Modeling the Impacts of Price of an Over-the-Counter Progestin-Only Pill on Use and Unintended Pregnancy among U.S. Women

Published:April 13, 2020DOI:



      To model the impacts of out-of-pocket cost of an over-the-counter (OTC) progestin-only pill on use and associated unintended pregnancy among U.S. women.

      Study Design

      Using data from a 2015 nationally representative survey of 2,539 U.S. women aged 15 to 44 assessing interest in using an OTC progestin-only pill, we used discrete survival analysis and a Markov model to analyze women's likelihood of using of an OTC pill at different price points and by sociodemographic characteristics. We modeled the impact of product price on the potential total number of U.S. users and on unintended pregnancies in 1 year among adult women at risk of unintended pregnancy.


      In a model assuming no out-of-pocket costs, more than 12.5 million adults and 1.75 million teens reported likely use of an OTC progestin-only pill if available. Among adults, this resulted in an estimated 8% decrease in unintended pregnancy in 1 year. Adult and teen women on average were willing to pay $15 and $10, respectively, resulting in 7.1 million adult and 1.3 million teen users and an estimated 5% decrease in unintended pregnancy among adults.


      At low and no out-of-pocket cost, a large population of women in the United States might likely use an OTC progestin-only pill. A low retail price and insurance coverage are necessary to provide equitable access to this method for low-income populations across the United States, fill current gaps in contraceptive access, and potentially decrease unintended pregnancy.
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      Alexandra Wollum, MPH, is a Senior Project Manager at Ibis Reproductive Health. Her research focuses on improving reproductive health in underserved communities and exploring innovative approaches to increase reproductive health access.


      James Trussell, PhD, was emeritus professor of Public and International Affairs at Princeton University. He authored or co-authored more than 350 scientific publications, primarily in the areas of reproductive health and demographic methodology.


      Daniel Grossman, MD, is the Director of Advancing New Standards in Reproductive Health at the University of California, San Francisco. His research focuses on improving access to contraception and safe abortion and evaluating the impact of integrating reproductive health and HIV services.


      Kate Grindlay, MSPH, is an Associate at Ibis Reproductive Health and Project Director of the Free the Pill project. She oversees the implementation of a program to move an oral contraceptive pill over the counter in the United States.