OBJECTIVES: This study examined trends in prescription contraceptives in 2017-2021 among US women of childbearing ages (16 to 49) before and during the Covid-19 pandemic.

METHODS: Continuously eligible and commercially insured members who filled any prescription contraceptive were included. Analyses included orals, non-orals, and intra-uterine devices (IUDs). Non-orals included prescription gels, patches, rings, injections, and implants. Interrupted time series (ITS) models were used to assess changes in the prevalence of use (per 100,000 women) pre- pandemic (January 2017 to March 2020) and during the pandemic (April 2020 to December 2021). Secondary models adjusted for member characteristics (age and race/ethnicity) and the Evernorth’s social determinant of health index.

RESULTS: There was a significant and immediate decline during the pandemic (vs. pre-pandemic) in the prevalence of women using orals (Coefficient: -199.0, Pvalue: 0.0057), non-orals (Coefficient: -41.1, Pvalue: 0.0331) and IUDs (Coefficient: -66.15, Pvalue: 0.0038). During the pandemic, there was a declining trend in the prevalence of women using orals (Coefficient: -45.60, Pvalue: <0.0001) and non-orals (Coefficient: -3.26, Pvalue: 0.0167). In contrast, there was an increasing trend in the prevalence of women using IUDs (Coefficient: 2.29, Pvalue: 0.142). In secondary models, the immediate level change of IUDs (Coefficient: -78.99, Pvalue: 0.0022) and the declining trend for oral contraceptives (Coefficient: -41.36, Pvalue: 0.0079) remained statistically significant.

CONCLUSIONS: A decline in oral and non-oral contraceptive use could be partly due to women shifting to over-the-counter methods, IUDs, or sterilization. A decline in IUD use could be attributed to office closures and patients avoiding potential exposure to Covid-19 at doctor offices. Furthermore, a decline in use across all contraceptive methods could signal an increase in intended pregnancy; as birth rate increased significantly in 2021. Nonetheless, contraceptive use may provide benefits besides pregnancy prevention, including a reduction in the risk of certain reproductive cancers.