Mississippi tops US for Medicaid enrollees prescribed birth control some say is linked to brain tumors

By Sophia Paffenroth and Julie Lee | Originally published by Mississippi Today

Marlena Jenkins is a public high school teacher who loves helping kids ask the right questions. 

Jenkins, 47, knows what happens when kids don’t learn that skill. At 18, Jenkins had a baby after graduating high school in Hattiesburg in 1997 with no sex education. While she counts her daughter as “one of her greatest blessings,” Jenkins said what came next was not. Two months after giving birth, Jenkins was prescribed “the birth control shot” at her local county health department. Over the next two decades, she developed diabetes and struggled to lose the 60 pounds she gained during her four-year stint on the contraceptive. 

With her first shot, Jenkins joined thousands of Mississippi women on Medicaid who receive the injectable contraception, typically administered as one shot four times a year. In 2025, Mississippi Medicaid recipients received more than 19,000 prescriptions for the drug known as depot medroxyprogesterone acetate or by its brand name “Depo-Provera,” across both generic and brand name versions. In that same year, the state accrued the highest prescription rate per Medicaid recipient in the U.S., the fourth year in a row Mississippi led the nation. 

Experts say that too often, providers don’t give Medicaid patients extensive options or engage in discussion to reach informed consent. Many times, it comes down to providers making assumptions about what might be best for low-income women, young women and people of color. 

Jenkins said thinking about birth control once every three months appealed to her. But she wishes she had been given more information. If she had, Jenkins said she might not have taken the shot. And she might not have needed gastric sleeve surgery in 2019. 

Now, Jenkins partners with Converge, a Jackson-based nonprofit program that administers Title X federal family planning funds to 91 clinics statewide. She tables events monthly and shares her experience with other women to ensure Mississippians know what informed consent around contraceptive care looks like. 

“If you’re new (to something), you don’t know what to ask,” Jenkins said. 

Brain tumors?

Some people who have taken this contraceptive say they experienced side effects more adverse than weight gain. 

Two studies published in 2024 and 2025 found that prolonged use of the shot is associated with a higher relative risk of meningiomas, a brain tumor that is not usually cancerous but can still have harmful side effects. A 2024 case-control study from France of more than 108,000 women found increased risk with more than a year of use, and a 2025 retrospective study of more than 10 million U.S. women on birth control found that the risk increased after more than four years of use.

Over 6,400 plaintiffs across the country have since filed lawsuits against the manufacturers of Depo-Provera.

One plaintiff is Ecclesiastes Patton, a 37-year-old Clinton resident who filed a lawsuit on behalf of his mother. 

For years, Victoria Patton suffered migraines. But it wasn’t until she turned 50 that she learned she had a meningioma. According to her son, by that time, the tumor had swelled to “the size of a grapefruit.” Within two weeks of being admitted to a hospital in Jackson, she couldn’t hold a glass or form sentences, he added. Doctors successfully removed the tumor, but the surgery left the elder Patton with sepsis, a life-threatening condition where the body overreacts to an infection. She was placed in a medically-induced coma for 10 days.

She recovered enough to leave the hospital, but two years later, in 2022, she died of heart complications. Her meningioma and death were due partly to the Depo-Provera shots she had taken for 25 years, the lawsuit alleges. She was 51.

“I had a lot of anger around that time,” recalled Patton, adding that many of his questions about the cause of her death remain unanswered. Since he was a child, Patton said his mother suffered migraines, and he doesn’t know why doctors didn’t take them more seriously. 

Cassandra Welchlin, executive director of the Mississippi Black Women’s Roundtable, a nonprofit program that fights for economic justice, voting rights and reproductive health, was not surprised to hear that doctors took so long to diagnose the elder Patton. 

Along with her collaborators, Welchlin’s organization interviewed 34 Black women around the state about their experiences with contraception and the medical system. Welchlin said she couldn’t comment on the specifics of Patton’s case, but that stories of Black women being dismissed in doctor’s offices are common. 

“We always hear that they are not believed, that the pain is ignored,” she said. 

Welchlin thinks providers should have paused on dispensing the drug after scientists linked it to meningiomas, so that more information could be made available. “When they saw the risk, they should have discontinued it,
because now people are hurt by it,” she said. 

Dr. Jennifer Karlin, associate professor of family and community medicine at University of California, San Francisco and clinical director of a provider-focused reproductive healthcare hotline, emphasized that while there is a risk of meningiomas from the shot, the overall risk is still small, adding that all contraceptives have pros and cons.

“The absolute risk of it is so low, and yet, there’s an absolute risk,” said Karlin, adding that individuals need to weigh their own tolerance for that risk against the risk of pregnancy. “Part of it is telling people about these different risks.” 

Karlin also shared a draft of an upcoming article from the hotline that cited more recent, smaller studies suggesting that stopping use may reverse or stabilize meningiomas.

Patton’s lawsuit, and the thousands of others, have been consolidated into multi-district litigation, a type of lawsuit that resembles a class action but that keeps individual lawsuits distinct. In June 2026, Pfizer agreed to a settlement with about 80% of plaintiffs. The other 20% are continuing to pursue litigation to trial.

In an emailed statement Thursday, a Pfizer spokesperson told Mississippi Today that the settlement agreement “includes no admission of liability or wrongdoing and has no effect on cases pending in state courts.”

In late December, the Food and Drug Administration approved the addition of a safety warning to Pfizer’s label for Depo-Provera. “Cases of meningiomas have been reported following repeated administration of medroxyprogesterone acetate, primarily with long-term use,” the warning reads. 

The Pfizer spokesperson told Mississippi Today that “Pfizer stands behind the safety and efficacy of Depo-Provera, which has been used by millions of women worldwide and remains an important treatment option for women seeking to manage their reproductive health.”

Questions emerge about provider bias

The FDA first approved Depo-Provera in 1992. The now-defunct Upjohn Company manufactured the medication until Pfizer acquired its then-parent company in 2003. A year later, the first generic version of the medication became available. Generics now account for the overwhelming majority of Medicaid prescriptions. (The multi-district litigation only applies to brand-name Depo-Provera and “authorized generics” by a handful of manufacturers that repackage the Pfizer formulation). 

The history of the injectable contraceptive known as “the shot” has dark beginnings. Decades before Depo-Provera was approved by the FDA, the largest study of its use was conducted in the 1960s and 1970s at the Grady Memorial Hospital Family Planning Clinic in Atlanta. According to “Contraceptive Risk,” a book by political scientist and historian William Green, more than 11,400 women were administered the drug. Most were Black and on Medicaid. Later, an FDA audit would conclude that these women had signed consent forms without knowing the drug was not yet FDA approved. 

In 1987, a congressional hearing examined the drug’s use by the Indian Health Service, which had administered it to more than 150 Native American women, even though the FDA had declined to approve the drug in 1978 for contraceptive use, due to early concerns of breast tumors from animal studies.

Millions of women have taken the drug at least once in their lifetime, many of them through Medicaid. Among contraceptive users, Depo-Provera and its generic are more popular among Medicaid recipients than those with private insurance, according to a KFF analysis of nationwide Centers for Disease Control and Prevention data. A Center for Mississippi Health Policy analysis of 2016 data from more than 26,900 reproductive-age Mississippi women found that 58% of Medicaid users used an injectable contraceptive compared to 45% of privately-insured women.

Across the country, Black sexually-experienced women are more than twice as likely as white sexually-experienced women to have ever been prescribed an injectable contraceptive, according to the CDC. It was also three times more common in women without a high school diploma than those who had a bachelor’s degree or higher, according to the same report.

Women aren’t necessarily taking Depo-Provera because they prefer it to other forms of contraception, said Danielle Lampton, co-founder and co-executive director of Converge, the Jackson-based nonprofit program that administers Title X federal family planning funds to 91 clinics statewide. 

Contraceptive use is greatly influenced by provider bias, Lampton continued. For example, providers might make assumptions that the convenience of not having to take a pill every day will outweigh potential side effects for patients. Most of the time, she said, providers have good intentions. 

“Bias often is not located in a nefarious plot to harm someone,” Lampton said. “It’s often located in believing that you know what’s best for them.”

Mississippi is not the only state where exam rooms hold little discussion or women are dismissed. Studies show that across the U.S., asymmetrical power dynamics between providers and patients are starker when it comes to patients who are young, low-income and people of color. 

Years of stagnant research has left many people feeling disillusioned about their available birth control options, said Mary Ziegler, a professor and reproductive health expert at the University of California, Davis, School of Law. 

Among sexually active women not using contraception, 1 in 5 don’t use birth control because they dislike or worry about the side effects, according to a 2024 KFF analysis. Improving birth control methods demands deeper investment in research, said Ziegler, but that’s unlikely to happen if the issue remains politically polarized. 

Conservatives often discourage research on birth control because they fear contraceptives verge on being abortion-causing substances, Ziegler said. But progressives worry that saying anything negative about the existing options paves the way to restrict abortion and contraception. 

“What’s looming over everything involving reproductive health is the abortion debate, and it kind of twists everything else,” Ziegler said. 

‘…then she ended up pregnant’

In September, Sen. Kamesha Mumford, a Democrat from Jackson, got a call from one of her constituents. The woman she spoke to, Mumford said, had received a letter in the mail about the multi-district litigation for Depo-Provera and didn’t know what to do. 

That was the first time Mumford heard about the issue, and she said it has reignited concerns for her about health disparities for vulnerable women in rural areas. Mumford said her constituent turned to Depo-Provera because it meant skipping a monthly trip to the pharmacy.

“She talked to me about a family member of hers who tried to go the pill route, and things would come up, she couldn’t get a ride, she ended up missing a week here or there, and then she ended up pregnant,” Mumford said. 

Mumford has advocated for women’s healthcare and the right to contraception throughout her first year in the Mississippi Legislature. She said she intends to introduce legislation next session that expands access to healthcare through telehealth and transportation. Mumford said she hopes that will allow more women to choose the option best for them – and not just the only one they can access. 

Dr. Jennifer Karlin, the UCSF professor, said resource limitations might obstruct providers from counseling patients adequately. 

“Providers aren’t being malicious. They don’t care whether someone’s on depo or not,” said Karlin. “They just want to have the time to be able to counsel people so people can be on things that work for them.” 

Karlin encouraged providers to reach out to the reproductive health hotline that she is clinical director of, ReproHH, which is available to providers all around the country. “We will help you,” she said. “There are specialists sitting online right now ready to answer your questions.”

Cassandra Welchlin, the executive director of the Mississippi Black Women’s Roundtable, agreed that better provider training is integral to addressing inequities in contraceptive access. 

In 2026, Welchlin’s team conducted several two-hour cultural sensitivity training sessions with 52 healthcare providers across Jackson, Biloxi, Mound Bayou and Laurel. They also gave those providers guides on how to use language as a tool for equity, dignity and quality care. The guide advises providers to swap phrases such as “resistant to care” for “patient expressed concerns or requested more information.”

That additional training is necessary, Welchlin said, because racism has been baked into the healthcare system. It has caused providers to make assumptions about who should give birth – and when. 

“Mississippi should not regulate when and how a woman should or should not have a baby,” Welchlin said. 

The New York Times’ Susan Beachy and Kitty Bennett contributed research.

Methodology: Centers for Medicare and Medicaid Services (CMS) State Drug Utilization Data was used to calculate the number of prescriptions for medroxyprogesterone acetate (brand name “Depo-Provera”) for each state and year. Medicaid data does not distinguish between prescriptions that were made to the same user and different users. So, the number of prescriptions is likely several times higher than the number of unique users, as the contraceptive is typically taken once every three months. Both brand-name and generic versions were included, as the vast majority of Medicaid prescriptions (more than 95% in 2025) use the generic version. Prescriptions for oral tablets/pills and high-dose formulations (400 mg/mL), typically used for palliative cancer care, were excluded. Subcutaneous (“SubQ”) formulations, which can be dispensed at a pharmacy and self-administered, make up less than 1% of Medicaid prescriptions and were excluded, though Mississippi’s ranking did not change with inclusion. CMS Medicaid & CHIP enrollment data was used to calculate the number of Medicaid enrollees for each state and year, obtained via KFF. Data analyses were restricted to 2018 onward as data from 2017 is unreliable due to state and federal Medicaid changes. (While Census data includes the number of self-reported Medicaid recipients, this tends to be an undercount.) State Drug Utilization Data is not broken down by age or sex, so all Medicaid enrollees, regardless of age or sex, were used to calculate the prescription rate among Medicaid enrollees.

This article was originally published by Mississippi Today and is republished here under a Creative Commons license.

Source: Original Article