ACOG Recommendations on Over-the-Counter Hormonal Contraception

The American College of Obstetricians and Gynecologists (ACOG) has expanded its recommendations on over-the-counter access to hormonal contraception. ACOG believes that vaginal rings, the contraceptive patch, and depot medroxyprogesterone acetate (DMPA) injections are safe and should be available over the counter with no age restrictions, according to updated guidance released today.

This broadens and replaces ACOG’s Committee on Gynecologic Practice’s initial recommendation that oral contraceptives be available over the counter. The updated recommendations acknowledge that regulatory action needs to take place to achieve over-the-counter access. ACOG also recognizes that some states are currently implementing direct access to hormonal contraception at pharmacies or through online ordering, but over-the-counter access should be the ultimate goal.

“A prescription is an unnecessary obstacle for some women to get their preferred contraceptive method. Over-the-counter hormonal birth control would be a step toward greater access to an essential component of women’s health care and give adolescents and women more options to manage their reproductive health,” said Rebecca H. Allen, MD, MPH, an ACOG committee member who helped update the opinion. “Over-the-counter access to hormonal contraception will improve availability, but it should not be at the expense of affordability. Insurance coverage and other financial support for contraception should still apply. Each woman should be able to select the contraception that works best for her, including over-the-counter hormonal contraceptives, a long-acting reversible contraceptive provided by her health care provider, or other methods.”

The Committee Opinion says that any plan to make contraception available over the counter should address the issue of cost, including for women whose insurance currently covers their preferred method. It also says there is no medical or scientific justification to limit access to over-the-counter contraception based on age.

ACOG reiterates that women should still see a gynecologist each year for a well-woman health assessment—which can include discussing reproductive health plans, a pelvic or breast exam, cervical cancer screening, or sexually transmitted infection testing—but obtaining contraception does not require an exam or office visit.

“The need to consistently obtain a prescription, get a refill approval, or schedule an appointment can lead to inconsistent use of a preferred birth control method,” said Michelle Isley, MD, MPH, who coauthored the opinion. “Making more methods available over the counter would lead to reliable, equitable access for more women. A move to over-the-counter status would complement, not replace, policies that ensure availability of the full range of contraceptive options and safeguard access to a robust network of qualified family planning providers.”