A new study takes a look at prescription refills of contraceptives in the post-Dobbs era. The authors report that fills of emergency contraceptives dropped significantly in states that adopted restriction on abortion, but there was apparently no difference in fills of ordinary oral contraception:
What's peculiar here is the secular drop everywhere in oral contraception. From 2021 to 2023 fills declined overall from 6,800 to 5,000, a 26% drop. This trend is consistent throughout the entire period and has nothing to do with Dobbs. There are two interesting things here:
- Is it really true that contraceptive use dropped by 26% in only three years? Why? This doesn't jibe with other research.
- It appears that in states where abortion is easy to get, fewer women use oral contraceptives. Is this because, for some reason, they tend to use other kinds of contraception? Or is it because the easy availability of abortion makes them less likely to bother with contraception in the first place?
I'm going to tentatively put this in the "interesting if true" bucket. I'm not sure I trust these numbers, but they're interesting if true.
The "if true" part continues to grow in importance. I'm really not sure who to believe these days. I'm very confident that I know a *lot* of sources to not believe, but that's only a start.
The only reasonable explanation for the longish term secular decline is that women are switching to IUDs. That would make sense: IUDs are awesome, but they have such a bad rap from the toxic shock days, that you could see uptake moving slowly as women meet with their gynecologists and learn that IUDs are safe now. That could also explain why states that are more protective of abortion rights have fewer pill takers—those states have better contraception education, and thus started out with more IUD-havers.
There's also a general reduction in post-lead generations for casual sex.
And there are day after pills as well as IUDs, and this also isn't being matched to a birth rate, either.
This rings true to me. Could be lots of causes, but I have to think that increased IUD use is one.
Not only that, but the Dobbs decision made a whole of people decide on permanent sterilization.
Kevin can put chasing down how those numbers have up held since the decision on his blogs-posts-to-store-for-when-radiation-is-making-me-feel-shitty list.
This is certainly my take. Even the bit about IUD information being more readily available in blue states.
At the same time I'm a little puzzled that we would continue to see the decline in oral contraceptives. I don't have definite information on this topic, but it is suspected that the drop in abortion rates over the past couple of decades is most likely due to increased IUD use. It would be kind of strange that after decades of increased use the trend would not only continue, but actually increase.
I'm not sure how many people remember the toxic shock days or that it is discouraging anyone. Someone linked below showing: Women ages 36-49 were most likely to have used an IUD in the past 12 months (28%) compared to all women of reproductive age (23%).
It's just straight up fills, tho, and like employment data, only a small portion of women need it for the middle part of their life - a certain number age out every year. They've tried to deal with this by using an age group, but... is the sexual activity of that group really static? There's alot less sex going on at the younger ages than in prior generations.
And this says 'fills' - more fills are for ninety days, six months instead of monthly. Did it correct for that?
I'd expect uptake to be higher during recessions, but also that's when spending is curtailed so maybe that would also lower uptake. So we're looking at post-recession recovery as well.
But if you do look at these lines, the post Dobbs lines stop being parallel.
As the lines trend towards zero we might expect them to get closer together.
Kinda looks like it was already going down before Dobbs, so it’s likely unrelated. Wish the data went back further.
Raw numbers? Should be adjusted by cohort size, e.g. ‘per thousand women of childbearing age’.
Read the label on the y-axis.
Ah, thanks; I was just going by KD’s text, which only says ‘fills’.
Americans are having a lot less sex (google it), so it isn’t surprising we need a lot less birth control
Is there a longer term graph? When I see any graph showing a change over the last few years, my first explanation is the pandemic.
Mother Jones, as perhaps is their want, has a more alarmist take: https://www.motherjones.com/politics/2024/06/the-first-national-data-on-birth-control-post-dobbs-is-here-and-the-news-is-not-good/
Well, if you zoom in on those sections, you'll see the gap between the most restrictive states and the least is visibly narrowing more after the decision.
All these lines are trending towards zero. It would be best to compute the gaps as percentages rather than absolutes. Perhaps your Mk I eyeballs can do that but plugging into a spreadsheet would be indicated.
There are many new options besides oral contraception and IUDs. My college age daughter has a 3-year implant in her arm. Simple procedure, reversable, don't have to think about it for three years.
I have no data on this, so I don't know how prevalent it is, but she has other college friends doing the same thing.
My hunch is that 1. fewer women are married or in intimate relationships these days, so they may not feel the need to be on the pill just because, and among younger people, casual sex and "hookup culture" isn't as prevalent as it once was (thanks, internet porn!) and 2. as others have pointed out, more women are using IUDs or contraceptive implants because, yes, they don't know when some whack-ass judge like Kasczmaryk is going to all of a sudden ban the pill or something.
Some additional context:
- This Statista chart suggests contraceptive use among "sexually active women" is increasing.
- A 2020 KFF chart shows that 37% of all contraceptives used by women are oral contraceptives.
I would agree with an increase in IUDs; it seems to be preferred by younger women.
You don't have to remember to take it every day, it doesn't muck with your periods, and it doesn't mask your ovulation cycle.