Background: Oral contraceptives prevent unintended pregnancy and abortion, yet the impact of the U.S. Supreme Court’s Dobbs v Jackson Women’s Health Organization decision overturning Roe vs. Wade is unknown.
Objectives: To evaluate patterns and trends in the use of oral preventive and emergency hormonal contraceptives before and following the Dobbs decision at the national and state-level
Methods: Study
Design: Descriptive analysis of serial, cross-sectional data derived from IQVIA’s National Prescription Audit for oral preventive and emergency hormonal contraceptive prescriptions dispensed at retail pharmacies between January 2019 and December 2022 in the U.S. We used the American Community Survey to derive the total population of women and girls of reproductive age (15-49 years of age) overall and by insurance type, and data from the Guttmacher Institute to stratify states based on the availability of abortion services after Dobbs: full ban, partial ban, legal with restrictions and legal with protections. Measures include number of prescriptions filled per 10,000 women and girls of reproductive age (per-capita). We also used interrupted time-series analyses to quantify changes in level and trend in monthly prescriptions filled before (January 2022-May 2022) and after Dobbs (July 2022- December 2022).
Results: Between January 2019 and December 2022, monthly rates of oral preventive contraceptives filled at retail pharmacies steadily declined by ~29% from 780 to 550 per-capita. These rates varied substantially across states and were generally highest in states with restrictive abortion policies. There was no substantial change in trend or level after the Dobbs decision for oral preventive contraceptives. The Dobbs decision was associated with an immediate increase in monthly emergency contraceptives filled per capita from 4.5 (95% confidence intervals [CI] 2.7- 6.2) before Dobbs to 9.5 (CI 6.8- 12.2) after Dobbs representing a 100% change (p < 0.01). Change in level was greatest in states with a full ban (135.1%) and lowest in states where abortion was legal with protections (57.4%). For emergency contraceptives, increases after Dobbs were substantially greater among women and girls with private insurance (56.4%) than those with Medicaid coverage (8.2%). Since Dobbs, however, monthly trends for emergency contraceptives significantly declined by 5.39% nationally; this trend, however, was not observed in states where abortion is legal with protections.
Conclusions: The Dobbs decision was associated with substantial increases in the use of emergency - but not preventive - oral contraceptives in the United States, particularly in states with a full ban on abortion. These immediate increases, however, were followed by steady declines in the most restrictive states.
