Objectives The 2022 United States Supreme Court Dobbs v. Jackson Women’s Health Organization (Dobbs) decision to overturn federal protections for abortion access has impacted contraceptive use and access. This study aimed to examine whether Dobbs further impacted contraceptive preference fulfillment and related outcomes. Study design We used panel and cross-sectional data from household-based Surveys of Women representative of women ages 18–44 in three states with varying abortion policy contexts post-Dobbs: Arizona and Wisconsin (more restrictive; n = 2525 pre-Dobbs 2021 timepoint; n = 4052 early post-Dobbs 2022–2023 timepoint) and New Jersey (less restrictive; n = 1186 pre; n = 2025 early post). We examined the impact of Dobbs on four contraceptive preference-related outcomes via quasi-experimental difference-in-difference models. Results We found an association between Dobbs and receipt of contraceptive care; predicted probabilities among women in more restrictive states were 8.21 %age points higher (95% CI: 1.96, 14.47) than among those in the less restrictive state. There were no differential impacts of Dobbs on barriers to preferred contraception, contraceptive use, and preference fulfillment among users of methods other than female permanent contraception. In restrictive states, barriers to preferred contraception increased, contraceptive use including non-condom barriers declined, and use of emergency contraception increased pre- to early post-Dobbs. In both contexts, female permanent contraceptive use declined. Conclusions Immediately post Dobbs, people in more restrictive policy settings may have changed contraceptive care and method seeking differentially compared to those in the less restrictive setting; we observed no change in contraceptive preference fulfillment among users of methods other than female permanent contraception. Implications Our findings signal that conceptualizations of contraceptive preferences, which were originally conceived in a pre-Dobbs research landscape, may need to be revisited and interrogated for its salience in a post-Dobbs landscape, especially in states where people’s reproductive choices are severely constrained. More broadly, our findings on changes in specific method use from pre- to post-Dobbs—especially decreases in female permanent contraceptive use documented across state contexts—challenge findings from several other studies documenting increases in this outcome from pre-to post-Dobbs among different study populations.
Objective: While intrauterine devices (IUDs) are highly effective for contraception and menstrual-related concerns, a significant barrier to usage in adolescents is fear of pain during placement. We sought to identify patient characteristics associated with receiving sedation for IUD placement among adolescents. Study design: A retrospective cohort study was performed at a single institution from January 2022 to December 2023. Patients (N = 284) assigned female at birth, aged <= 18, who underwent IUD placement for any indication with or without sedation were included. Demographic and clinical characteristics were analyzed using multivariable logistic regression. Results: Two hundred thirty-three patients (82.0%) underwent IUD placement in clinic without sedation and 51 (18.0%) underwent placement with sedation. There were no significant differences in age, race, ethnicity, or insurance type between cohorts. Sedation patients had a higher BMI (26.2 vs 24.3 kg/m(2), p = 0.04), were more likely to identify as non-binary (13.7% vs 4.3%, p = 0.01), and were less likely to be sexually active (25.4% vs 62.7%, p < 0.001). In multivariable analysis, a bleeding disorder was associated with a 19.6 percentage-point higher predicted probability of undergoing sedation (95% CI 4.7-34.5 percentage points), whereas being sexually active was associated with an 11.8 percentage-point lower predicted probability (95% CI -23.3 to -0.3 percentage points). Conclusions: We identified several patient characteristics that increase the likelihood of adolescents undergoing IUD placement with sedation, including higher BMI, having a bleeding disorder, identifying as non-binary, and not being sexually active. These findings may help clinicians identify adolescents who could benefit from expanded pain management options. Implications: This study identifies specific adolescent patient characteristics associated with use of sedation for IUD placement, including obesity, having a bleeding disorder, identifying as non-binary, and not being sexually active. Expanding equitable pain management access may reduce deterrents to IUD use and strengthen patient-centered contraceptive care. (c) 2026 The Author(s). Published by Elsevier Inc. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
