3 years after abortion rights were overturned, contraception access is at risk – The Conversation

Report on the Impact of the Dobbs Decision on Abortion and Contraception Access in the U.S. with Emphasis on Sustainable Development Goals (SDGs)

Introduction

On June 24, 2022, the U.S. Supreme Court issued a landmark decision in Dobbs v. Jackson Women’s Health Organization, overturning nearly 50 years of constitutional abortion rights and returning the authority to regulate abortion to individual states. This ruling has significantly altered the national abortion landscape and has had profound implications for access to contraception, which is critical to achieving several Sustainable Development Goals (SDGs), particularly SDG 3 (Good Health and Well-being) and SDG 5 (Gender Equality).

Changes in Abortion Access and Contraceptive Demand

State-Level Abortion Restrictions

1. As of June 2025, 12 states have enacted near-total abortion bans.
2. 10 states prohibit abortion before 23 or 24 weeks of gestation, the point of fetal viability.
3. 19 states restrict abortion after viability, while nine states and Washington have no gestational limits.

Increased Demand for Effective Contraception

• Women in states with abortion bans or severe restrictions are increasingly motivated to avoid unintended pregnancies.
• Health care providers face legal concerns when treating pregnancy-related emergencies, increasing the risk associated with planned pregnancies.
• Research indicates a rise in the use of long-acting reversible contraceptives (LARCs) such as intrauterine devices (IUDs) and permanent contraception methods like sterilization.
• A 2024 national survey found nearly 20% of women aged 18 to 49 changed their contraceptive practices due to the Dobbs decision, including initiating contraception use, switching to more effective methods, or obtaining sterilization procedures.
• Studies report a 16% increase in long-acting contraception or sterilization among women, and a 33% increase in vasectomies among men post-Dobbs decision.

Impact on Contraception Providers and Services

Decline in Healthcare Provider Availability

• States with strict abortion laws have experienced a 4.2% decrease in OB-GYN practitioners compared to states without such restrictions.
• Applications to residency training programs in states with abortion bans have declined, potentially leading to a long-term reduction in healthcare providers.

Closure of Abortion Clinics Affecting Contraceptive Services

• Abortion clinics, which often provide comprehensive reproductive health services including contraception, have closed in states with near-total abortion bans.
• All 57 abortion clinics in the 12 states with near-total bans closed by March 2024.
• There has been a reported 4.1% decline in oral contraceptive dispensing in these states.

Threats to Contraception Access and Coverage

Misclassification of Contraceptives

• Efforts have emerged to redefine effective contraceptives such as emergency contraceptive pills (Plan B, Ella) and certain IUDs as abortion-inducing medications.
• Emergency contraceptive pills are up to 98% effective at preventing pregnancy, and IUDs are 99% effective; neither terminates an established pregnancy.
• Misinformation conflating contraception with abortion may deter use of effective contraceptive methods and increase reliance on less effective options.

Insurance Coverage Risks

• Medicaid has provided no-cost family planning services since 1972, and the Affordable Care Act (ACA) mandates coverage of FDA-approved contraceptives without cost-sharing.
• Research shows ACA coverage has increased IUD use, which can be costly without insurance.
• If contraceptives are reclassified as abortion-inducing, they may lose coverage under Medicaid and ACA, jeopardizing access to effective contraception.
• Project 2025, a conservative policy agenda, advocates removing Ella from ACA coverage due to its classification as a “potential abortifacient.”
• Several state politicians support restricting access to these contraceptive methods.

Implications for Sustainable Development Goals (SDGs)

SDG 3: Good Health and Well-being

• Access to effective contraception is essential for reducing unintended pregnancies and improving maternal health outcomes.
• Restrictions on abortion and contraception threaten progress in reducing maternal mortality and ensuring universal access to sexual and reproductive health services.

SDG 5: Gender Equality

• Contraceptive access empowers women to make informed reproductive choices, promoting gender equality and women’s autonomy.
• Legal and policy barriers undermine women’s rights to health and bodily autonomy.

SDG 10: Reduced Inequalities

• Low-income populations relying on Medicaid are particularly vulnerable to loss of contraceptive coverage.
• Ensuring equitable access to contraception is critical to reducing health disparities.

Conclusion

Three years following the Dobbs decision, the United States faces a complex reproductive health landscape marked by increased demand for contraception amid declining provider availability and threats to contraceptive access and insurance coverage. These developments pose significant challenges to achieving key Sustainable Development Goals related to health, gender equality, and reduced inequalities. It is imperative to address these issues to safeguard reproductive rights and health for all individuals.

1. Sustainable Development Goals (SDGs) Addressed or Connected

1. SDG 3: Good Health and Well-being
   • The article discusses issues related to women’s health, reproductive rights, access to contraception, and the impact of abortion restrictions on health services.
2. SDG 5: Gender Equality
   • The article highlights the impact of abortion restrictions on women’s autonomy, reproductive rights, and access to family planning services, which are central to gender equality.
3. SDG 10: Reduced Inequalities
   • The article touches on disparities in access to contraception and healthcare services across different states, affecting low-income and marginalized populations.
4. SDG 16: Peace, Justice, and Strong Institutions
   • The legal and policy changes regarding abortion and contraception regulation involve justice and institutional frameworks affecting health rights.

2. Specific Targets Under Those SDGs Identified

1. SDG 3: Good Health and Well-being
   • Target 3.7: Ensure universal access to sexual and reproductive health-care services, including family planning, information and education, and the integration of reproductive health into national strategies and programs.
   • Target 3.8: Achieve universal health coverage, including financial risk protection and access to quality essential health-care services and medicines.
2. SDG 5: Gender Equality
   • Target 5.6: Ensure universal access to sexual and reproductive health and reproductive rights as agreed in accordance with the Programme of Action of the International Conference on Population and Development and the Beijing Platform for Action.
3. SDG 10: Reduced Inequalities
   • Target 10.2: Empower and promote the social, economic and political inclusion of all, irrespective of age, sex, disability, race, ethnicity, origin, religion or economic or other status.
4. SDG 16: Peace, Justice, and Strong Institutions
   • Target 16.6: Develop effective, accountable and transparent institutions at all levels.
   • Target 16.7: Ensure responsive, inclusive, participatory and representative decision-making at all levels.

3. Indicators Mentioned or Implied to Measure Progress

1. Contraceptive Prevalence Rate
   • Implied by data on increased use of long-acting contraception methods (IUDs, sterilization) and emergency contraception after the Dobbs decision.
2. Number of Health Care Providers
   • Decrease in OB-GYN practitioners and residency applications in states with abortion restrictions, indicating availability of reproductive health services.
3. Access to Family Planning Services
   • Closure of abortion clinics that also provide contraception services, and decline in oral contraceptives dispensed.
4. Health Insurance Coverage of Contraception
   • Coverage mandates under Medicaid and the Affordable Care Act for contraceptive methods, and potential changes if contraceptives are reclassified.
5. Legal and Policy Environment
   • Number of states with abortion bans or restrictions, and legislative efforts to redefine contraceptives as abortifacients.

4. Table of SDGs, Targets, and Indicators

Source: theconversation.com