Teenage interest in permanent contraception surges after Roe ruling

Adismarys Abreu, 16, had been talking to her mother for about a year about a long-lasting contraceptive implant as a possible solution to increasing menstrual pain.

Then Roe v. Wade fell, and Abreu joined the throng of teenagers who rushed to their doctors when states began to ban or severely restrict abortion.

“I’m definitely not ready to get pregnant,” said Abreu, who had Nexplanon — a reversible, matchstick-sized contraceptive — implanted in her arm in August. Her home state of Florida bans most abortions at 15 weeks, and not having that option is “such a scary thought,” she said.

Experts say the US Supreme Court’s June ruling appears to be accelerating a trend toward increased use of birth control among teens, including long-acting reversible forms such as IUDs and implants. Appointments have skyrocketed and Planned Parenthood has been inundated with questions as doctors report demand even among teens who are not sexually active.

Some patients are particularly concerned because new abortion laws in several states do not include exceptions for sexual assault.

“Please, I need some birth control in case I get raped,” patients tell Dr. Judith Simms-Cendan, a pediatric gynecologist in Miami, where state law doesn’t allow exceptions for rape or incest after 15 weeks.

Simms-Cendan, the president-elect of the North American Society for Pediatric and Adolescent Gynecology, said parents who may have hesitated in the past now want to talk about birth control.

“It’s a sea change from ‘I don’t have a place to play. We need to get my kid up to something,'” she said.

Teens are already switching to more effective, long-acting forms of birth control that have similar or even lower failure rates than sterilization, said Laura Lindberg, a professor in Rutgers University’s School of Public Health in New Jersey. Their research found that the number of 15-19 year olds using these methods increased to 15% in 2015-2019, up from 3% in 2006-2010.

No national data is available for the months since Roe’s ouster, said Lindberg, who previously worked for nearly two decades at the Guttmacher Institute, a research group that advocates for abortion rights.

However, she said that “big ripple effects” could be expected from the loss of access to abortion, noting that this is not the first time the policy has led to a shift in birth control use.

In the weeks following former President Donald Trump’s election, as women voiced concerns online that the Affordable Care Act would be repealed, demand for long-acting birth control rose nearly 22% across all age groups, according to a research letter published in JAMA Year 2019 Internal Medicine.

In Ohio, where a judge this month blocked a ban on virtually all abortions, patients — both male and female — are now listening with rapt attention to the birth control talk Dr. Peggy Stager has long made a part of the routine appointments at her Cleveland pediatric office.

Stager said her practice’s dedicated Nexplanon implant placement slots are constantly occupied and requests for contraceptive refills have increased 30% to 40% since Roe was knocked over. She recently spoke to a college student who wasn’t sexually active but decided to go into an IUD anyway.

“She was very clear, ‘I want a good four years without worries,'” recalled Stager, who is chair of the Division of Adolescent Health at the American Academy of Pediatrics. “And that’s a change.”

In Missouri, one of the first states in the country to pass a trigger law banning abortion at any point in pregnancy, Dr. David Eisenberg also noted a similar sense of urgency in college-bound teenagers to choose the most effective option.

“Fear is an amazing motivator,” said Eisenberg, an associate professor at Washington University School of Medicine in St. Louis, who performs abortions in neighboring Illinois. “They understand that the consequences of contraceptive failure could mean becoming parents because they may not have access to an abortion.”

Even in the contraceptive clinic that Dr. Elise Berlan in Columbus, Ohio, has generated great interest. Prior to the Supreme Court decision, the clinic booked appointments for new patients within a week or two.

Now they book several months for first appointments, said Berlan, an adolescent medicine specialist who sees mothers and daughters in tears in her exam room. She said demand is so high they are adding a vendor.

On the day the Supreme Court ruled against Roe, Roo, Planned Parenthood’s online chatbot aimed at teens, received twice the usual birth control questions.

Online birth control appointments also skyrocketed that day — 150% more than on a typical day, with an even bigger 375% surge in IUD seekers, said Julia Bennett, director of digital education and learning strategy at Planned Parenthood Federation of America.

Through mid-July, several weeks after the ruling, birth control appointments remained up about 20%, although the data is not broken down by age group.

There is growing interest even in states like North Carolina, where abortion remains legal but the legislature is conservative.

dr Kavita Arora, an ob/gyn at Chapel Hill, said she may have seen a teenager a month before the verdict. Now, she said, she sees them at every clinic session.

“You are aware that this is an incredibly fluid situation, and what is permissible one moment may not be permissible a week or a month later,” said Arora, the chair of the American College of Obstetricians and Gynecologists’ ethics committee.

That uncertain future is part of what motivated Abreu, the Florida teenager whose implant will prevent pregnancy for up to five years.

“I don’t know what’s going to happen with the laws in that timeframe,” said Abreu, who was using a short-acting form of birth control before the switch. “Having this already in my arm makes me feel so much more secure.”

Her mother, Maribys Lorenzo, said in Spanish that she too was a little more reassured knowing her daughter cannot conceive and said she would recommend the implant because her daughter doesn’t have to remember to take birth control pills .

She said she is no more or less concerned that her daughter would become sexually active because of the implant. But if it happens she will be protected, Lorenzo said.

“I don’t think it’s fair to me or my family not to have an option to have an abortion,” her daughter Abreu said.