Immediately after the Supreme Court overturned Roe v. Wade via the Dobbs decision, giving states control to restrict abortion, Google recorded the highest volume of searches for “vasectomy” in the past five years. Research later reported rising interest in tubal sterilizations among females was twice as high as the increase among vasectomies in males. The data reflected a broader trend: more women were seeking out birth control options as they faced a future of a more restrictive abortion access landscape.
But now, a new study has found that the stress of the Dobbs decision wasn’t only affecting what contraceptive methods patients were seeking, but also how some doctors were responding and counseling their patients in return.
Published in the journal Reproductive Health, researchers conducted in-depth interviews with 41 contraceptive health care providers across the United States. An estimated 63 percent of them resided in states with abortion restrictions. The researchers found that the providers noted an increase in requests for contraception such as IUDs and other effective methods, as anticipated. However, the researchers concluded that Dobbs “profoundly” impacts providers’ contraceptive counseling and care.
“Our interviews highlight the moral injury and fear among health care providers resulting from abortion bans, even in contraception care,” the researchers wrote in their conclusion. “To sustain providers, clinics must invest in training and legal support so providers can safely advocate for their patients and effectively provide health care in uncertain, and increasingly hostile, environments.”
Yasaman Zia, a researcher at the Bixby Center of Global Reproductive Health and lead researchers of the study, told Salon that their findings highlight the increased pressure both on patients requesting more long-acting and permanent contraception options, and then on the providers’ ability to respond in a “patient-centered” way. While birth control hasn’t been directly affected by abortion bans — though there is genuine concern it could be banned next — misinformation and legal ambiguity are influencing how providers practice.
“There's a deliberate legal ambiguity around inserting IUDs for emergency contraception and misinformation through abortion restrictions as IUDs causing an abortion,” Zia said. “This is despite the scientific evidence that its mechanism of action greatly differs.”
One example of how the fear that is prevalent among providers can be found in the case of using misoprostol before inserting an IUD. Misoprostol, which is used in conjunction with mifepristone as part of a medication abortion, can soften the cervix and make placement more comfortable. For some women, the pain of getting an IUD can be extreme.
Recently, after years of public outcry, the Centers for Disease Control and Prevention (CDC) issued recommendations for clinicians on how to help manage the pain that women might experience. While Misoprostol wasn’t recommended for routine use, the CDC advised it could be used in “selected circumstances,” like when a patient experienced a first failed placement. But in the recent study, a provider during an interview raised concerns that by using misoprostol, people could think that the provider is “causing an abortion.”
“Is someone going to try to get us in trouble for doing that?” the nurse practitioner based in a restrictive state, who was interviewed in the study, posited. “Is the pharmacy going to fill it? We know we’re not doing anything wrong, but... that too.”
Another nurse practitioner also said they were concerned about placing IUDs, and revealed some doctors are adding additional layers of protection to ensure it doesn’t look as if they’re performing an abortion if they’re practicing in an abortion-ban state. And it has even changed what kind of tests doctors run, sometimes opting for more sensitive pregnancy tests using the blood instead of urine.
“There are some doctors that I am working with who have started doing SDHCG [serum detected human chorionic gonadotropin test] instead of just a urine HCG to prove that they weren’t pregnant before they put in an IUD and those kinds of things,” another nurse practitioner said.
Many providers who were interviewed also expressed concern that abortion restrictions will soon expand to contraception care. In Justice Clarence Thomas' concurring opinion on the Dobbs decision, he opined that the Supreme Court should revisit precedents that codified same-sex marriage, same-sex relationships, and the right to contraception. Earlier this year, U.S. lawmakers had a chance to codify access to birth control by passing the Right to Contraception Act, but failed to do so.
“We also offer emergency contraceptive pills at our clinic. … But I definitely have concerns moving forward, is this something that will continue?” one provider said. “Will restrictions become more and more?”
Zia said that the fears expressed by providers that contraceptives could be the next target of restriction “are real and felt.”
“We need institutions to protect providers legally in navigating these hostile environments, and equip providers with the information they need to battle misinformation and shifting policies, in order to continue providing patients with the full range of contraceptive options,” Zia said.
Notably, providers in abortion-ban states felt the void of not being able to discuss abortion care with their patients. Providers who deliver contraceptive care may also provide abortion counseling or care, but now they are taking it upon themselves to see what options in other states are available to their patients.
“As far as caring for patients I think it’s going to be important for us to educate ourselves about the law in different states so we can offer them... while I know this is what we can do for you here, in this state you can do XYZ,” one nurse practitioner said. “Learning resources to provide them I think is going to be important going forward.”
Zia said it was “surprising to witness” how these restrictions are affecting the range of contraceptive care.
“Contraception is not directly implicated in these abortion restrictions, and yet it's profoundly impacted,” Zia said.
