Abortion Policy
Clinic Closures and Confusion Trigger Alarming Drop in Contraception Use, Study Reveals
A sharp decline in contraceptive prescriptions has been observed in states with the most restrictive abortion bans since the Dobbs decision, according to a University of California Los Angeles study. The study, led by pharmacy professor Dima Qato, found significant decreases following the June 2022 ruling that allowed states to regulate abortion procedures. The research utilized national prescription audit databases to estimate the monthly volume of prescriptions dispensed across more than 93% of retail pharmacies nationwide.
Professor Dima Qato stated, “Given that abortion would be restricted in many states even more after Dobbs, I wondered whether now more people would get covered through contraception to prevent pregnancy and the need for an abortion.” However, her hypothesis didn’t hold in states with near-total abortion bans.
Over the past six months, lawmakers in these states have debated proposals to protect access to contraception but largely failed due to concerns over emergency contraception. Anti-abortion organizations often label Plan B, a drug designed to prevent pregnancy after unprotected sex, as an abortion drug because it can impede the implantation of a fertilized egg.
The researchers attribute the decline partially to confusion among residents and pharmacists regarding the legality of emergency contraceptives. Although Plan B is available over-the-counter, prescription data showed a dramatic drop in states like Arkansas, Kentucky, Louisiana, and Tennessee, where it fell by over 70%. In Missouri, the decline was about 60%.
According to Qato, the rates peaked in July 2022 before falling below pre-Dobbs levels. “For patients seeking emergency contraception but can’t get it prescribed or filled, that’s where it matters,” she stressed.
A poll by the Kaiser Family Foundation revealed that half of the women in states with abortion bans were unsure if Plan B was legal. Conversely, states like Idaho and South Dakota saw sharp increases in emergency contraceptive prescriptions, attributed to ulipristal (Ella) rather than levonorgestrel (Plan B). Ella is effective for up to five days after unprotected sex, while Plan B is most effective within three days and less effective for those over 165 pounds.
Overall, emergency contraceptive prescriptions dropped by 60% across the 12 states with the most restrictive bans, and oral contraceptives fell by 24%. Texas saw the largest decrease at 28%, followed by Kentucky, Louisiana, Alabama, and Tennessee with declines near 20%.
Clinic closures in these states likely contributed to the decrease in contraceptive prescriptions since these clinics also offered other family planning services. The study found no change in the use of IUDs and other contraceptive methods like the patch or vaginal ring.
In Iowa, Medicaid coverage restrictions on family planning clinics led to a two-thirds decline in contraceptive use within two years. A Guttmacher Institute report released this week confirmed that 42 clinics closed between 2020 and 2024 nationwide, even as abortion rates increased.
While Plan B and Opill are available over the counter, Qato pointed out these options are not economically feasible for low-income women and women of color. “Opill is convenient for those who don’t want to go to the doctor and have that discretionary income to purchase it,” she noted. “Those options are accessible but not affordable to women who could really benefit from it.”
Qato emphasized the need to restore and protect access to both abortion and contraception in restrictive states. She warned that the decline in contraceptive use could result in increased live births from unintended pregnancies. “A woman may not feel safe choosing emergency contraception in those states anymore,” she said.