To prevent pregnancy after sex, U.S. teenage girls and young women are more likely to rely on unproven strategies such as prayer, exercise and jumping up and down than they are on evidence-based methods such as Plan B emergency contraception, according to a new study.

The study, published in The Journal of Sex Research, is based on a survey of 1,259 girls and women between the ages of 15-29. A quarter of the 633 respondents who reported having sexual intercourse and were not pregnant said they had used a post-coital method to prevent pregnancy.

Of those, about 9% said they’d used evidence-based emergency birth control such as Plan B or a copper intrauterine device.

But about 16% used methods without proven efficacy, including prayer (9.4%), douching (6%), jumping up and down or exercising (3.3%), ingesting something by mouth (1.9%), punching one’s stomach or uterus (1.4%), taking medicine or vitamins (0.9%), inserting something vaginally (0.5%), or using an enema (0.2%). About one-fifth of this group used more than one method — praying and douching being the most common combination.

These types of methods were more common among minors and non-white respondents.

“There is a need to better understand what is underlying these practices or the use of these strategies,” said Riley J. Steiner, an associate professor at the University of Pittsburgh School of Medicine and one of the authors of the study.

“We really don’t want young people to be seen as misguided or to be judged for these practices,” she said. “They’re trying things, and so how do we best support them to meet what their goals are?”

The release of the study comes on the heels of the Trump administration cutting and reshaping programs such as Title X and the Teen Pregnancy Prevention Program, created to lower the rate of unintended pregnancy and to inform people of safe and effective options for preventing pregnancy.

In August, a federal judge blocked the U.S. Department of Health and Human Services from implementing sweeping changes to grants under the Teen Pregnancy Prevention Program, amid an ongoing lawsuit brought by Hennepin County, Minnesota; King County, Washington; an Iowa Planned Parenthood affiliate; and SIECUS: Sex Ed for Social Change, a nonprofit advocacy group. However, grant funding that has already been cut won’t be restored for now, the judge ruled.

The Trump administration has cast doubt on the safety of hormonal contraception, which is increasingly perceived as controversial on social media.

“In our current environment where there’s a lot of mis- and disinformation online and structural constraints that make it hard to access medically evidenced contraceptive methods, it does make sense that people are behaving in broader ways to try to manage that risk,” Steiner said.

But she also noted that the study found the lack of information on contraceptive methods was more likely to drive people to choose post-coital methods rather than concerns about hormones or an inability to obtain clinical care.

Meanwhile, sex education varies widely across the country. And this year several states modified their sex education policies, according to an analysis by SIECUS.

In Alabama, Republican Gov. Kay Ivey signed a law requiring sex education to be focused on promoting “sexual risk avoidance,” updated terminology for “abstinence-only” instruction. The law prohibits sex education before fourth grade and prohibits school districts from partnering with organizations that do not promote “sexual risk avoidance,” as well as organizations that provide or promote abortion.

Instructors are prohibited from teaching students about birth control, but parents can opt out of sex education classes.

Currently, 15 states offer abstinence-only sex education, according to SIECUS.

In Wisconsin, Democratic Gov. Tony Evers signed a law requiring instruction on adoption as part of sex education. In Arizona, Democratic Gov. Katie Hobbs vetoed a bill that would have required instruction on adoption and newborn safe-haven laws whenever contraception or sexually transmitted infections are mentioned. The state already requires instruction to refer to adoption and parenting as the “preferred choice” over abortion.

Three states – Alabama, Louisiana and South Dakota – enacted laws requiring or requesting instruction on fetal development in schools or the viewing of a fetal ultrasound or animated video, such as the “Baby Olivia” video developed by anti-abortion groups.

In California, Democratic Gov. Gavin Newsom signed bills requiring instruction on human trafficking and dating abuse and digital violence.

Stateline reporter Sofia Resnick can be reached at sresnick@stateline.org.

As physicians continue to navigate care for patients with complex pregnancies in states with abortion bans, a group of maternal-fetal medicine specialists has developed new guidelines to help providers in those states navigate legal risks for themselves and medical challenges for their high-risk patients. 

Maternal-fetal medicine specialists handle some of the most high-risk pregnancies, including patients with high blood pressure, diabetes, cancer, fetal anomalies or other complications. In states with abortion bans, those conditions can become even more dangerous for a patient if a doctor is unsure when they can terminate a pregnancy without potentially jeopardizing their medical license or facing criminal penalties that can include jail time.

“Individuals at high risk for pregnancy-associated morbidity and mortality have unique needs for reproductive health services, including abortion care,” the Society for Maternal-Fetal Medicine wrote in a special statement published this month. 

Ten states plus the District of Columbia allow abortion access without gestational restrictions, while 13 states ban abortion at all stages. Following the implementation of those bans since 2022, many hospital systems and clinics have offered different interpretations of how to avoid legal jeopardy under the bans and what qualifies under exceptions, leading to confusion and delays in care that have been documented in many states nationwide. 

To mitigate those problems, the guidelines encourage providers and administrators to set up referral networks across state lines, work to find agreement on what is permissible under state law and counsel patients on their options even in states with restrictions to deliver the highest-quality care. 

“We are uniquely positioned as high-risk pregnancy experts to make that case to our leaders,” said Dr. Justin Lappen, a maternal-fetal medicine specialist in Ohio who chaired the committee that developed the statement. “And a statement like this would give providers and our colleagues some confidence to be leaders in this space.”

The Society for Maternal-Fetal Medicine and the American College of Obstetricians and Gynecologists agree that access to abortion and counseling about options is the standard of care for obstetric patients, but there are conscientious exceptions for doctors who do not want to provide abortion care. 

Some doctors choose to affiliate with the American Association of Pro-Life Obstetricians and Gynecologists, and offer their own guidance about approaching complications, which still includes termination in some situations. The group is officially a partner of the Alliance Defending Freedom and several anti-abortion groups, as well as the Alliance for Hippocratic Medicine, which is the group that sued to revoke federal approval of one of two drugs used to terminate a pregnancy or treat miscarriages.

A representative from the American Association of Pro-Life Obstetricians and Gynecologists could not be reached for comment before publication.

Worse outcomes for high-risk patients

Nationwide, women in states with bans have reported difficulties receiving care when experiencing pregnancy complications. 

One of the most common emergencies occurs when a patient’s amniotic sac breaks before a fetus is viable. If left untreated, it can quickly turn into a deadly infection. The statement noted that after Texas passed Senate Bill 8 in 2021 banning abortion at an early gestation, waiting to treat patients in those medical situations dramatically increased negative health outcomes. According to research cited in the statement, complications such as blood transfusion, intensive care admission and serious infection resulted in 57% of cases, versus comparable research in states without restrictions that showed a complication rate of 33%. In all of the cases, the fetus did not survive.

Federal judge’s order allowing an Idaho doctor to perform certain abortions is put on hold

The guidance states hospitals and clinics should expand their abortion care to the extent allowed by law, and recognize maternal-fetal medicine specialists as sources of best care practices. It also instructs providers to work with legal teams in their networks to understand the federal Emergency Medical Treatment and Labor Act and when it may require abortion care, as well as encouraging training for basic termination procedures. 

Dr. David Hackney, a maternal-fetal medicine specialist in Ohio who published a book in August about navigating high-risk pregnancy care under Dobbs, said the statement will be useful for many providers nationwide.

“We don’t always focus enough on hospital administration, care and systems, but there’s always so much that can be done in those regions that is almost — if not more — important,” Hackney said.

After the Dobbs decision in June 2022, Hackney said, many individual healthcare systems didn’t know what to do when faced with certain situations where termination might be needed, and set a patchwork of policies that increased confusion for providers. But in the years since, providers and administrators in some healthcare systems have come together to reach informal agreements about what they are comfortable doing within the confines of an abortion ban.

“You have some defense if everyone has agreed to do the same thing,” he said.

When laws are unclear, he said, people will most often lean toward over-complying, which can create worse outcomes for the patient. 

“Even outside of abortion, medical care tends to work better when you have consensus and you have common best practices, even if it’s on a regional level,” he said. 

‘When they need me, they call me’

Many specialists’ cases aren’t emergencies, but rather pregnancies that put a patient at risk because of underlying health conditions, whether they existed before a pregnancy or developed during pregnancy, or late-term diagnoses of fetal anomalies that upend a wanted pregnancy. 

In those cases, the maternal-fetal organization says, patients should be told that their options include termination, even if that can’t happen in their home state.

Dr. Leilah Zahedi-Spung, a maternal-fetal medicine specialist who co-authored the special statement, moved to Colorado from Tennessee in 2023 after that state enacted a near-total abortion ban.

She said she saw firsthand how difficult it was in Tennessee to try to take care of patients without clarity around the law and without leadership that was willing or able to try to provide support. One goal of the statement is to help provide that kind of support to physicians, she said.

“We know you’re in a tough situation, we’re not blind to that. No one is blaming you for what you can and cannot do,” Zahedi-Spung said.

The society’s statement suggests that providers establish relationships with leaders within their clinical settings as well as in the community, region and state to agree on legal interpretations of abortion restrictions, particularly those who might hold leadership positions themselves. It also encourages doctors to establish referral networks locally and between states to ensure patient access.

“I have lots of people from Texas who have my phone number, and when they need me, they call me,” Zahedi-Spung said. “That is a system that works. And then those patients go back to safe providers who can take care of them.”  

Stateline reporter Kelcie Moseley-Morris can be reached at kmoseley@stateline.org.

More than half of women of reproductive age have seen or heard the false claim that hormones in contraceptives are harmful, and about 4 in 10 have been exposed to the false idea that hormones in contraceptives limit your ability to get pregnant in the future, according to a new survey.

The survey by KFF, a nonprofit health research organization, also found that about a third of women between the ages of 18 and 49 have seen or heard the inaccurate assertion that natural family planning methods are just as effective as hormonal birth control, and a similar percentage have been exposed to the erroneous idea that emergency contraceptive pills cause abortions.

According to the American College of Obstetricians & Gynecologists, long-acting reversible contraception and hormonal birth control are much more effective at preventing pregnancy than fertility awareness-based methods such as menstrual cycle tracking.

A large majority of reproductive age women said health care providers are their most trusted source for reliable health care information, with 85% saying they trust them a great deal or a fair amount. In contrast, only 26% said they trust U.S. Department of Health and Human Services Secretary Robert F. Kennedy Jr. for reliable health information, and 48% said they trust federal health agencies. About 25% said they trust AI tools and chatbots, and 14% said they trust  social media and social media influencers.

Kennedy has made several statements related to reproductive and sexual health that contradict the medical consensus, including that prenatal exposure to Tylenol and COVID vaccines may be linked to autism. Under Kennedy, HHS has shifted the focus of federal family planning and pregnancy prevention grants away from expanding contraceptive services and toward promoting childbearing or what’s known as restorative reproductive medicine.

The KFF survey found that among 3,538 women of reproductive age, about 35% said they saw or heard something about contraception on social media in the past 12 months.

Of those who saw social media posts about contraception, 78% said they had used contraception in the past 12 months, with 62% using hormonal methods. Of those, 8% stopped and 9% started a new method because of something they saw or heard on social media.

But for a larger share of this group, contraception-related posts led to further consultation, either with a doctor (19%) or online or from AI (36%). Women ages 18 to 25 were more likely to consult AI or the internet (46%) compared with women ages 36 to 49 (29%).

Stateline reporter Sofia Resnick can be reached at sresnick@stateline.org.