What over-the-counter access to Opill could mean for transgender, nonbinary, and gender-expansive people in the United States
Ibis Reproductive Health operates Free the Pill, a project that has been working to bring birth control pills over the counter in the United States since 2004. You can learn more about Free the Pill here, and learn more about Ibis’s portfolio of research related to trans and gender-expansive (TGE) people’s access to reproductive health care services here.
This Pride Month, we celebrate the LGBTQ+ community and honor the trans and gender-expansive activists who fought for their right to bodily autonomy during the Stonewall Uprisings and those who continue this fight today. And as trans, gender-expansive, and LGBTQ+ folks continue to face heightened attacks and discrimination across the country, we are reminded that all struggles for freedom and bodily autonomy are intertwined. Earlier this week on Juneteenth, we honored the enduring strength and resilience of the Black community and reflected on the long journey toward freedom and racial justice. And on Monday, June 24th, we will reflect on two years since the Supreme Court’s decision in Dobbs v. Jackson Women’s Health Organization devastated access to abortion care across the United States.
As we grapple with these attacks, we know that sexual and reproductive justice cannot be advanced without the liberation of Black and LGBTQ+ communities. Ibis is committed to advancing reproductive autonomy, choices, and health through collaborative, principled partnerships with advocates and other change champions to shift power to communities that face the greatest barriers to access. Both Ibis’s Free the Pill project and our trans and gender-expansive (TGE) research portfolio exemplify this unique approach.
Understanding interest in over-the-counter progestin-only birth control pills among transgender, nonbinary, and gender expansive individuals
The Free the Pill coalition—a group of more than 200 reproductive justice advocates, researchers, youth activists, health care providers, and others — has been working since 2004 to bring birth control pills over the counter in the United States and ensure that they are affordably priced, fully covered by insurance, and accessible to people of all ages. Meanwhile, working in partnership with transgender, nonbinary, and gender-expansive (TGE) leaders and community organizations, Ibis’s TGE portfolio has documented the urgent need for investment in safe, affirming, and inclusive care for TGE individuals. In 2019, the two projects teamed up in partnership with The PRIDE Study to explore interest in over-the-counter (OTC) progestin-only birth control pills (POPs) among transgender, nonbinary, and gender-expansive individuals assigned female or intersex at birth. In February, they published their findings — one of the only studies published on this topic.
Researchers surveyed 1,415 transgender, nonbinary, and gender-expansive people assigned female or intersex at birth who were between the ages of 18 and 49 from across the United States. They found that almost half of respondents reported interest in using OTC POPs. Interest was higher among the following demographics:
🧡 young people (aged 18–24)
💛 folks who were uninsured
💚 those with education up to a high school degree
💙 folks currently using birth control pills
💜 folks who had used POPs before; and
🤎 those who wanted to avoid estrogen generally or specifically because they viewed it as a “feminizing” hormone.
These study findings demonstrate that the availability of OTC POPs has the potential to improve contraceptive access for transgender, nonbinary, and gender-expansive (TGE) individuals. The study data can also aid policymakers, health care providers, drugstore owners, and community members in understanding that TGE people are interested in OTC progestin-only birth control, and to ensure that TGE folks are meaningfully represented in further research and outreach efforts.
The promise of Opill — and the continued importance of equitable access
In March 2024, the first-ever over-the-counter birth control pill in the United States, a progestin-only birth control pill called Opill, became available nationwide. This groundbreaking advancement in reproductive health is a game-changer for contraceptive access in the United states, especially for the communities that currently that face the most barriers to sexual and reproductive health care due to systemic oppression, including trans, nonbinary, and gender-expansive folks, as well as other members of the LGBTQ+ community. Especially in the face of increasing restrictions on trans-inclusive care across the country, OTC and self-managed options like over-the-counter birth control pills can allow greater autonomy and decision-making for TGE folks, breaking down barriers to access.
But to ensure equitable access, Opill must be fully covered by insurance, affordably priced, and stocked nationwide without barriers. Free the Pill continues to advocate for policies that will ensure everyone can access the contraceptive care that they need, without barriers or stigma. You can learn more about Free the Pill’s advocacy for equitable access on their website.
