The COVID-19 pandemic combined with change in abortion access post the overturn of Roe v Wade in June 2022 increased the need for contraceptive access for adolescents. Ohio has the26th worst rate of adolescent pregnancy in the US; rates in Cuyahoga County are four-fold higher. This study examined use of various contraceptive methods in the two years pre- versus post-COVID-19across a single large health system in northeastern Ohio.

After IRB approval, electronic medical record (EMR, epic) data was collected on prescribed contraceptive methods in youth assigned female at birth ages 12-18 years from 1/1/2018-7/30/23 across all 27 family health centers and 12 hospitals within the Cleveland Clinic Health System in Ohio. Data collection was extended through 7/2023 to assess any extra impact of the Dobbs vs Jackson decision (6/2022) and to extend evaluation post pandemic (pandemic status lifted 5/11/23). Data from pediatric resident clinics (mainly Medicaid) were also analyzed. Contraceptive rates were compared between 2018 and 2022 using Chi-square tests.

The number of unique patients available for analysis was 9901 in 2018, 10086 in 2022, and 10085 in 2023. The percentage of adolescents assigned female at birth ages 12-18 years who had been prescribed contraception increased significantly from 2018 to 2023 (2 LARC insertions, 0.02%, 90 patients prescribed any contraception, 0.91% in 2018 vs 274 LARC insertions, 2.1% and 2533 prescribed any contraception, 21.53% in 2022, p< 0.001 for both). A simultaneous decrease in the percent of youth prescribed oral contraceptives (81.9% in 2018 versus, 72.48% in 2022 and 72.76% in 2023YTD) plus an increase in LARCS prescribed (5.37% in 2018 vs 14.33% in 2022 and 13.84% in 2023YTD) was found across all providers at all sites. When pediatric resident clinic patients were separated, an increase in contraceptive prescribing of all forms of contraception across the years was observed (2018: 1/746 =0.13% adolescent with a LARC, and 20 patients on any contraceptive, 2.69%, versus 29/679, 4.3% youth with a LARC in 2022, and 154 patients with any contraception, 30.33%).

The increase in use of LARCs both in pediatric residency clinics as well as across our entire health system may reflect the prioritization of more effective methods in a post-Roe world, as well as heightened education on contraceptive access in this age group. Further education of providers on use of LARCs and other means of contraception may help decrease teen pregnancy in a high-risk region.