Training providers to improve access to emergency contraception in abortion ban states in the U.S

Disparities in abortion and contraceptive care have intensified across the U.S. post-Dobbs, particularly in states with abortion bans and limited access to full-scope services. However, efforts to expand emergency contraception (EC) access and provider education have been limited. This study evaluated the impact of an evidence-based training on provider ability to offer the full range of EC methods.

We developed and delivered a training intervention for providers, from 2022 to 2024, at 283 clinics in Texas, Oklahoma, and Indiana, all abortion restrictive states. Participants (N = 507) completed online surveys at baseline and three months post-intervention on clinical practices for EC levonorgestrel pills (LNG ECP), ulipristal acetate (UPA), copper intrauterine devices (IUDs), and levonorgestrel 52 mg IUDs (LNG IUD). We used generalized estimating equations to assess changes in provider attitudes, counseling, and availability of each type of EC.

Providers reporting that they strongly agreed that EC was safe increased across all methods, with the largest gains for UPA (58% to 78%; adjusted odds ratio [aOR 2.58], 95% confidence interval [CI] 1.37-4.89) copper IUDs (65% to 75%; aOR 1.76, 95% CI 1.03-3.00) and LNG IUDs (38% to 62%; aOR 2.71, 95% CI 1.91-3.83). More providers reported they included EC when counseling on contraception, with significant increases for IUDs for EC, from 61% to 77% for copper IUDs (aOR 2.39, 95% CI 1.38-4.13) and 44% to 64% for LNG IUDs (aOR 2.26, 95% CI 1.50-3.42). Counseling on pills was already high but increased further (LNG ECPs and UPA: 89% to 96%; aOR 2.78, 95% CI 1.87-4.15). Overall EC availability in clinic also improved, with LNG ECPs reaching universal availability (91% to 100%), and significant increases in UPA (67% to 79%; aOR 1.64, 95% CI 1.37-1.96) and IUDs (64% to 76%; aOR 1.77, 95% CI 1.07-2.91). Advance provision of EC pills increased modestly (28% to 34%; aOR: 1.40, 95% CI: 1.06-1.83).

This replicable training intervention was associated with increased provider counseling and clinic availability of EC. Remaining gaps to reach universal provision of EC methods highlight the need for ongoing initiatives to increase access, including in abortion ban states.