More than a year after the first over-the-counter birth control pill became available in the United States, new research suggests the option is reaching populations that previously faced barriers to contraception.
A study published Monday in JAMA Network Open found that over a quarter (26.2%) of people currently using nonprescription oral contraceptives had not been using any modern birth control method beforehand. Those most likely to rely on the pill without a prescription were uninsured, adolescents, and individuals living in rural areas.
“Not having health insurance and living in rural communities are two of the biggest barriers to accessing health care,” said Dr. Maria Rodriguez, lead author of the study and professor of obstetrics and gynecology at Oregon Health & Science University.
The pill, sold under the brand name Opill, received FDA approval in July 2023 and became the first nonprescription birth control pill in the U.S. It began shipping to major retailers in March 2024, with prices ranging from $19.99 for a one-month supply to $89.99 for a six-month pack.
Rodriguez emphasized that the pill is reaching people who need it most. “In a country facing a maternal health crisis and restricted abortion access, this option gives people more control over preventing unintended pregnancies,” she said.
Survey Shows Growing Uptake
The research team surveyed 986 people between ages 15 and 45, spanning 49 states, about their contraceptive use. They found that 32.5% had used the over-the-counter pill. The option was especially appealing to those without insurance or access to a prescription provider, with participants noting that avoiding a doctor’s visit was a key reason for choosing Opill.
Access gaps remain a major concern across the country. According to Rodriguez, rural areas are seeing maternity units close, reproductive health providers leave certain states, and fewer resources overall for preventive care. “This is contributing to what many experts call ‘contraceptive deserts,’” she noted.
Safe and Effective Option
Opill is a progestin-only “mini-pill,” different from combination pills that also contain estrogen. While combination pills carry risks for certain groups, such as older smokers or people with hypertension, progestin-only pills are considered safe for most users of reproductive age. Contraindications include breast cancer, liver disease, or certain medication interactions.
When taken at the same time daily, Opill is 98% effective in preventing pregnancy, according to manufacturer Perrigo.
A Milestone in Contraceptive Access
Experts say the introduction of Opill is especially significant for people in areas with limited access to reproductive health care. “The biggest population that will benefit from this are those living in what we call contraceptive deserts,” said Dr. Anne-Marie Amies Oelschlager, professor of obstetrics and gynecology at the University of Washington.
Advocates argue that greater availability—both online and in stores—empowers people to make their own reproductive health decisions. “This is a huge milestone,” said Megan Kavanaugh, principal research scientist at the Guttmacher Institute. “It represents a critical step forward in expanding contraceptive access for all.”
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