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Use of most contraceptive methods steadily decreased from 2019 to 2022, except for vasectomy services, according to new research published in JAMA Network Open. Findings also showed that more advanced practice clinicians (APCs) and fewer physicians were providing contraception services.

“In 2022, Dobbs v. Jackson Women’s Health Organization dramatically changed the landscape of reproductive health, causing ripple effects that will extend beyond abortion care,” first author Julia Strasser, DrPH, MPH, of the Milken Institute School of Public Health at George Washington University, and colleagues wrote. “Contraception may be especially vulnerable to further restrictions and barriers, both to those seeking care and those providing it.”

To analyze national changes in contraception services and workforce, investigators identified 731 447 clinicians who provided contraception services between January 2019 to December 2022 from IQVIA, which “captures approximately 93% of retail pharmacy prescriptions and medical claims for approximately 191 million patients,” they wrote.

The primary outcomes were the monthly volume of contraception service visits by type and the annual number and type of clinicians providing the services. Contraception methods included new prescriptions for pills, patches, and rings and visits for intrauterine devices (IUDs), implants, injectable (depo-medroxyprogesterone acetate), vasectomy, and tubal sterilization.

Findings

The research team found that most contraception services showed steady downward trends, except for sharp declines during the early months of the COVID-19 pandemic and temporary increases in the month following the Dobbs v Jackson Women’s Health Organization decision.

According to the results, from 2019 to 2022, there were decreases in the volume of IUD services (from 650 043 to 591 509) and tubal sterilization services (from 103 547 to 74 537). However, the volume of vasectomy services steadily increased, going from 146 796 in 2019 to 198 212 in 2022.

Also, new contraceptive prescriptions (ie, pill, patch, and/or ring) decreased from more than 25 million in 2019 to less than 22 million in 2022. Investigators noted that prescription duration increased with 44 237 865 prescriptions (68%) in 2019 limited to 1 month compared with 27 925 732 (46%) in 2022.

Investigators added that the workforce providing contraception services shifted from 2019 to 2022, with increases in the number of APCs providing IUD, implant, and prescriptions and decreases in physicians providing prescriptions. APCs included advanced practices nurses (eg, nurse practitioners, nurse midwives) and physician assistants; physicians included obstetricians and gynecologists, family medicine, internal medicine, pediatrics, and other physicians (eg, emergency medicine).

Strasser and colleagues noted that the combination of decreasing numbers of physicians providing prescriptions and current state-level policies that restrict APCs from full scope of practice, is cause for concern.

They continued: “The decreases we saw in certain contraception services may be driven by shifts in the workforce as well as patient preferences and changing markets (eg, growing presence of online pharmacies). Some of the decrease in contraception prescriptions may be due to increases in extended supply prescribing, and the growing use of vasectomy may indicate shifts in gendered approaches to reproductive decision-making.”

Limitations of the study include the fact that the data researchers used had limited coverage of online-only pharmacies and health maintenance organization pharmacies, the comprehensiveness of the medical claims varied among individual clinicians.

“As 2023 data become available, future research should continue to track changes in contraception workforce composition and access to the full range of contraceptive methods,” investigators concluded.

Reference: Strasser J, Schenk E, Luo Q, et al. Contraception usage and workforce trends through 2022. JAMA Netw Open. Published online April 15, 2024. doi:10.1001/jamanetworkopen.2024.6044