- In 2023, the FDA approved Opill, the first over-the-counter oral contraceptive that became widely available at in-person and online pharmacies.
- Researchers examined whether Opill increased birth control access and found that the pill has helped more women to begin or improve their birth control.
- Experts say access to birth control is especially important as access to safe and legal abortion remains restricted in many parts of the U.S.
In 2023, the Food and Drug Administration (FDA)
Opill is a progestin-only once-daily oral contraceptive that does not contain estrogen and is 91% effective at preventing pregnancy.
This form of birth control works by thickening cervical mucus, preventing the sperm from reaching the egg. It may additionally stop the egg’s release from the ovary.
For the first time, a large study highlights the impact of Opill by examining whether access to an over-the-counter birth control option has improved since its FDA approval.
According to researchers at Oregon Health & Science University, there is good news: Opill reached many people who previously did not use any contraception or relied on less-effective methods.
The findings were more pronounced among underserved populations such as uninsured people, adolescents, and those living in rural areas. The results of this nationally representative study were published on August 18 in
The research looked at nearly 1,000 people ages 15 to 45 in 49 states who received oral contraceptive pills between April 2024 and February 2025.
About one-third of this group purchased over-the-counter birth control through either a large pharmacy chain or through Opill’s online retailer. Two-thirds of subjects obtained a prescription from a healthcare professional.
Compared with prescription users, those who used OTC birth control pill were more likely to:
- be uninsured (32% vs. 4%)
- live in rural areas (14% vs. 8%)
- be adolescents ages 15 to 20 (14% vs. 7%)
- identify as Black or Latina
- have lower levels of formal education
- reside in Southern states
As the study authors note, these groups are more likely to face obstacles to obtaining a prescription for contraception.
Those who used OTC birth control were also more likely to have been pregnant or given birth before. They reported having sex more often but were less likely to have received contraceptive counseling in the past year.
By contrast, prescription users were more likely to already be using highly effective methods
The biggest impact of expanded OTC birth control access, however, was in helping people start or upgrade their contraception:
- Among those not using any modern method before, 42% of OTC birth control users started the pill, compared with only 11% of prescription users.
- Among those previously using less effective methods, 49% of OTC birth control users switched to the pill, compared with 8% of prescription users.
In other words, people who might otherwise go without reliable contraception were much more likely to begin or improve their birth control use when the pill was available over-the-counter.
Carly Ross, MD, an OB-GYN and Winx Health advisor specializing in patient advocacy and accessibility, said that access to contraception is essential.
“With reproductive rights facing increasing restrictions, prevention is more important than ever,” she told Healthline. “We’re seeing women lose autonomy over their bodies while simultaneously facing reduced access to comprehensive reproductive care — with nearly 19 million women living in reproductive care deserts.”
Ross added that birth control is about more than just pregnancy prevention. “[It] gives women the power to plan their futures, their careers, and their families on their terms,” she said.
“When accurate information about our bodies is being erased from public websites and over a third of states don’t require medically accurate sex education, we’re setting people up to make uninformed decisions about their health,” she noted.
Increasing accessibility, whether that’s through OTC birth control pills or other types of reproductive healthcare, is crucial for empowering women in their healthcare choices, Ross said.
In addition to pregnancy prevention, hormonal contraception can also help with the management of certain chronic health conditions, including endometriosis.
If you’re interested in learning more about the best form of birth control to suit your needs, talk with your doctor.
If you make an informed decision that doesn’t require a prescription, OTC birth control is widely available at large chain pharmacies and big-box retailers.
Sadia Saeed, MD, a physician at Welzo, noted that many of these retailers provide online ordering for in-store pickup or delivery.
“In areas where local access is limited, reputable online pharmacies and telehealth services can ship directly to your home,” Saeed told Healthline.
If you do go this route, however, Saeed cautioned that you should ensure you’re obtaining OTC birth control from a licensed retailer that carries only FDA-approved products.
You can also ask your pharmacist before you make your purchase. Even though these medications are OTC, a pharmacist can still provide invaluable information, Saeed said.
“They can guide you on correct usage, potential side effects, and interactions with other medications, ensuring both safety and effectiveness,” she explained.
The FDA’s approval of Opill as the first over-the-counter birth control pill marked a turning point in contraceptive access in the United States.
As new research shows, the impact of OTC birth control availability is reaching those who need it most — uninsured individuals, young people, and those living in rural or underserved areas.
For many, OTC birth control provides an opportunity to use reliable contraception or switch from less effective methods.
Experts emphasize that access to birth control is not only about preventing pregnancy but also about supporting people’s ability to make decisions about their futures, families, and health on their own terms.
As Opill becomes more widely available, it may help close gaps in access and give more people the freedom to choose safe, effective contraception.
