Women have become less likely to get birth control in states that restricted abortion, study finds

Women in states with the most restrictive abortion laws have also become less likely to access prescription birth control, a new study suggests.

In a dozen states that have enacted near-total abortion bans, monthly prescription rates for birth control pills and emergency contraceptives were significantly lower in the second half of 2023 than they were before the US Supreme Court Dobbs decision that revoked the federal right to abortion, according to the study published Wednesday in the JAMA Network Open medical journal.

The researchers point to the closures of some family planning clinics and broad public confusion about what options remain legal in the wake of the June 2022 Dobbs decision as key factors contributing to this trend.

“It’s really important to recognize that these issues all fall under the scope of reproductive health care,” said Dr. Michael Belmonte, an Ob-Gyn and fellow with the American College of Obstetricians and Gynecologists focused on complex family planning. He was not involved in the new research. “When something touches on abortion care, that will ultimately have ripple effects for miscarriage care, for contraception and emergency contraception, and, quite frankly, access to general medical health care for many women across the United States.”

For the new study, researchers tracked trends in monthly birth control prescription rates from March to November 2021 – a period before the Dobbs decision leaked – and after the decision, from July 2022 to October 2023. They compared rates in a group of 12 states that enacted the most restrictive policies to a group of 14 states where abortion policy remained relatively consistent.

The use of birth control pills has been trending down in the US overall – and other research suggests that use of IUDs, a longer-acting form of birth control, has been growing for decades – but the prescription fill rate fell about 4% more than expected in states with the most restrictive laws post-Dobbs, according to the new research.

States with abortion bans saw an even more significant drop in prescriptions for emergency contraception – including levonorgestrel, such as Plan B, and ulipristal, such as Ella.

Both groups of states studied – those that enacted bans and those where abortion policies stayed more consistent – had a similar prescription fill rate pre-Dobbs and both and saw an initial spike following the decision. But by the second half of 2023, the prescription rate for emergency contraception in the states with bans was less than half of what it was before the Dobbs decision – dropping from about 20 fills for every 100,000 women of reproductive age each month down to eight fills. In states where abortion policies stayed consistent, the rate actually ticked up in the same timeframe – from 20 to 21 fills.

“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 authors wrote.

Emergency contraception has become enmeshed in the abortion debate, and survey data suggests that there was widespread public confusion around the legality of emergency contraception months after the Dobbs decision and how it differed from medication abortion.

Nearly a third of adults were “unsure” if emergency contraceptive pills were legal in their state, according to a KFF survey from January 2023. The confusion was even greater in states with abortion bans, where half of women either incorrectly thought that it was illegal or were unsure.

“This drives home the importance for proper and accurate patient education, consumer education, and the need to combat disinformation and misinformation about the conflation and confusion between (emergency contraception and abortion,” said Karen Diep, a women’s health policy analyst with KFF who was not involved in the new research.

In December 2022, the US Food and Drug Administration adjusted the Plan B label to explicitly state that it “does not terminate pregnancy.”

All while reproductive health care deserts are getting worse.

About 1 in 9 women of reproductive age in the US – and closer to 1 in 5 Black and Hispanic women – rely on family planning clinics to get contraception, according to a KFF analysis from 2022. But dozens of clinics closed post-Dobbs – and the new study found that declines in emergency contraception prescriptions were greatest in states that saw more widespread closures of family planning clinics.

And the landscape continues to change rapidly, adding to the confusion and challenges around access.

On Wednesday, Senate Republicans voted to block a bill put forward by Democrats that would guarantee access to contraception nationwide.

But the Biden administration has “redoubled” commitments to protect access to reproductive health care, including support for Title X family planning clinics and work to ensure birth control remains accessible under the Affordable Care Act.

“In the two years since Dobbs, we have witnessed the devastating impacts. Many women, especially those in states with stringent abortion restrictions, have found themselves navigating care deserts, forced to travel great distances to receive essential services. These barriers disproportionately affect marginalized communities, exacerbating existing health disparities,” US Department of Health and Services Secretary Xavier Becerra said in a statement Monday.

“The Biden-Harris Administration stands firm in its commitment to defending reproductive rights. We believe that no woman should have fewer rights than her mother and that women must have the autonomy to make decisions about their own bodies without fear or interference from politicians,” he said.