Two years ago, the Food and Drug Administration approved the sale of an over-the-counter birth control pill for the first time in the United States without a prescription.

A nationwide study in the journal JAMA Network Open reveals the decision has dramatically improved access to contraception, especially among women who otherwise would have had no birth control at all, either because they lack insurance or routine access to health care. The study was conducted by researchers at Oregon Health & Science University.

The study surveyed 986 people in 44 states who obtained the OTC pill either online or at a pharmacy and compared outcomes with people using the pill by prescription.

The research team found a 31.8 percentage point increase in people who shifted to the pill after using no contraceptive method.

The majority of OTC pill users were not using a method of contraception, or a much less effective method, and reported it was extremely important to them to avoid pregnancy.

“This is one of the first studies to show that over-the-counter birth control pills are reaching the very people they’re meant to help—those who face the greatest barriers to care,” said lead author Maria Rodriguez, M.D., M.P.H., professor of obstetrics and gynecology in the OHSU School of Medicine and director of the OHSU Center for Women’s Health.

Among the group accessing the oral contraceptive pill over the counter, researchers found higher rates of use among racial and ethnic minority groups, adolescents, the uninsured and Medicaid recipients.

“At a time when pregnancy is becoming even more dangerous in the United States—especially for people of color, those with low incomes, and those living in rural communities—our findings underscore that OTC contraception is a powerful tool for reproductive autonomy,” Rodriguez said.

Rodriguez noted that the U.S. Supreme Court’s decision in 2022 to overturn constitutional protection for access to abortion has decreased access to abortion and contraception, especially for populations at the highest risk for maternal morbidity and mortality. This study suggests that the OTC birth control pill is helping to address the gap in contraceptive access for the populations with the greatest barriers to care.

The study notes that it costs about $50 for a three-month supply of the daily oral medication.

“These findings suggest that removing prescription requirements for [the oral contraceptive pill] can expand contraceptive access, particularly for underserved populations, such as the uninsured and those in rural areas,” the authors conclude.

“As reproductive health care access faces growing threats, [over-the-counter] contraception offers a promising strategy to support reproductive autonomy and reduce disparities in contraceptive use.”