporate evidence-based labeling, user education, and accessible decision-support tools to address trust gaps.

While many women support over-the-counter oral contraceptive availability, trust and willingness to use vary by age, education, and race/ethnicity. Clinicians should proactively address safety and effectiveness concerns and provide targeted, culturally responsive counseling about OTC contraceptive options.