Abstract
Objectives
The 2022 United States Supreme Court Dobbs v. Jackson Women's Health Organization (Dobbs) decision to overturn federal protections for abortion access has impacted contraceptive use and access. This study aimed to examine whether Dobbs further impacted contraceptive preference fulfillment and related outcomes.Study design
We used panel and cross-sectional data from household-based Surveys of Women representative of women ages 18-44 in three states with varying abortion policy contexts post-Dobbs: Arizona and Wisconsin (more restrictive; n=2525 pre-Dobbs 2021 timepoint; n=4052 early post-Dobbs 2022-2023 timepoint) and New Jersey (less restrictive; n=1186 pre; n=2025 early post). We examined the impact of Dobbs on four contraceptive preference-related outcomes via quasi-experimental difference-in-difference models.Results
We found an association between Dobbs and receipt of contraceptive care; predicted probabilities among women in more restrictive states were 8.21 percentage points higher (95% CI: 1.96, 14.47) than among those in the less restrictive state. There were no differential impacts of Dobbs on barriers to preferred contraception, contraceptive use, and preference fulfillment among users of methods other than female permanent contraception. In restrictive states, barriers to preferred contraception increased, contraceptive use including non-condom barriers declined, and use of emergency contraception increased pre- to early post-Dobbs. In both contexts, female permanent contraceptive use declined.Conclusions
Immediately post Dobbs, people in more restrictive policy settings may have changed contraceptive care and method seeking differentially compared to those in the less restrictive setting; we observed no change in contraceptive preference fulfillment among users of methods other than female permanent contraception.Implications
Our findings signal that conceptualizations of contraceptive preferences, which were originally conceived in a pre-Dobbs research landscape, may need to be revisited and interrogated for its salience in a post-Dobbs landscape, especially in states where people's reproductive choices are severely constrained. More broadly, our findings on changes in specific method use from pre- to post-Dobbs-especially decreases in female permanent contraceptive use documented across state contexts-challenge findings from several other studies documenting increases in this outcome from pre-to post-Dobbs among different study populations.