EC prescribing has not changed post Dobbs

Few pediatric primary care providers (PCPs) have changed their prescribing practices for emergency contraception (EC) since the US Supreme Court’s Dobbs v Jackson Women’s Health (Dobbs) decision decreased access to abortion in many states. This was the primary finding of a survey of 51 pediatric PCPs, primarily physicians (85%), about attitudes and practices related to EC.

The 31-question, internet-based survey focused on participants’ EC knowledge, attitudes, and clinical practices post Dobbs. It included knowledge questions related to EC, such as types, indications for use, and timing, from which investigators calculated a “knowledge score.” Participants used a 5-point Likert scale to answer questions about attitudes and practices related to EC. 

Overall, participants achieved a mean knowledge score of 71%, and only 12% could identify all 5 types of EC used in the US, although 100% could name at least 1. About 75% of respondents knew that long-term contraception can be initiated at the same time as EC. At least two-thirds of respondents did not know that oral EC can be used for up to 5 days after sex. However, almost all respondents (90%) knew that teens do not need parental consent to access oral EC, and most knew that oral EC and intrauterine devices are not abortifacients.

Regarding attitudes, 62% of providers reported being “likely” or “extremely likely” to prescribe EC reactively, and 36% reported a similar likelihood of prescribing EC in advance for use when needed. Nonetheless, about 27% indicated they are not comfortable prescribing EC at all, and 33% of these respondents reported having no mechanism for an appropriate referral. With regard to practices, more than 80% of respondents believe EC has achieved more importance post Dobbs, although only 7% reported increasing their own EC prescribing practices. In addition, only 10% of providers “almost always” or “often” discuss EC regularly at well visits, and only 26% “almost always” or “often” discuss it at sexual health visits. Only 28% of providers had prescribed EC during the past year, and these providers were more likely to be in urban or rural areas than in the suburbs. Only 16% of providers had prescribed EC in advance.

Thoughts from Dr Farber

For the time being, emergency contraceptive pills are still available in the US. I feel that letting adolescents know about this option, regardless of their current sexual history, should be part of every well-child examination, at a minimum.

Reference

Hovel E, Pickett M, Visotcky A, et al. Inaction despite motivation: assessing systemic and personal barriers to pediatricians’ post-Dobbs emergency contraception utilization. J Pediatr Adolesc Gynecol. 2025;38(4):504-508. doi:10.1016/j.jpag.2025.03.006.