Background: Since the Dobbs vs. Jackson Women's Health Organization decision in June 2022, providers throughout the U.S. have been navigating the shifting legal landscape of abortion bans, which diminish the delivery of evidence-based healthcare. The Dobbs decision has had a detrimental impact on medical training, the physician-patient relationship, and provision of medical care. However, few studies have captured the effects on providers in adjacent fields, including contraceptive care. Our objective was to examine the impact of Dobbs on contraceptive care.
Methods: We conducted semi-structured in-depth interviews (August 2022-July 2024), with 41 contraceptive healthcare providers across the US, with the majority (63%) in abortion restrictive states. We utilized deductive thematic analysis to assess providers' practice changes and experiences related to contraceptive services.
Results: In reaction to the Dobbs decision, providers noted increased requests for contraception, especially for highly effective methods. Providers worried that certain methods, such as IUDs or emergency contraception, would become restricted, and mentioned advance provision of pills and other ways that they would try to ensure supplies. Providers also discussed that their patients were worried about threats to contraception, including for adolescents. Some expressed concern, however, that the abortion bans may prompt providers to overemphasize high-efficacy methods with directive counseling. Providers shared that it was stressful to practice in contexts of uncertainty, with shifting abortion policies affecting contraceptive care, including emergent needs such as providing contraceptive services to out-of-state patients before they go home. Several providers shared that they felt an increased importance of their role in their communities, and a deepened commitment to advocate for their patients.
Conclusions: Abortion restrictions profoundly impact providers' contraceptive counseling and care. The effects of Dobbs on providers and their clinical practices underscore providers' legally precarious position in today's reproductive health landscape. Attention to contraceptive access and person-centered care has become a salient public health need across the U.S. The long-term impacts of limited reproductive rights may stretch an already under-resourced healthcare system and further emphasize moral pressures.
Since the Dobbs vs. Jackson Women’s Health Organization decision in June 2022, providers throughout the U.S. have been navigating the shifting legal landscape of abortion bans, which diminish the delivery of evidence-based healthcare. The Dobbs decision has had detrimental impacts on health care, including medical training, the physician–patient relationship, and how medical care is provided for patients. This study is focused on the impacts of the Dobbs decision on the clinic practices and experiences of providers in contraceptive care, where patients receive birth control counseling and methods. We conducted interviews with healthcare providers working in contraceptive care to assess their practice changes and personal reactions since the Dobbs decision. Providers noted changes in increased patient requests for certain contraceptive methods, uncertainty about abortion restrictions affecting contraceptive care, and feeling personally obligated to provide contraceptive care and medical advice around abortion despite the shifting legal landscape. Providers also expressed personal experiences of stress, or moral injury, around the high stakes impact of abortion restrictions on patients as well as confusion and uncertainty of how legal restraints impact their work. Nevertheless, they felt an increased emphasis on the importance of their roles in their communities. Abortion restrictions profoundly impact providers’ contraceptive counseling and care. Providers’ comments underscored a sense of moral injury, a feeling of urgency to help patients, and shifts in counseling approaches that may over-emphasize contraceptives in the context of limited abortion access.
© 2024. The Author(s).