The potential impact of over-the-counter access to oral contraceptives to reduce unintended pregnancy

Over the past five years, several advances have been made in the provision of contraceptive services that have markedly reduced barriers to access. Unquestionably, the most important development is the contraceptive coverage guarantee under the Affordable Care Act, which requires most health insurers to cover all methods approved by the U.S. Food and Drug Administration (FDA) without cost sharing such as copayments or deductibles. In some settings where the cost barrier has been removed and counseling has focused on method effectiveness, the uptake of long-acting reversible contraceptives—including intrauterine devices and implants—has increased significantly. 

However, the next big thing in birth control is already making news before it is even available: over-the-counter (OTC) access to oral contraceptives. Unlike the contentious debate over the availability of OTC emergency contraception, there has been little argument about the safety and effectiveness of OTC daily oral contraceptives. Although this could certainly change as the debate intensifies (particularly concerning adolescent use of OTC pills and insurance coverage), the clear support for OTC access by medical groups such as the American Academy of Family Physicians (AAFP) and the American College of Obstetricians and Gynecologists (ACOG) has helped focus the discussion.