Fewer filled oral contraceptive prescriptions in states restricting abortion

Key takeaways:

• Prescriptions for oral contraceptives dropped while those for emergency pills were steady after vs. pre-Dobbs.
• Restrictive states had fewer prescriptions for oral and emergency contraceptives after Dobbs.

The Dobbs decision was associated with declines in prescriptions for oral contraceptive pills, especially for emergency contraception, in states with the most restrictive abortion laws, according to cohort study results.

“The association between the recent Dobbs decision and the use of oral contraceptives — both daily oral contraceptive pills and emergency contraceptives — are not known. This information is important because many family planning clinics closed directly following the Dobbs decision, particularly in states that became most restrictive with a full ban on abortion,” Dima M. Qato, PharmD, MPH, PhD, an associate professor at the University of Southern California School of Pharmacy, and colleagues wrote in JAMA Network Open. “These closures may have reduced access to contraceptives because 11% of women rely on these clinics for their contraceptive care, including prescriptions for oral contraceptives.”

Qato and colleagues conducted a cohort study using data on 142.8 million daily oral contraceptive pill prescriptions and 904,269 emergency contraceptive prescriptions for girls and women aged 15 to 49 years in the U.S. from IQVIA’s National Prescription Audit PayerTrak from March 2021 to October 2023. Researchers used data from the Guttmacher Institute to categorize abortion restriction changes in each U.S. state before and after the Dobbs decision. Researchers compared monthly fill rate changes per 100,000 women before (March to November 2021) and after (July 2022 to October 2023) Dobbs for daily oral contraceptive pills and emergency contraceptives in states that implemented full abortion bans and states with a medium level of abortion restrictions.

Trends in monthly fill rates for oral contraceptive pills and emergency contraceptives were similar among all U.S. states before Dobbs. From March 2021 to October 2023, the monthly fill rate for oral contraceptive pills decreased by 25.6% (P < .001). The monthly fill rate for emergency contraceptives increased from 33.3 fills per 100,000 women from December 2021 to June 2022 to 40.5 fills per 100,000 women before Dobbs. Directly after Dobbs, prescriptions for emergency contraceptives peaked at 52.6 fills per 100,000 women before steadily declining to 32.9 fills per 100,000 women by October 2023, which were comparable to levels observed before Dobbs.

After Dobbs, states with the most abortion restrictions had an additional 4.1% decline in oral contraceptive pill prescription fills with 285.9 fewer fills per 100,000 women compared with other states (P = .04). However, prescription fills for emergency contraception increased in the first year after Dobbs in all states, but after July 2023, states with the most abortion restrictions had an additional 65% decrease in emergency contraceptive prescription fills with 13.2 fewer fills per 100,000 women compared with other states (P = .01).

“Given the role of daily oral contraceptive pills and emergency contraceptives in preventing pregnancy and the need for abortion, efforts to improve and protect access to oral contraceptives are needed, especially for emergency contraceptives in states where abortion is most strongly restricted,” the researchers wrote.