Primary care physicians can help solve the current birth control crisis

Just before the holidays, a patient was in my office for what I thought was going to be a routine appointment. After completing the exam, however, we started talking about what was really on her mind.

“I want a new birth control implant placed ASAP,” she said.

“The one you have already in your arm is still effective until 2026,” I said.

“I need it now, before anything changes,” she said. Ah, I understood.

There was of course no medical reason for replacing her birth control implant (this particular patient uses Nexplanon). The small, flexible rod inserted under the skin of the upper arm provides safe, effective birth control for three to five years — and she had a year left. She was doing well with this method: She had no troublesome side effects and preferred it over having to remember to take a daily pill. Nonetheless, given the current climate surrounding birth control access — in early 2024, Senate Republicans blocked a bill designed to protect access to contraception and Project 2025 recommends curtailing access to some types of contraception — and how that might affect her insurance coverage and contraceptive access, early replacement made a certain kind of sense. We replaced her Nexplanon.

Following the 2024 election, anxiety around access to contraceptive healthcare is at an all-time high.

Following the 2024 election, anxiety around access to contraceptive healthcare is at an all-time high. Google searches for “birth control” and Plan B (a form of emergency contraception) reportedly doubled between Nov. 2 and Nov. 6., suggesting an incoming wave of demand for contraceptive services on an already struggling healthcare system. Clinics have noted an increase in appointment requests for birth control, especially long-acting and permanent methods.

As a physician, I’m seeing this anxiety firsthand almost daily. Patients are not just requesting early IUD and implant replacements; they’re asking about stockpiling birth control pills and emergency contraception.

And it’s not just the results of the election making people (understandably) nervous. Evidence suggests that the Supreme Court’s 2022 Dobbs decision, which took away the constitutional right to an abortion, gutting abortion access for millions, also harmed contraceptive access in a variety of ways.

One study examining contraceptive care in four states found that after Dobbs, women reported more difficulty accessing their preferred contraceptive method and lower-quality care overall. Over a third of OB-GYNs nationally — and half in states where abortion is banned — report their ability to treat their patients with the right medicine or procedure at the right time has deteriorated since Dobbs.

Another November 2024 study examining the impact of Dobbs, which included 41 qualitative interviews with providers, found that the ruling led to increased patient demand for contraception, especially long-acting reversible contraceptives (LARC) and permanent methods such as vasectomy.

As a practicing family doctor, I am increasingly aware that we’re on a very slippery slope. Fear-based decision making compromises both patient choice and the highest standards of care. Every procedure involves some risk, even when the risk seems trivially small.

Medically unnecessary replacement procedures are costly. Replacing a medical device like Nexplanon one or two years early for millions of people is an unnecessary cost to our already too expensive healthcare system. And the emphasis on highly effective long-term contraceptive methods might inadvertently lead to coercive counseling practices. As one provider from the November 2024 “Reproductive Health” study put it: “I do think that providers, and pediatricians in particular, feel like everybody needs a LARC right now basically. And so I do worry that those conversations that they’re having are a little bit more directive you know.” Healthcare providers have more knowledge and power than their patients and can influence patients to accept a particular treatment or medicine. Even if this is done with good intentions, patients may wind up hearing limited options from providers and pressure to use a birth control method the provider strongly recommends.

The reality, of course, is that the political climate surrounding contraception and abortion will not improve anytime soon. But contrary to the dominant narrative, we don’t have to wait for political change to act. There’s a lot that we can do right now to ease people’s anxieties and expand access to contraceptive care.

A major barrier to access is confusion. Misinformation about contraception, particularly emergency contraception, is rampant. In states where abortion is banned, more than half of the population — including half of women — don't know that Plan B remains legal. This confusion extends to less restrictive states, where a third of adults are "unsure" if emergency contraceptive pills are legal where they live. In Massachusetts, where I practice medicine, patients can get an entire year of birth control medication at once from their pharmacies, reducing the chance that they will miss doses because their busy lives prevent them from getting to the pharmacy monthly. Few patients are aware of this change. Birth control pills are also over the counter and available without a prescription, another change that is not widely known.

As a practicing family doctor, I am increasingly aware that we’re on a very slippery slope. Fear-based decision making compromises both patient choice and the highest standards of care.

We also need to make people aware of their rights, raise awareness about what remains legal and underscore how restrictions on abortions have widespread downstream effects. We're already seeing abortion bans impact access to medications like mifepristone and misoprostol, which are used for managing miscarriages and other medical conditions in addition to medical abortions. Similarly, hormonal medications used for birth control, including estrogen and progesterone, also treat conditions like polycystic ovarian syndrome (PCOS), acne, endometriosis and menopause symptoms. There's nothing partisan about these medical uses.

Primary care providers (PCPs) need support to provide the full range of contraceptive choices for their patients. These practitioners are trusted sources of medical information and many of them provide contraceptive care. But not enough of them see reproductive health as a core responsibility. Roughly half of PCPs who care for adults and two-thirds of pediatricians don’t prescribe contraception, and provision of the most effective methods (like IUDs and other LARC) is particularly uncommon. The result: patients wait up to six months to access an appointment through their primary care physician, and then wait again when they get referred to another provider who actually prescribes the preferred method of contraceptive.

Expanding contraceptive re-training and resources for PCPs would ease the burden on family planning specialists while making it more convenient for patients to access the type of birth control they want. Every provider who can prescribe birth control should be encouraged — and empowered — to do so. And they need to adopt a shared decision making model that centers patients’ needs and preferences while equipping them with medically accurate information as they navigate this challenging and uncertain landscape.

We may not be able to eliminate patient anxiety. But by combating misinformation, speaking clearly about the stakes and creating a culture where the full range of contraceptive care is available at any primary care office, we can work toward a system that helps patients feel secure and get the high-quality care they deserve.

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