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Over-the-counter emergency contraceptive sales before and after Dobbs: a difference-in-difference analysis of US
Alice Abernathy1,2,3, Brandon Wagner4, Kelly Cleland5
1Department of Obstetrics and Gynecology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, United States.
Introduction:
The US Supreme Court ruling in Dobbs v Jackson Women's Health Organization (Dobbs) substantially altered abortion access nationwide, underscoring the importance of emergency contraception as the last opportunity to prevent an unwanted pregnancy.
Methods:
We conducted a nationwide retrospective cohort study of over-the-counter (OTC) emergency contraceptive (EC) sales from January 1, 2016, to December 31, 2022, comparing states that enacted a total or 6-week abortion ban after Dobbs with those with no new abortion restrictions. Weekly OTC sales per 1000 females aged 15-44 years were analyzed using a synthetic difference-in-differences and event study specification.
Results:
In 2022, approximately 14.8 million units of EC were sold OTC, equivalent to 228 units per 1000 individuals at risk of pregnancy. Following Dobbs, OTC EC sales increased for 4 weeks, with larger short-term increases in states enacting more restrictive abortion policies. In the longer post-Dobbs period, we did not find significant sustained differences in sales (Average Treatment Effect on the Treated, ATT = -0.143, P =0.084; 95% CI: -0.31 to 0.02).
Conclusion:
Future work is needed to understand how individuals adapt their reproductive health care decisions, including use of emergency contraception, under restrictive abortion policies.
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