States with abortion restrictions triggered by the Dobbs decision saw a decline in prescriptions of oral contraceptives — particularly emergency contraceptives — a cohort study showed.
The most restrictive abortion states saw a 4.1% decline in oral contraceptive pill prescriptions, with 285.9 fewer fills per 100,000 women of reproductive age (95% CI −495.8 to −6.8, P=0.04) versus comparison states, reported Dima Qato, PharmD, MPH, PhD, of the University of Southern California School of Pharmacy in Los Angeles, and colleagues.
And while fills for emergency contraceptives increased in both groups in the year following Dobbs, after the 1-year mark, prescriptions for emergency contraceptives fell by 65% in restrictive states, with 13.2 fewer fills per 100,000 (95% CI −27.2 to −4.1, P=0.01), they wrote in JAMA Network Open.
Prior to the Dobbs decision, the monthly fill rates for oral and emergency contraceptives was similar between those two groups of states.
Qato told MedPage Today that the Dobbs decision “led to the closure of many family planning clinics and confusion around the legality of emergency contraceptives.” The team wanted to know how this change “affected access to contraceptives and, in turn, the potential need for an abortion, in states that became most restrictive with a full ban on abortion after Dobbs.”
Notably, Qato said that “only in states with a full ban on abortion did post-Dobbs declines in emergency contraceptives reach levels lower than the pre-Dobbs period.”
Fills for emergency contraceptives peaked in July 2022 — shortly after Dobbs — but the increase was “short-lived, as fills declined to pre-Dobbs levels by October 2023 in most states,” Qato said.
Most oral contraceptives were prescribed by ob/gyns (35.2%) and paid for by commercial insurance (79.6%), while emergency contraceptives were mostly prescribed by nurse practitioners (44.7%) and paid for by Medicaid (47.2%). For future research, Qato said the team is interested in exploring the impact of Dobbs on “access to contraceptives in Medicaid, low-income populations, and disparities across neighborhoods within these most restrictive states.”
The researchers used data from IQVIA’s National Prescription Audit PayerTrak to estimate monthly prescription volume for oral contraceptives; from the 2021 American Community Survey to determine the number of women and girls of reproductive age (age 15 to 49); and data from the Guttmacher Institute to classify states based on abortion restrictions and protections. The study period was from March 2021 through October 2023. In that time, U.S. pharmacies dispensed 142.8 million prescriptions for oral contraceptives and 904,269 prescriptions for emergency contraceptives.
They compared changes in the monthly fill rates for both contraceptive types between states that enacted a full ban on abortion after Dobbs with a group of comparison states that kept a medium level of abortion restrictions.
They also conducted sensitivity analyses to check that decreases in oral contraceptives were not offset by increases in non-oral hormonal contraceptives, as well as an analysis excluding Iowa and Wisconsin from the reference group since they both briefly became abortion-restrictive a year after Dobbs.
Authors noted a few limitations, including that the data are limited to prescription medications filled at retail or mail-order pharmacies and don’t include sales over-the-counter or through some online platforms, as well as the use of aggregate data. Also, changes in oral contraceptive use may be affected by dynamic federal and state laws, and that the study design could not assess the impacts of states that enhanced abortion protections, which tended to be several months later than when other states’ restrictions kicked in.
“Given the role of daily oral contraceptives and emergency contraceptives in preventing pregnancy and the need for an abortion, efforts to improve and protect access to oral contraceptives are needed, especially for emergency contraceptives in states where abortion is most strongly restricted,” the researchers concluded.
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Disclosures
Qato reported being a consultant for the WHO Reproductive and Sexual Health Unit, as well as Public Citizen’s Health Research Group.
Other co-authors reported relationships with Flatiron Health, FDA’s Peripheral and Central Nervous System Advisory Committee, the Robert Wood Johnson Foundation, and Stage Analytics.
Primary Source
JAMA Network Open
Source Reference: Qato DM, et al “Use of oral and emergency contraceptives after the US Supreme Court’s Dobbs decision” JAMA Netw Open 2024; DOI: 10.1001/jamanetworkopen.2024.18620.
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