The U.S. Supreme Court's 2022 decision in Dobbs v. Jackson Women’s Health Organization overturned the federal constitutional right to abortion, allowing individual states to impose new restrictions or outright bans. Abortion is common in the U.S., with about 1 in 5 pregnancies ending in abortion. It is also just one type of sexual and reproductive health care (SRH), among many, that individuals may need access to over their lifetime. Mirroring how people live their lives, none of these individual areas of SRH can be siloed from one another. Disruptions to one will inevitably have impacts across the broad continuum of care.
Decreased access to abortion may influence contraceptive use through changes to the health systems and providers who offer this care (the supply side) and also through changes in individual attitudes, behaviors, and experiences related to accessing contraception (the demand side). Ongoing threats to insurance coverage and decreased funding to the Title X network of clinics also pose barriers to contraceptive access through disruptions on both the supply and demand sides.
Supply and Demand: Contraceptive Access Post-Dobbs
Following the Dobbs decision, one study investigating supply-side changes in contraceptive care delivery found evidence that family planning clinics in both restrictive and less restrictive/protective states changed certain contraceptive counseling practices and took steps to adjust their clinic workflows to mitigate the effects of Dobbs. On the demand side, health system data, internet searches, and survey findings from providers signal clear signs of heightened interest in contraception, and IUDs and permanent contraception in particular.
Since the Dobbs decision, there has been a growing body of evidence that is starting to paint a picture of how many people’s contraceptive behaviors are shifting in its aftermath. Importantly, studies on contraceptive use trends from before to after Dobbs or in the time period since the decision have primarily drawn on administrative, claims, and electronic health record (EHR) data, all of which represent distinct and different study populations than broader, population-level studies of reproductive-aged people more broadly. From these studies, an overall pattern of many people shifting to longer-acting and more permanent forms of contraception in the post-Dobbs context is emerging. One study drawing on electronic health record data from across the US highlighted findings of sharp increases in both female and male permanent contraception among adults ages 18-30 after the Dobbs decision. Another study drawing on claims data mirrors these findings: tubal sterilization and vasectomy visits increased from before to after the Dobbs decision among individuals ages 19–26. These findings, of increased demand by female and male patients is supported by data from a multihospital system in Ohio, where female permanent contraception and LARC increased by 15.8 percent post Dobbs.
Data from the multi-state Reproductive Health Impact Survey (RHIS) provides an in-depth examination of how individuals’ access to contraception has changed at the state level across differing restrictive contexts post-Dobbs. Notably, an analysis of state-representative surveys of reproductive-aged women under the RHIS did not identify the same changes in use of longer-acting or more permanent methods from before to after the Dobbs decision at the state population level as were identified in the studies described above. This analysis, however, did find changes in people’s access to contraception. Reproductive-aged women in Arizona, Iowa, and Wisconsin, states with less supportive SRH climates immediately post-Dobbs, reported trouble and/or delays in accessing their preferred contraception at higher levels than were reported prior to the decision. There was no change in these reported barriers during this same time period among reproductive-aged women in New Jersey, a state with a more supportive SRH climate. Among women in all four of these states who accessed contraceptive care, reports of that care being high-quality decreased from before to after the Dobbs decision.
Little is known about how abortion bans may influence postpartum contraceptive use, a key concern because the communities disproportionately affected by abortion restrictions, have the highest rates of maternal morbidity and mortality. SRH care is a continuum, and highly interconnected. As maternal morbidity is anticipated to rise following abortion bans, it is key to recognize that people who have severe maternal morbidity are at a six-fold risk for repeat severe morbidity or mortality in a subsequent pregnancy and may be less likely to receive postpartum contraception.
While demand for contraception is rising, historic disparities in contraceptive access are widening. A nationally representative survey found that barriers to reproductive care—including cost, transportation, and appointment availability—increased significantly between 2017 and 2021. The greatest rise was among low-income, Hispanic, and Spanish-speaking individuals. The RHIS analysis highlighted above also documented that young people ages 18-24, those identifying as a sexual or gender minority, and those living with low incomes all reported greater challenges accessing their preferred contraception as compared to their counterparts in the post-Dobbs landscape.
Since Dobbs, some states have moved to shore up access to contraception. Others have proposed restrictions that could jeopardize the availability of certain methods. Although no state currently bans birth control outright, legal language in some abortion bans—like defining pregnancy at fertilization—has created fears that IUDs and emergency contraception could be restricted or misclassified as abortifacients. Providers in restrictive states also report increased uncertainty about what they’re legally allowed to offer or discuss with patients. Some have adjusted their counseling practices to emphasize long-term methods or avoid legal risk.
Dobbs didn’t just rewrite abortion law—it reshaped how people imagine their lives. As access shrinks, so does the freedom to make decisions about one’s own body and future. In response, people are seeking out more longer-term, effective—and often more permanent—forms of contraception. However, significant barriers, from cost and provider shortages to legal uncertainty, stand in the way of true contraceptive access. Access to contraception remains a critical component of comprehensive reproductive health care. As legal and policy landscapes evolve post-Dobbs, ensuring that people can obtain the full range of contraceptive options without barriers is essential to supporting people’s full reproductive autonomy and wellbeing.
This post has been authored by one of AcademyHealth’s Reproductive Health Senior Scholars in Residence, Dr. Maria Rodriguez, who provides thought leadership on reproductive health issues within the health services research field and provides expert guidance to the Research Community on the Equity Impacts of Dobbs.
Supported by the Commonwealth Fund, a national, private foundation based in New York City that supports independent research on health care issues and makes grants to improve health care practice and policy. The views presented here are those of the author and not necessarily those of the Commonwealth Fund, its directors, officers, or staff.