In March 2024, an oral contraceptive pill (OCP) became available over the counter (OTC) for the first time in the United States. This change has the potential to make birth control more accessible, especially for adolescents and young adults, who often face barriers to obtaining contraception.
However, it’s unclear whether young people know about this new option, what they understand about it, and what challenges they may still face in using it.
To better understand these issues, a study conducted by University of Michigan researchers with MyVoice National Poll of Youth data polled 761 young people aged 14 to 24 from across the U.S., with 559 answering at least one question. About half of the respondents identified as female, and 20% were under age 18. The survey aimed to find out how aware young people were of the OTC OCP, what they knew about it, and what they saw as the main facilitators and barriers to its use.
Results are published in the paper, “Adolescents’ awareness, knowledge, and perceptions of an over-the-counter oral contraceptive pill” in the journal Contraception. First author is Alana K. Otto, MD, MPH, of the Department of Pediatrics at U-M; other authors include Lotte Brewer, MPH, of the Division of Community Health at the University of Illinois – Chicago; Victoria Tsao, a U-M Medical School student; Bianca Allison, MD, MPH, of the Department of Pediatrics at the University of North Carolina School of Medicine; and Julie Maslowsky, Ph.D., of the Department of Health Behavior and Health Equity at the U-M School of Public Health.
The results showed that most young people (72%) had not heard of the OTC OCP, nor did they know it was available. Only about a quarter (26%) had heard of the pill, and even fewer could provide specific information about it. Among those who had heard of it, cost and affordability were their most common concerns.
When asked what might prevent young people from using the OTC OCP, the most common answers were concerns about potential risks (32%) and the cost (32%).
“Making it low-cost, especially for young people if they are trying to purchase them discreetly without their parents knowing, they’re not going to have a lot of money to spend probably,” said a 21-year-old participant.
Some participants (13%) mentioned that legal or store policies, such as age restrictions or keeping the pill behind the pharmacy counter, could make it harder for young people to get the pill. Notably, there are no age restrictions on the purchase of the pill, and no identification is required to purchase it.
When asked what information would be helpful, more than half wanted to know about side effects and risks, while others wanted to know where to buy the pill, whether young people could purchase it, how effective it is, and how to use it.
When asked what might make it easier for young people to access the OTC OCP, many participants mentioned the importance of making the pill more affordable, such as through the availability of coupons or insurance coverage. Easy availability was also important, with participants wanting the pill to be accessible in many locations, including pharmacies, convenience stores, and online.
“I think availability of the pill in local drug stores would make it easy. I also think descrite (sic) packaging or the ability to get the pill delivered would make people a lot more comfortable purchasing it,” said a 19-year-old respondent.
Privacy was also a concern mentioned by 10% of respondents, who noted many young people would want to be able to buy the pill without others knowing. Most respondents (78%) said keeping the pill locked or behind the counter could negatively affect youth, with 25% saying it might deter them from buying the pill. Fifty-five percent expressed concern that having to interact with a store employee would prevent them from discreetly buying the pill.
A 21-year-old respondent spoke about the potential emotional distress that might come from having to ask others to obtain birth control.
“People my age have anxiety about talking to people and the embarrassment of having to ask can be enough to stop someone from buying it at all.”
A 15-year-old respondent talked about the stigma associated with taking birth control as a deterrent.
“(There’s) a fear of judgement from their peers or family members … . Sometimes it is seen as taboo to take birth control.”
The study found that while the OTC OCP could help address some barriers to contraception for young people, simply making it available without a prescription is not enough.
“There is a clear need for more information to be shared through clinicians, pharmacists, educators, and public health campaigns,” said the study’s first author Otto. “Information should cover not just how to use the pill and its side effects, but also where to buy it, how much it costs, and how to purchase it privately, such as online.
“It’s also important that young people know that although they may come across the pill locked in security boxes in stores, there are no age restrictions on the purchase of this pill, and no identification is required to buy it.”
Article cited: Otto, A. K., Brewer, L., Tsao, V., Allison, B. A., & Maslowsky, J. (2025). Adolescents’ awareness, knowledge, and perceptions of an over-the-counter oral contraceptive pill. Contraception, 111211. https://doi.org/10.1016/j.contraception.2025.111211