After Roe’s reversal, states restricting abortion saw steep declines in prescriptions for contraceptives—precisely where women need birth control the most.
The June 2022 Supreme Court decision eliminating the constitutional right to abortion was followed by steep declines in prescriptions for birth control pills and emergency contraception in states where abortion is banned. This finding was revealed by a new study published in the top-ranked journal Obstetrics & Gynecology.
“In states such as Texas and Mississippi, where women now don’t even have the option to have an abortion, their access to contraception is also becoming more difficult,” said lead author Dima M. Qato, associate professor at the USC Mann School of Pharmacy and Pharmaceutical Sciences and the Hygeia Centennial Chair in Clinical Pharmacy.
Researchers found that states enacting the most restrictive laws experienced about a 5 percent total decline in oral contraceptive prescriptions filled by pharmacies in the first year after Roe’s reversal. In Texas, the rate dropped 28 percent. The declines were particularly dramatic for the emergency contraception (EC) pills Plan B and Ella, which dropped 65 percent more in the most restrictive states compared to less restrictive states.
The antiabortion movement has worked for years to blur the line between emergency contraception and abortion pills.
The study authors attribute the decline to the closure of abortion clinics, where many women access prescriptions for contraception. Post-Dobbs, 63 brick-and-mortar abortion clinics in 14 states closed, including 24 in Texas.
“Because 11 percent of women rely on such clinics for the provision of prescriptions for contraceptives— many of which are filled at outside pharmacies—these closures may have reduced access to oral and emergency contraceptives,” Qato said in a press release.
Declines in emergency contraception prescriptions filled were greatest in the most restrictive states that had closed a larger share of their family-planning clinics.
Misunderstandings about the legality of emergency contraception may also be a factor in the decline, noted the study’s authors. According to research from the Kaiser Family Foundation, half of women living in states where abortion is currently banned either incorrectly believe ECs are illegal in their state (7 percent) or say they are unsure (43 percent). The antiabortion movement has worked for years to blur the line between emergency contraception and abortion pills, perpetuating this confusion.
Another crucial cause of the decreasing prescriptions for contraceptives is states’ restrictive policies, which include allowances for pharmacists to refuse to provide contraceptives based on their own particular religious, ethical or moral beliefs, dropping ECs from insurance coverage mandates and a lack of over-the-counter coverage for EC for those on Medicaid.
Before Roe was overturned, Mississippi was lowest in filling emergency contraceptive prescriptions; it’s also the only state that refuses to cover the emergency contraceptive Plan B for Medicaid members. After Dobbs, prescriptions for emergency contraceptives increased the most in Idaho, which is a state with a near-total ban on abortion that allows pharmacists to prescribe ECs to women without any age restrictions.
Other possible factors in the decline may be more women ordering birth control pills and emergency contraception from online sources (not tracked in this study), switching to other options such as IUDs or sterilization, and using condoms more often.
Regardless, between abortion bans and decreasing access to contraception post-Dobbs, women are facing ever-increasing barriers to maintaining control over their reproductive lives, whether ending unwanted pregnancies—or preventing them.
This article has been co-published with The 19th. It originally appeared in the Fall 2024 issue of Ms. magazine, which hit newsstands Sept. 24. Join the Ms. community today and you’ll get issues delivered straight to your mailbox.
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