Use of most contraceptive methods steadily decreased from 2019 to 2022

Key takeaways:

• From 2019 to 2022, IUD and tubal sterilization use decreased while vasectomy use increased.
• New contraceptive prescriptions fell from more than 25 million in 2019 to fewer than 22 million in 2022.

Use of most contraceptive methods steadily decreased from 2019 to 2022, except for vasectomy, with more advanced practice clinicians and fewer physicians providing new contraceptive prescriptions, researchers reported.

“In 2022, Dobbs v. Jackson Women’s Health Organization dramatically changed the landscape of reproductive health, causing ripple effects that will extend beyond abortion care,” Julia Strasser, DrPH, MPH, assistant professor in the department of health policy and management at the Fitzhugh Mullan Institute for Health Workforce Equity at the Milken Institute School of Public Health at George Washington University, and colleagues wrote. “Contraception may be especially vulnerable to further restrictions and barriers, both to those seeking care and those providing it.”

Strasser and colleagues identified 731,447 clinicians who provided contraception services from 2019 to 2022 from IQVIA, which captures about 93% of retail pharmacy prescriptions and medical claims for approximately 191 million patients. Researchers evaluated contraceptive service visits for IUDs, implants, injectables, vasectomies and tubal sterilizations and contraceptive methods, including new prescriptions for pills, patches and rings.

Primary outcome was the monthly volume of contraceptive service visits by type and the annual number and type of clinicians.

Most contraception services had steady downward trends, except for sharp declines observed during the early months of the COVID-19 pandemic and temporary increases observed immediately after the Dobbs decision, according to the researchers.

Results, published in JAMA Network Open, demonstrated decreases in IUD (from 650,043 to 591,509) and tubal sterilization (from 103,547 to 74,537) use from 2019 to 2022. Conversely, vasectomies steadily increased from 146,796 in 2019 to 198,212 in 2022. New prescriptions for contraceptives decreased from more than 25 million in 2019 to fewer than 22 million in 2022.

Researchers also observed shifts in the workforce providing contraception from 2019 to 2022, with increases in the number of advanced practice clinicians providing IUDs, implants and new prescriptions and decreases in physicians providing new prescriptions.

According to the researchers, the decrease in the number of physicians providing new prescriptions, coupled with state-level policies restricting advanced practice clinicians from full scope of practice, is “a cause for concern.”

“The decreases we saw in certain contraception services may be driven by shifts in the workforce as well as patient preferences and changing markets,” the researchers wrote. “Some of the decreases in contraception prescriptions may be due to increases in extended supply prescribing, and the growing use of vasectomy may indicate shifts in gendered approaches to reproductive decision-making.”