New research from Beyond the Pill researcher Yasaman Zia, PhD exposes how the impacts of the Dobbs decision have spilled over into contraceptive care—endangering birth control access and bodily autonomy.
Abortion bans have spread across the country since the Supreme Court ended the constitutional right to abortion care, profoundly impacting reproductive health care. Given how birth control services are often delivered alongside abortion care, the Dobbs decision was likely to affect contraceptive care, yet there has been very little research exploring these impacts.
A new study led by Zia uses interviews with healthcare providers across the country, with the majority in states that restrict abortion, to examine how the Dobbs decision has changed contraceptive care.
The interview surfaced several impacts on care practices:
- Changes in requests for birth control methods. Many providers saw an increase in requests for long-acting reversal contraceptives like IUDs and permanent methods. One provider shared, “I’ve definitely had a lot of patients come in and they’re worried that IUDs are going to be outlawed, so they want one. I see that a lot.”
- Changes in counseling practices. Providers worried about pressure on patients and potential coercion in counseling. A nurse in a restrictive state shared, “I feel like it’s changed the way I feel about birth control in that it’s allowed me to feel a little bit more biased because I am putting my fear on them subconsciously.”
- Risk avoidance. Providers expressed confusion about how the scope of legal restrictions impacted contraception. Some shared practices suggesting they were limiting their practice in excessive avoidance of risk, worried about getting in trouble for things like placing IUDs.
- Conscientious provision of care. Some providers implied a willingness to stockpile emergency contraception and birth control pills for advance provision or to find contraception in Mexico to bring back to the US.
The interviewees also highlighted several ways their experience has changed:
- Moral injury. Providers expressed fear and moral injury due to being unable to provide evidence-based, comprehensive reproductive health care. One nurse shared, “I feel limited. I feel hurt. I feel powerless.”
- Fear of future restrictions on contraception. Given attempts by anti-abortion advocates to conflate IUDs and emergency contraception with abortion, providers feared being unable to offer these methods in the future.
- Confusion about how legal restrictions impact their work. Frequent changes and ambiguity around what forms of care and advice are illegal placed providers in a precarious position. Some providers did not feel support from their institutions to interpret their legal risk.
- Increased emphasis on their roles in the community. Providers felt an enhanced responsibility to serve their patients, inform them well, and advocate for them.
These findings show how Dobbs has undermined reproductive health care, including contraceptive care, and placed stress on healthcare workers. Clinics must invest in training and legal support so providers can safely advocate for patients and effectively improve health care in uncertain and increasingly hostile environments. The long-term impacts of the decision may perpetuate coercion and reduce approaches to contraceptive counseling that prioritize people’s needs and values.