OTC Access to Oral Contraceptives May Improve Equitable Contraception Use: JAMA
USA: Researchers have found in a new cross-sectional U.S. study that many individuals obtaining oral contraceptives over-the-counter had previously used no method or less-effective contraception, suggesting OTC availability could enhance equitable access.
The study, published in JAMA Network Open by Maria I. Rodriguez and colleagues from the Center for Reproductive Health Equity at Oregon Health & Science University, assessed how the introduction of non-prescription oral contraceptives is influencing contraceptive choices across diverse populations. With the U.S. Food and Drug Administration's approval of the first over-the-counter progestin-only oral contraceptive pill (OCP) in 2023, the research aimed to determine whether this pathway is reaching those who face systemic barriers to traditional healthcare.
The cross-sectional study analyzed baseline data from a national cohort of 986 participants aged 15 to 45 years who obtained OCPs between April 2024 and February 2025, either through pharmacies or online. Participants were at risk of pregnancy and were using OCPs for contraceptive purposes. Among the group, 320 individuals (32.5%) accessed their contraceptives through the OTC route, while the remainder relied on prescriptions.
The following were the key findings of the study:
- Individuals using OTC contraceptives were more likely to face structural disadvantages.
- Uninsured individuals comprised 31.6% of OTC users, compared with 3.5% of prescription users.
- Rural residents were more common among OTC users (14.4% vs 8.4%).
- Adolescents were more likely to use OTC options, showing benefits for younger groups with limited access to health services.
- Fertility preferences did not differ significantly between OTC and prescription groups.
- OTC access was linked to a 31.8 percentage point increase in transitioning from nonuse of contraception to an effective method compared with prescription users.
- OTC use was associated with a 41.0 percentage point increase in shifting from less-effective methods, such as condoms or emergency contraception, to oral contraceptive pills.
The authors emphasized that these patterns illustrate how OTC availability is enabling underserved populations to access effective contraception. “By removing prescription barriers, oral contraceptives are reaching individuals who might otherwise remain unprotected against unintended pregnancies,” the researchers noted.
While the findings emphasize the promise of OTC contraceptives, the authors also stressed the importance of broader awareness and supportive policies. Insurance reimbursement for OTC contraceptives and educational efforts to inform communities about their availability will be crucial for sustaining equitable access.
The study demonstrates that OTC oral contraceptives are not only increasing uptake among individuals at risk of unintended pregnancy but are also serving populations that historically face barriers to reproductive health care, including adolescents, uninsured individuals, and those living in rural areas. As restrictions on reproductive health care continue to evolve across the U.S., expanding OTC access offers a practical and impactful strategy to promote reproductive autonomy and reduce disparities in contraceptive use.
Reference:
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
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