Expansion of OTC Contraceptive Could Fill Reproductive Health Disparities

For patients looking to obtain oral contraception, OTC options were more common among underserved individuals and those with less health care agency when compared with prescription contraceptives. Researchers’ findings show that increasing OTC contraceptive options could improve disparities in reproductive health care, according to a study published in Contraception.¹

“Access to contraception is an essential component of reproductive health care and of upholding the right to decide whether and when to have children,” wrote authors of the study. “Improving such access is imperative to reducing unacceptably high rates of reproductive health disparities in the US.”

According to the National Conference of State Legislatures, 65% of women aged 14 to 49 years use contraception.² While patients are offered a variety of protections to access contraception under the Affordable Care Act, experts have expressed concerns regarding access since the overturning of Roe v. Wade in 2022 with the Dobbs v. Jackson decision on abortion.³ 

READ MORE: Is It Safe for Birth Control Users to Go Years Without a Period?

Following the monumental 2022 Dobbs decision, federal legislators acted on the potential impacts this event could have on contraceptive access. In 2022 and 2024, federal legislation was introduced in Congress to protect contraceptive products and services in HB 8373 and S 4381.⁴

However, concerns about contraceptive access have persisted since the overturn on abortion, forcing patients to seek and secure long-term contraceptives as well as preventing pregnancy altogether as a result of the 2022 decision.⁵ Finally, amid the ongoing political debates surrounding abortion and contraception, patients may be growing increasingly wary of visiting their providers for fear of judgment and stigma.

Among the ongoing discourse regarding reproductive health for the past 3 years, researchers of the current study wanted to further understand disparities in oral contraceptives.

“Given the effect of individuals’ experiences during contraceptive visits on contraceptive choice, an OTC contraceptive pill that sidesteps a clinician visit may fill an important gap in improving contraception access,” they continued.¹ “To better understand the association between OTC pill use and contraceptive autonomy, we used three validated measures to evaluate the association between individuals’ experiences with reproductive health care and use of the OTC pill.”

Using a cross-sectional online survey, researchers explored patients 15 to 45 years old and their experiences obtaining oral contraceptive pills, either OTC or through a prescription. Researchers compared the characteristics of patients gravitating toward OTC pills with those that preferred prescription oral contraceptives.

The final analysis included 497 patients (median age, 26 years; 73.6% white). Of the 497 participants, 69.6% were single, 89.5% resided in urban locales, and 25.2% were using less effective or no modern contraception prior to the survey. Among the study population, 112 (22.5%) used OTC pills, while 385 (77.5%) used prescription contraceptives.¹

“Participants with lower contraceptive agency and lower endorsement of patient-centered counseling were more likely to use OTC compared to prescription birth control pills,” wrote the authors. “Users of OTC pills were a higher percent minority, from rural locations, and on Medicaid or uninsured.”

For disparities among minorities, Black patients were 13.2% more likely to use the OTC option, while Hispanics were 7.8% more likely. Users of the OTC option were also more likely to reside in rural locations, be insured by Medicaid, or be uninsured compared with the prescription pill.

The pre-existing disparities between OTC or prescription pill users at the baseline of the study further highlighted the need to improve overall contraceptive access.

“We also found significant differences in baseline contraceptive use,” they continued.¹ “While most prescription pill users were already using more or most effective methods, only a minority of OTC pill users were using effective methods at baseline.”

Overall, researchers determined that OTC pill users had significantly less agency and desire to access person-centered care than participants reporting prescription pill use. These disparities, and the contrast between OTC and prescription contraceptive users, highlight the need for improvements in increasing access to reproductive health care.

For women with low health care agency, negative health care experiences, and systematic characteristics that make contraceptive care a challenge, increasing access to OTC contraception can significantly improve women’s reproductive health.

“In this national cohort of reproductive-age individuals, those obtaining OTC pills reported lower contraceptive agency and less person-centered care compared with those with prescription access, demonstrating the potential of OTC pills to improve reproductive care access, particularly for those with prior negative health care experiences,” they concluded.¹ “Our findings underscore the importance of integrating person-centered, equitable approaches into contraceptive delivery models.”

READ MORE: Women’s Health Resource Center

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REFERENCES

1. Schaefer KM, Burns H, Swartz JJ, et al. Association of over-the-counter birth control pill use and contraceptive autonomy among oral contraceptive users. Contraception. October 27, 2025:111253. https://doi.org/10.1016/j.contraception.2025.111253

2. State contraception policies. National Conference of State Legislatures. September 29, 2025. Accessed November 7, 2025. https://www.ncsl.org/health/state-contraception-policies

3. Ranji U, Diep K, Sanchez BC, et al. Key facts on abortion in the United States. KFF. July 15, 2025. Accessed November 7, 2025. https://www.kff.org/womens-health-policy/key-facts-on-abortion-in-the-united-states/

4. Lord-Biggers M, Curhan T. The right to contraception in the United States. The Guttmacher Institute. September 2024. Accessed November 7, 2025. https://www.guttmacher.org/fact-sheet/right-to-contraception-in-us

5. Chernoby K, Gandal-Powers M, Borchelt G. birth control under threat: how birth control rights and access are being undermined since Roe v. Wade was overturned. April 9, 2025. Accessed November 7, 2025. https://nwlc.org/resource/birth-control-under-threat-how-birth-control-rights-and-access-are-being-undermined-since-roe-v-wade-was-overturned/