University of Southern California (USC) researchers who conducted the study suggested that Dobbs v. Jackson Women’s Health Organization case had an even greater impact on women’s reproductive health than previously assumed.
The analysis published in the Journal of the American Medical Association Network Open determined that states that became the most restrictive after Dobbs and put a full ban on abortion in place also experienced significant declines in the number of prescriptions filled for birth control pills and ECs at retail pharmacies. These reductions were not observed in restrictive states whose policies were unchanged after the Dobbs decision, the authors pointed out.
As to why the decline might have occurred, lead author Dima M. Qato, PharmD, MPH, PhD, of the USC Alfred E. Mann School of Pharmacy and Pharmaceutical Sciences, advised that many family planning clinics with abortion services closed immediately after the Roe reversal—particularly in the most restrictive states.
“Because 11% of women rely on such clinics for the provision of prescriptions for contraceptives—many of which are filled at outside pharmacies—these closures may have reduced access to oral and emergency contraceptives,” Dr. Qato said.
In their cohort study involving more than 143 million prescriptions dispensed at U.S. retail pharmacies from March 2021 through October 2023, the researchers said that the Dobbs decision was associated with declines in fills for oral contraceptives—both daily oral contraceptive pills (OCPs) and ECs—in states that implemented the most restrictive policies with a full ban on abortion.
A year after Dobbs, declines were greatest for ECs, the authors added, noting that states that became the most restrictive had an additional 65% decrease in fills for ECs compared with states that kept moderate levels of abortion restrictions after Dobbs.
“These findings suggest that efforts to protect and improve access to oral contraceptives are needed, especially for emergency contraceptives in states where abortion is most strongly restricted,” the study team wrote.
Background information in the article recounts how the U.S. Supreme Court’s Dobbs decision allowed states to strengthen restrictions on abortion access, which led to the closure of many family planning clinics and has apparently led to confusion about the legality of ECs.
The researchers used data on contraceptive fills for women of reproductive age (15-49 years) in the United States from IQVIA’s National Prescription Audit PayerTrak, as well as data from the Guttmacher Institute, to categorize changes in abortion restrictions in each state.
A difference-in-differences analysis compared changes in monthly fill rates for daily OCPs and ECs in states that became most restrictive (those implementing a full abortion ban after Dobbs) and comparison states (those that kept a medium level of abortion restrictions after Dobbs) before (March 2021 to November 2021) and after (July 2022 to October 2023) the Dobbs decision.
The results indicated that between March 2021 and October 2023, 142.8 million prescriptions for OCPs and 904,269 prescriptions for ECs were dispensed at U.S. retail pharmacies.
“Before Dobbs, trends in monthly fill rates were similar for OCPs and ECs between the most restrictive and comparison states,” the study team explained. “After the Dobbs decision, states that became the most restrictive experienced an additional 4.1% decline in OCP fills with 285.9 fewer fills per 100,000 (95% CI, –495.8 to –6.8; P = .04).”
The trends with ECs were somewhat different. Fills increased during the first year after Dobbs (July 2022-June 2023) in both groups of states, according to the report, but, a year after Dobbs (July 2023-October 2023), the most restrictive states experienced an additional 65% decrease in emergency contraceptive fills with 13.2 fewer fills per 100,000 (95% CI, –27.2 to –4.1; P = .01).
In analyzing the trends, the authors posited, “The Dobbs decision may have also contributed to declines in the use of ECs due to misunderstanding about their legality, particularly in restrictive states. In fact, a January 2023 survey found that half of women in full ban states believed levonorgestrel was illegal in their state.”
There also are efforts to put more controls on contraceptives in some of the most restrictive states. “In states such as Texas and Mississippi where women now don’t even have the option to have an abortion, their access to contraception is also becoming more difficult,” said Dr. Qato. “More efforts to improve and protect access to oral contraceptives are needed, especially for emergency contraceptives in states where abortion is no longer an option.”
The researchers noted that EC fills post-Dobbs increased the most in Idaho, which, among states with the most restrictive abortion policies, is the only one that allows pharmacists to prescribe ECs to women without any age restrictions.
“We saw the greatest declines in birth control pills and emergency contraceptives in states that had closed a larger share of their family planning clinics. In Texas, for example, birth control pill prescriptions declined by 28% and emergency contraceptive fills declined by 48%,” said coauthor Rebecca Myerson, PhD, MPH, of the University of Wisconsin Madison.
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