Widespread Confusion and Clinic Closures Trigger Major Drop in Contraception Use

Clinic closures post-Dobbs decision and confusion surrounding the legality of emergency contraceptives have spurred a significant drop in contraceptive prescriptions in states with stringent abortion bans, according to a UCLA study.

The research revealed a profound decline in prescription rates in many states with restrictive abortion laws following the June 2022 Dobbs ruling, which reverted abortion regulation to state governments. Pharmacy professor Dima Qato led the team that utilized national prescription audit databases to measure monthly prescription volumes across more than 93% of retail pharmacies.

“With increased abortion restrictions, I wondered if more people would turn to contraception to avoid unwanted pregnancies,” Qato remarked.

Despite legislative attempts to safeguard contraceptive access in states with near-total abortion bans, these efforts mostly faltered due to debates over emergency contraception, often misclassified by anti-abortion groups as abortifacients.

Such debates have led to considerable uncertainty regarding the legality of emergency contraceptives. This confusion not only affects residents but potentially pharmacists as well. Although over-the-counter availability of Plan B exists, the study focused on prescription data, revealing over a 70% drop in states like Arkansas, Kentucky, Louisiana, and Tennessee, and about a 60% decline in Missouri.

“The peaks in July 2022 followed by drops below pre-Dobbs levels show the immediate impact,” Qato stated. “It’s impacting those seeking but unable to secure prescriptions for emergency contraception.”

A Kaiser Family Foundation survey from early 2023 indicated that over 30% of adults were unsure about the legality of Plan B across the nation. Furthermore, half of the women in states with abortion bans were uncertain or believed emergency contraceptives were illegal.

Interestingly, in Idaho and South Dakota, prescription rates for emergency contraceptives surged by 148% and 182%, respectively. These increases were linked to ulipristal (Ella), which is effective up to five days post-unprotected sex, as opposed to levonorgestrel (Plan B) which is less effective and weight-sensitive.

Across 12 states with the strictest bans, emergency contraceptive prescriptions plunged by 60%, and oral contraceptives by 24%. Texas saw the largest decline of 28%, with other states showing a roughly 20% decrease.

Qato posits that the closure of abortion clinics also contributed to the decline since these clinics provided various contraceptive services and screenings. The study noted no change in the usage of IUDs and other contraceptive methods.

Qato’s research indicates that in Iowa, following Medicaid coverage restrictions on clinics providing abortions, contraceptive use plummeted by two-thirds within two years.

Despite Plan B and Opill being available over the counter, this is not a viable solution for all, especially low-income women and women of color. “Opill is convenient for those able to afford it without a doctor’s visit, but inaccessible for low-income women who relied on now-closed clinics and prescriptions,” Qato explained.

She stressed the need for efforts to protect contraception access in restrictive states, alongside restoring and safeguarding abortion access. “The initial increases followed by sharp declines suggest a potential rise in unintended pregnancies and births, driven by constrained choices and fear of criminalization,” Qato warned. “Women in those states may no longer feel safe opting for emergency contraception.”