No prescription? No problem. Birth control pills hit shelves.

For the first time in the United States, a birth control pill is available to women without a prescription, expanding access to people who have difficulty seeing a health care provider or choose not to. 

As states across the country grapple with abortion rights – whether protecting, restricting, or banning abortion – contraception exists in a less controversial space. But in the greater conversation about reproductive health care, advocates call this over-the-counter option crucial. 

“We still have health care deserts across the country,” says Cathren Cohen, staff attorney at the UCLA Law Center on Reproductive Health, Law, and Policy. “And so being able to just go directly to the pharmacy and purchase it there is a really amazing opportunity and very important.”

Some people are voicing reservations about the unrestricted access to the hormone drug, Opill, especially for teenage girls. Removing medical doctors from the care chain, say detractors, leaves women to navigate reproductive health on their own. 

“Making it an over-the-counter option really just furthers this one size fits all approach that has underserved women for so long,” says Emma Waters, senior researcher with The Heritage Foundation. “[Opill] doesn’t empower them in the ways that it seeks to.”

Maria had her mom for guidance. The 19-year-old University of San Francisco student went on birth control last summer, after her first year away at college. She had to wait until she got back home to Chicago so she could see her family doctor for a prescription. 

“Before last year, I didn’t have insurance. I didn’t have an established doctor here,” says Maria, who withheld her last name for privacy. Over-the-counter birth control, she says, “would have come in handy.”

Now, that’s an option. And it’s as easy as clicking on Amazon. 

Choices of contraceptive

Opill’s main ingredient – norgestrel – has been in use since 1973, with a prescription. It’s also called the “mini pill” because it contains only one hormone (most birth control pills have two). The Food and Drug Administration approved it for nonprescription sales in July 2023. The once-a-day oral medication became available online in March, when it also started shipping to stores.

The cost is $19.99 for a one-month supply, or $49.99 for three months. The relatively low price makes it affordable for most women, without insurance. 

A 2022 survey shows 90% of women ages 18 to 49 have used contraception. There are a dozen different types: shots, pills, and implants for women, which all require prescriptions; sterilization procedures for both men and women; and barrier methods, like condoms. Emergency contraception (certain types are commonly called “morning-after pills”) does not require a prescription – but the $50 price tag is high for some. Other women simply track their own menstrual cycle to avoid unwanted pregnancies. 

An analysis of the most recent data from the Centers for Disease Control and Prevention shows more than a third of females age 15 to 49 who use contraception rely on sterilization. Another 21% use birth control pills, followed by long-acting reversible contraception (16%), like IUDs and implants. 

Maria, in San Francisco, chose a “rod” – or small implant – that goes in her upper arm and releases hormones to provides birth control over an extended period of time. “It was one time, and I’m done for three years,” she says.  

Safer than nothing?

Some people try more than one prescription before finding the right fit. And sex isn’t the only reason they initially seek it out. 

Seventeen-year-old Kat said that she wanted to try birth control pills to mitigate uncomfortable periods, so her mother took her to a doctor who provided a prescription. The Bakersfield High School student has since become sexually active and says that the safeguards of being on birth control outweigh any concerns she has about possible side effects. This can be especially true, she says, for other teens who may not have a trusted adult to turn to. 

“They might have really strict parents and they are trying to rebel, or they just want to try new things, you know?” says Kat, who also wanted her last name kept private. “I feel like [Opill] is safer” than using nothing.

Maria, too, says Opill is a good option for people with limited options – like women in rural or impoverished communities, and “especially in some states where they don’t have access to abortion but they were to get pregnant,” she says. “This is just another preventative measure for those people.” 

By one estimate, 19 million women live in “contraception deserts” – areas without easy access to a health clinic that offers a full range of contraception. It’s in that context, says Ms. Cohen, that nonprescription birth control is especially important.

In the wake of the U.S. Supreme Court’s decision that allows states to govern abortion policy, many states have restricted care. Existing providers are struggling to meet patients’ needs, says Ms. Cohen, and over-the-counter birth control “is a safe and valuable opportunity for people to access contraception without needing to make, wait for, or pay for a doctor’s appointment that will surely help increase access to care.”

It’s those women – living in marginalized communities – who face the greatest disadvantage when looking for contraceptive care, says Ms. Waters, who warns that the new, over-the-counter access encourages a laissez-faire approach to birth control. “We’re basically telling women that they don’t need time with a doctor,” she says. “Their concerns, whatever they are, whatever their motivation is in using birth control, are something that they can handle on their own.” 

The role of pharmacies

A 2022 study shows nearly 90% of Americans live within 5 miles of a pharmacy. And as of last year, the use of retail health clinics – the ones found inside a pharmacy like CVS or Walgreens – was up 200% over five years. More than half of states empower pharmacists to write prescriptions for birth control.

A different survey found more than three-fourths (77%) of women ages 18 to 49 believe birth control should be available without a prescription if research proved it to be safe and effective. In addition to being approved by the FDA, Opill is endorsed by the country’s major medical associations. 

By all accounts, Opill is not for everyone. And whether or not they consult a medical specialist, most women have an abundance of information at their fingertips. 

“It varies for everyone,” says Maria. “I mean, we all have access to Google nowadays.”