Medical providers are increasingly uncomfortable discussing and prescribing the full range of birth control options with their patients following the Supreme Court’s decision to end federal abortion protections in 2022.
A November 2024 study I co-authored in the journal Reproductive Health found that doctors, nurses, and other reproductive health providers feel particularly conflicted and nervous about inserting intrauterine devices (IUDs) and dispensing emergency contraception like Plan B—two contraceptive methods that anti-abortion advocates frequently misportray as being able to cause an abortion.
The study demonstrates how growing anti-abortion laws, policies, and activism in the U.S. since Dobbs v. Jackson Women’s Health Organization are having spillover effects on contraceptive care. These findings come at a time when ever more people are relying on contraception to prevent unwanted pregnancy—particularly long-lasting forms like the IUD and permanent contraceptive methods like tubal ligation—especially in states that ban abortion.
Meanwhile, the Trump administration is finding new ways to exert control over people’s reproductive rights, from slashing government-funded research on reproductive health to cutting both national and global funding to cover contraceptive care for low-income communities.
All of these changes have cascading effects. The ongoing attacks on reproductive rights trickle down into our lives and daily interactions—including with the people who provide our reproductive health care.
Providers feel ‘stressed and alarmed’
Patients aren’t the only ones harmed by today’s confusing and ambiguous reproductive health-care landscape after Dobbs was decided, our study found. The current pressure and politicization of their work is damaging to providers’ mental wellbeing, too.
In our qualitative study conducted from 2022 to 2024, we asked 41 providers across the U.S. how the Supreme Court’s decision to remove federal abortion protections in Dobbs had shaped their psychological experiences and their care delivery. Those interviewed included doctors, physician assistants, nurses and nurse practitioners, as well as educators who discuss and prescribe birth control.
Providers reported feeling stressed and alarmed about the potential legal repercussions of providing reproductive health care and counseling patients with a full range of options. Many expressed a sense of moral injury—that is, they felt forced to practice medicine in a way that violated their values and could cause life-altering outcomes for their patients, such as carrying an unwanted or risky pregnancy to term.
“I feel limited. I feel hurt. I feel powerless. I feel angry with the decision,” one physician from a state that restricts abortion told us in an interview for the research, referring to Dobbs and its fallout.
All the providers interviewed in the study, and consequently in this article, are cited anonymously to comply with the terms of the interviews, which were originally conducted for academic research.
“I feel like I can’t advocate for the patients I want to advocate for,” the same doctor said. “I feel like I have to … be very careful with the care I provide, and the words I say, and what I document.”
This chilling effect can cause providers in abortion-ban states to restrain themselves beyond what state restrictions require to avoid any risk of having their licenses revoked or facing legal troubles. That’s true for providers in states where abortion remains accessible, too, because they fear being legally pursued across state lines.
Junk science clutters the conversation
Suddenly, there are new grey areas in their medical practice.
Providers are targets for legislators and zealots who use junk science to argue that using emergency contraception or an IUD is the same as receiving abortion care. This is not true: emergency contraception prevents pregnancy from occurring; it does not cause abortion.
In many states, restrictions on abortion are unclear about how early into a pregnancy providing emergency contraception would be considered an abortion. This has caused some providers to be hesitant toward providing patients with emergency contraceptive methods, especially IUDs.
One nurse practitioner from a restrictive state told our research team, “I do feel like I am a little more stressed and worried about repercussions or that I am going to do the wrong thing or get in trouble for putting in an IUD. There are some doctors that I am working with who have started doing [blood tests] instead of just a urine [test] to prove that they weren’t pregnant before they put in an IUD and those kinds of things.”
On the other hand, numerous providers said they remained committed to giving their patients the health care they need. And what patients have increasingly said they need is long-acting contraception.
This, too, has some providers concerned. They worry that the urgency many of their patients feel could lead providers to offer more coercive advice that pushes patients toward longer-acting contraception like IUDs and implants over shorter-acting methods that some patients might prefer. With reproductive rights disappearing by the day, providers and patients are putting pressure on contraception as the solution.
And that’s made navigating these important conversations tricky.
“I do find myself feeling a little bit more fearful when a patient does leave without birth control and they don’t want to get pregnant,” one nurse practitioner, who provides care in a state that restricts abortion, told the research team. “I don’t know that it’s changed my counseling practices in general, but I feel like it’s changed the way I feel about birth control in that it’s allowed me to feel a little bit more biased because I am putting my fear on them subconsciously, I think.”
No ‘magic solution’ to abortion restrictions
This research was completed before Trump won a second term in office. Today, even some of the remaining options for preserving reproductive autonomy—such as affordable contraception and gender-affirming care—are under attack. The burden of any future restrictions on contraception will almost surely fall on communities of color and other systemically-oppressed groups, just as post-Dobbs abortion restrictions have.
Here’s the conclusion our study has left me with: Contraceptive care is not the magic solution to abortion restrictions. Yet without policies that protect reproductive rights and in the face of blatant attacks on affordable health care, fair, affordable, and reliable contraceptive access for all is an essential tool.
Providers deserve to feel safe when delivering this kind of care, and patients deserve the information and tools they need to make reproductive decisions that best suit them, unfettered by government interference.