States with abortion bans saw birth control prescriptions fall post-Dobbs, study finds

In the 16 months after the Supreme Court’s Dobbs decision, fewer prescriptions for birth control pills and emergency contraceptives were filled in states with the most restrictions on abortion, according to a study published Wednesday in the journal JAMA Network Open.

The researchers found a 5.6% decrease in birth control pill prescriptions in states with the strictest abortion laws, relative to states that continued to allow access to abortion. And although fills for emergency contraceptives rose temporarily post-Dobbs in all states, states with the most restrictive policies saw a 65% decline in those prescriptions by the months from July to October 2023, compared with states where abortion remains broadly legal.

A primary reason for the trend, the study posits, is that abortion bans enacted after the Dobbs decision in June 2022 led abortion and family planning clinics in those states — facilities where many women accessed birth control prescriptions — to close. The new laws also created confusion over whether emergency contraceptives, including Plan B, remained legal in states with abortion bans, according to the study. (They are still legal in all 50 states.)

“It’s important to show that restrictive environments around reproductive health, and in this case Dobbs, impact access to contraception and threaten a woman’s right to reproductive choice,” said Dima Qato, the study’s senior author and the director of the University of Southern California pharmacy school’s Program on Medicines and Public Health.

The study used monthly data on prescriptions filled from March 2021 through October 2023. The researchers classified states into seven categories ranging from most restrictive to most protective based on their abortion policies, such as gestational time limits and constitutional protections. Prescriptions in the most restrictive states were then compared to those in states with moderate abortion restrictions.

The researchers looked at two types of emergency contraceptive pills: ella and Plan B. The former requires a prescription, but Plan B is available over the counter. However, Plan B is covered by insurance in some states when obtained with a prescription, so Qato said the study data is “limited to Plan B fills that were processed and dispensed at a pharmacy, not purchased over the counter.”

That gap makes it difficult to understand overall trends in emergency contraception use, said Julia Strasser, the director of the Jacobs Institute of Women’s Health at George Washington University, who was not involved in the new study.

“You’re only looking at a part of what’s happening,” she said, though she added that her own research separately found a temporary increase in oral contraception use in the month after Dobbs, and then an overall decrease through December 2022.

The study period also ended before the United States’ first over-the-counter birth control pill, Opill, became available.

Birth control pills are the most commonly used hormonal contraceptive in the U.S., with 1 out of 4 women ages 15 to 44 who use contraceptivestaking them, research published in February showed. Around 28% of women in that age group who have had sex with men had used emergency contraception at least once in their lifetime as of 2019,according toan analysis by KFF, a health care research and policy organization.

CVS and Walgreens declined to comment on whether they have observed changes in prescription fills for contraceptives at their pharmacies.

Rebecca Myerson, a co-author of the study and assistant professor of population health sciences at the University of Wisconsin, said the results surprised her because she had assumed that if people didn’t have access to abortion, that might incentivize them to be more diligent about preventing pregnancy via contraception.

The temporary increase in emergency contraceptives “resembled stockpiling behavior,” she added, “but then there’s subsequently such a large decline, and it seems like either there’s genuine reductions in access to these emergency contraceptives or confusion about whether they can be legally accessed.”

In the U.S., 11% of women of reproductive age who use contraceptiondepend on family planning clinics for contraception prescriptions, according to KFF.

A 2022 report from the Guttmacher Institute, a research group that supports abortion rights, found that 100 days after Dobbs, 26 out of 66 clinics that had offered abortion care across 15 states with bans had shut down.

Patients who had relied on those clinics for birth control prescriptions may not have been able to access alternative care or could have been in pharmacy deserts, Myerson said.

Idaho, the only state that allows pharmacists to prescribe hormonal contraceptives to women without age restrictions, was the only one to see an increase in the use of emergency contraceptives among states with abortion bans.

Qato highlighted widespread confusion around whether emergency contraception is legal in states with abortion bans and whether it is the same as abortion pills. (It is not: The drugs used in a medication abortion end a pregnancy, whereas emergency contraception medications prevent a pregnancy from happening.)

Half of women living in states where abortion is banned think emergency contraceptives are illegal or are unsure if they are legal, according to a survey last year from KFF.

Strasser pointed out one other factor that could be affecting the trend: Her research has shown that people are using oral contraception less in general. That could be because they’re opting for other forms of contraception or turning away from hormonal birth control, but the reasons are still being investigated, she said.

Elysee Barakett

Elysee Barakett is a health intern at NBC News.