Contraception demand up after Roe reversal, doctors say

By Virginia Langmaid, CNN

In the days since the US Supreme Court issued its ruling in Dobbs v. Jackson Women’s Health Organization and overturned Roe v. Wade, reproductive health care has needed to operate in a new landscape.

Doctors and prescribers are now seeing an increase in demand for different forms of contraception, including emergency contraception and longer-lasting forms of birth control.

Some national pharmacy chains imposed limits on purchases of emergency contraception, even temporarily.

Nurx, an online pharmaceutical company that prescribes birth control along with other medications, saw increases in demand for emergency contraception after the leak of the Dobbs opinion in May as well as after the decision came down in June.

“When that decision was leaked, we saw a massive demand for emergency contraception. We saw a 300% increase in prescriptions being asked for and by our patients,” said Kelly Gardiner, vice president of communications with Thirty Madison, Nurx’s parent company.

The company then saw a “huge surge” in demand after the decision was final.

“We saw a 10 [times] surge for prescription-only Ella, and even though demand has leveled out right now, what we’re starting to see is birth control requests are [three to four] times higher than usual,” Gardiner said.

Ella is an emergency contraceptive pill that can be taken up to five days after sex. Emergency contraceptives work by delaying ovulation or preventing implantation and cannot terminate a pregnancy.

More people were also buying multiple forms of birth control. According to Gardiner, before the decision was released, about 30% of Nurx customers who had traditional birth control prescriptions would add Ella to their order. After the decision, that number rose to 60%.

“We’re seeing people who used to just kind of use their birth control regularly, really want that added protection,” she said.

For health care providers, the Supreme Court decision has brought more questions and concerns from patients.

“I am definitely seeing people who are saying, you know, ‘My IUD expires in a year. Should I get a new one? That way if I can’t access it, I’ve got coverage for another five years,’ ” said Dr. Jennifer Lincoln, a board-certified ob-gyn in Portland, Oregon, and a fellow with the American College of Obstetrics and Gynecology. “Or ‘I’m not sure if I’m done having kids, but should I get a tubal [ligation] just in case? Because I don’t know what to do.’ “

A tubal ligation is a permanent surgical sterilization procedure. Although Lincoln said it’s a procedure OB-GYNs are “happy to provide,” it does require some consideration.

“We don’t want people to just feel rushed into it and be like 80% sure, and so then they’re going to regret it. So we don’t want to perform surgeries on people who are conflicted. And so that’s another another bump in the road.”

Dr. Meera Shah, chief medical officer of Planned Parenthood Hudson Peconic in New York, said she’s seen more interest in vasectomies, as well.

“We’ve had an increase in number of calls to our health center of patients requesting vasectomies because of the decision,” she said.

Confusion after Supreme Court decision

Some of the demand might be driven by concerns that certain types of birth control won’t be available.

“People are confused,” Lincoln said. “They hear that they can no longer have abortions or be able to control their reproductive future, and they’re wondering if things like IUDs [intrauterine devices] are going to be next, if emergency contraception might be next, if their birth control might be next,” she said.

“There’s mass confusion, and I get it, because it’s really hard to know what’s true and what’s not,” Lincoln said.

Shah, who practices in New York and Indiana, said much of her post-Roe work around contraception has involved reassuring patients that they can still access health care, “telling the patients that, you know, in New York, abortion access is protected, and so is contraception access,” she said.

Shah thinks some of that fear is coming from social media and discussions around the ruling.

“In the final decision, it was mentioned that we should revisit other cases that are rooted in the same theory as Roe v. Wade was, so Griswold being one of them,” she said. Griswold v. Connecticut, a 1965 Supreme Court decision that protected a right to marital privacy and allowed access to contraception, was referenced in US Supreme Court Justice Clarence Thomas’ concurring opinion on the Dobbs case.

“When is that going to happen? Is that going happen? Is that a real threat?” Shah said.

Lincoln, who has a large audience on TikTok, said she has heard from followers about difficulty accessing over-the-counter contraception products.

“I’ve had my followers on social media send me screenshots of the aisles where condoms are sold, and they’re all gone too, because people are like, ‘Oh my goodness, we need everything,’ ” she said.

“I love that people want to be prepared, but the stockpiling mentality doesn’t help anybody, because we do end up with shortages,” Lincoln said.

‘Demoralizing’ to health care practice

With the decision in place, reproductive health care providers now face an additional challenge.

“It’s demoralizing to go through the amount of years of training that we go through, to know and to see the outcomes that happened with people when they didn’t have a choice, when they had situations that they couldn’t take control of, and to see that patients now who are just being told that they are not able to be in control of their life and their reproductive choices,” Lincoln said.

“We’ve already been down, because of Covid and seeing our patients be left behind, out of the vaccine trials, and now this, it’s just — it’s just hard when you never thought this would have to be an issue. And we’ve got plenty of other stuff to focus on, right?

“We’ve got so many other things that we could be focusing on, and we’re having to relitigate this and see our patients have their autonomy taken away, and it’s just really hard,” Lincoln said.

Shah noted the level of fear and uncertainty, particularly with her work in Indiana, that comes with ordering procedures that may not be legal the next day.

“It’s really scary. We have to tell the patients, ‘we’ll put you on a schedule, but we don’t know what tomorrow holds.’ And as a patient, that is absolutely terrifying to hear,” she said.

“As a provider, that’s devastating. Turn somebody away? That’s awful. Say ‘I can’t take care of you because the government says I can’t’? When I know that this is safe and that your bodily autonomy is first and foremost?

“It’s hard. Infuriating, actually.”

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