The FDA approved Opill® as the first over-the-counter (OTC) progestin-only pill (POP) in July 2023, offering potential to expand contraceptive access. However, approval alone does not ensure equitable access, particularly for young adults, who may face structural, financial, informational, and psychosocial barriers. Without addressing these barriers, OTC POP may primarily benefit those with existing access to oral contraception, leaving inequities unaddressed. This study aims to provide evidence to inform policies and practices that advance equitable access to OTC POP for young adults. Using five years of longitudinal data from participants in the REACH Youth Study—a diverse cohort of young adults in Texas and California—we will assess how prior contraceptive experiences and structural barriers shape awareness, interest, and concerns about OTC POP. Our aims include examining whether OTC POP reaches young adults with structural barriers to care, evaluating cost-related barriers, and exploring how prior contraceptive experiences impact youth perceptions of OTC POP. We will also conduct in-depth interviews with young adults who prefer oral contraceptive pills, which will provide deeper insights into barriers and facilitators to OTC POP access. The findings will inform strategies for equitable implementation of OTC POP. By centering youth-engaged approaches and equity-informed principles, this research seeks to advance contraceptive access and autonomy for young adults facing systemic barriers.