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News|Articles|June 26, 2024

Impact of Dobbs v. Jackson on oral contraceptive prescriptions

A recent study revealed that the Supreme Court's Dobbs Dobbs decision is linked to reduced oral contraceptive prescriptions, highlighting the need for improved access amidst restrictive abortion policies.

The US Supreme Court Dobbs v Jackson Women’s Health Organization decision is associated with reduced rates of oral contraceptive prescriptions at US pharmacies, according to a recent study published in JAMA Network Open.1

Takeaways

  1. The Dobbs v. Jackson decision is associated with a significant decline in oral contraceptive prescriptions, particularly in states with restrictive abortion policies.
  1. States that became more restrictive post-Dobbs saw a 4.1% additional decline in oral contraceptive fills, with even greater reductions observed over time.
  1. While there was an initial increase in emergency contraceptive fills immediately after the Dobbs decision, the rates eventually returned to pre-Dobbs levels.
  1. Obstetricians and gynecologists filled the majority of oral contraceptive prescriptions, while nurse practitioners were the primary prescribers for emergency contraceptives, indicating differing health care provider roles.
  1. The study underscores the urgent need for efforts to protect and improve access to oral contraceptives, especially in states with restrictive abortion laws.

Oral contraceptives are vital for pregnancy and subsequent abortion prevention, with hormonal contraceptives being the most common in the United States. Full or partial abortion bans have been implemented in 26 states since the Dobbs decision, and concerns have arisen that contraception was also impacted.

One study reported anger and fear surrounding contraception challenges in college students post-Dobbs.2 Most participants expressed opposition to the Supreme Court decision, and many planned to switch to long-acting reversible contraception. A sense of pressure to use more effective contraceptives was commonly expressed.

Additional data has linked restrictive abortion policies to reduced contraceptive access, such as the 2019 Title X Final Rule preventing abortion service provision in participating clinics leading to reduced contraception availability.1 However, there is little information about the impact of Dobbs on contraception use, both for daily oral contraceptive pills (OCPs) and emergency contraceptives (EC).

Investigators conducted a study to evaluate trends in prescription fills for OCPs and ECs using data on fills in US pharmacies from March 2021 to October 2023. Daily OCP and EC use were determined using the Anatomic Therapeutic Categories.1

National and state-level estimates of the total population of reproductive aged women were obtained from the 2021 American Community Survey, while information about abortion-related policies was obtained from the Guttmacher Institute. Changes in policy between June 2022 and October 2023 were assessed.

Categories for states based on abortion policies included most restrictive, very restrictive, restrictive, some restrictions, protective, very protective, and most protective. Changes included more restrictive shortly after Dobbs, more restrictive after Dobbs, more protective after Dobbs, and no changes after Dobbs remaining restrictive, some restrictions, or remaining protective.1

Primary outcomes included monthly rates of prescription fills per 100,000 reproductive-aged women for daily OCPs and oral ECs. Secondary outcomes included fills for ulipristal and levonorgestrel separately.

There were 142.8 million OCP prescriptions filled during the study period, at a mean 4.3 million per month. For ECs, these numbers were 904,269, and 28,206, respectively.1

Of OCPs, 35.2% were filled by obstetricians and gynecologists and 79.6% were paid for by private insurance, compared to 44.7% of ECs being prescribed by nurse practitioners and 44.7% paid for by Medicaid. Additionally, 52.4% of EC prescriptions were levonorgestrel, with higher rates of pharmacist prescription and Medicaid coverage vs ulipristal.

Between March 2021 and October 2023, a 25.6% reduction in the monthly fill rate for OCPs was observed, from 6784 fills per 100,000 women to 5049 per 100,000. However, a national increase was observed for EC fills rates directly after the Dobbs decision in July 2022 before returning to pre-Dobbs levels by October 2023.1

A link was also reported between the Dobbs decision and reduced OCP fills in states that became most restrictive, with a 4.1% decline. These reductions were greater with an additional 5.6% when separating data from less than 1 year vs 1 year after Dobbs and evaluating 1-year or longer data.

EC fills were not significantly reduced in the post-Dobbs period, with only 7 less fills per 100,000 women. One year after Dobbs, a greater reduction was observed in the most restrictive states, with 13.2 less fills per 100,000 women. Additionally, levonorgestrel and ulipristal fills in the most restrictive stated declined by an addition 48% and 89.9%, respectively, 1 year after Dobbs.

These results indicated a reduction in oral contraceptive fills in states with restrictive abortion policies following the Dobbs decision. Investigators concluded efforts to improve and protect access to oral contraceptives are needed.1

Reference

  1. Qato DM, Myerson R, Shooshtari A, Guadamuz JS, Alexander C, et al. Use of oral and emergency contraceptives after the US Supreme Court’s Dobbs decision. JAMA Netw Open. 2024;7(6):e2418620.doi:10.1001/jamanetworkopen.2024.18620
  2. Krewson C. Impact of Dobbs: College students navigate contraception challenges. Contemporary OB/GYN. January 29, 2024. Accessed June 26, 2024. https://www.contemporaryobgyn.net/view/impact-of-dobbs-college-students-navigate-contraception-challenges

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