Inaction Despite Motivation: Assessing Systemic and Personal Barriers to Pediatricians' Post-Dobbs Emergency Contraception Utilization.

Purpose: Following the US Supreme Court's Dobbs vs Jackson Women's Health (Dobbs) decision and subsequent changes to abortion access, increasing emergency contraception (EC) access for adolescents is vital. The first step is understanding providers' knowledge, attitude and practices regarding EC post-Dobbs.

Methods: This cross-sectional internet-based survey was sent to providers within three general pediatric primary care systems from November 2023 to January 2024. Questions addressed EC knowledge, attitudes (perceived barriers and desired support to increase EC prescription) and practices post-Dobbs.

Results: There were 51 participants. Most (81%) providers felt adolescent EC prescription was more important post-Dobbs, but very few (7%) had changed their own prescribing practices. Overall, providers had a mean knowledge score of 71%. Providers closer to training had a higher EC knowledge score (77% vs 68%, p = 0.02), as did providers who were generally willing to provide EC (72% vs 58%, p=0.004). Providers in urban and rural areas were more likely to have prescribed EC than suburban counterparts (54% urban, 40% rural, 16% suburban, p = 0.04). Various barriers were elicited, most commonly relating to lack of awareness and knowledge about EC. Over half of respondents noted they would be more likely to prescribe EC with clinical decision support built into the EMR (69%), an order set in the electronic medical record (57%), and education sessions (55%).

Discussion: This study highlights a strong need to bolster provider EC education in pediatrics and address systems factors that will facilitate easier, more confident EC prescription.