Over-the-counter emergency contraceptive sales before and after Dobbs : a difference-in-difference analysis of US retail data

Introduction The US Supreme Court ruling in Dobbs v Jackson Women's Health Organization (Dobbs) substantially altered abortion access nationwide, underscoring the importance of emergency contraception as the last opportunity to prevent an unwanted pregnancy. Methods We conducted a nationwide retrospective cohort study of over-the-counter (OTC) emergency contraceptive (EC) sales from January 1, 2016, to December 31, 2022, comparing states that enacted a total or 6-week abortion ban after Dobbs with those with no new abortion restrictions. Weekly OTC sales per 1000 females aged 15–44 years were analyzed using a synthetic difference-in-differences and event study specification. Results In 2022, approximately 14.8 million units of EC were sold OTC, equivalent to 228 units per 1000 individuals at risk of pregnancy. Following Dobbs, OTC EC sales increased for 4 weeks, with larger short-term increases in states enacting more restrictive abortion policies. In the longer post-Dobbs period, we did not find significant sustained differences in sales (Average Treatment Effect on the Treated, ATT = −0.143, P =0.084; 95% CI: −0.31 to 0.02). Conclusion Future work is needed to understand how individuals adapt their reproductive health care decisions, including use of emergency contraception, under restrictive abortion policies.