Adolescent and Young Adult Perspectives on Contraception Post-Dobbs: "The Next Closest Step to Having Control Over My...

Adolescents and young adults (AYAs) face unique barriers to contraceptive care that may be exacerbated by the June 2022 Dobbs v. Jackson Women's Health Organization decision that removed federal protections for abortion rights. We examined AYA perspectives on contraception and measured changes in AYA contraceptive use pre- and post-Dobbs.

This study used a mixed-methods design. We analyzed qualitative data from the MyVoice project, an SMS-based survey among AYAs ages 14-24 in the United States. The research team analyzed open-ended responses to questions about the influence of changes to abortion access on AYA contraceptive decision making. We analyzed quantitative data from the IQVIA Longitudinal Pharmacy and Medical Claims data for patients ages 15-26. We identified monthly new contraceptive prescriptions and services for intrauterine device insertion and implant placement in 2021 and 2022. We used segmented regression analyses to test for changes in prescriptions and services post-Dobbs.

Our qualitative analysis identified themes of risk aversion, urgency and fear, and access concerns in response to the Dobbs decision. Our quantitative analysis demonstrated a slight increase in both prescriptions and services in the months immediately after Dobbs, but there were no significant changes in the slope for monthly services post-Dobbs for any age group or method type. We also identified an overall decreasing trend for all age groups and all method types during the full study period of January 2021-December 2022.

Limited changes in contraceptive use despite AYA expressions of fear, feelings of lost agency, and concerns over access may reflect continued (or worsened) barriers to contraceptive access post-Dobbs.