AHCJ – Association of Health Care Journalists
07/24/2024 | News release | Distributed by Public on 07/24/2024 16:21
Infants dying, women at risk: Medical literature describes wide-ranging consequences of Dobbs
Graphic by Kevin Ridder
Published studies have begun to report the effects of state abortion restrictions on patients since the Supreme Court ended the constitutional right to abortion in June 2022.
The following papers, all of which appear in peer-reviewed journals, examine a range of issues that may inspire story ideas or provide a new angle to a story you're already working on.
The data are still in the early days (notably, rates of state and federal maternal mortality and morbidity data have not yet been released for the post-Dobbs period). Still, some findings pop out:
- Overall access to contraception - not just abortion - declined.
- Women with health conditions that put them at high risk of pregnancy complications shoulder disproportionate burdens.
- Threats to infant health have increased.
This list was compiled using multiple sources including PubMed searches.
People are traveling more to end pregnancies
- Estimated Travel Time and Spatial Access to Abortion Facilities in the US Before and After the Dobbs v Jackson Women's Health Decision (JAMA, Nov. 1, 2022). Estimated median and mean travel times to an abortion facility in 2021 grew from 10.9 minutes and 27.8 minutes in 2021 to 17 minutes and 100.4 minutes.
- Use of Abortion Services in Massachusetts After the Dobbs Decision Among In-State vs Out-of-State Residents (JAMA Network Open, Sept. 6, 2023). Patients traveling to Massachusetts increased despite Massachusetts not bordering any state with a ban, with increased use of charitable funding among out-of-state residents.
- Travel Time and Costs for Abortion for Military Service Members After the Dobbs Decision (JAMA, Nov. 10, 2023). Median travel time for military personnel to get an abortion increased, although travel reimbursement represents a small expense for the Department of Defense.
- Change in Clinic Volume and Gestational Age at Time of Abortion in Southern Illinois Before and After Dobbs v Jackson Women's Health Organization(Contraception, November 2023). One clinic had a twofold increase in volume with patients receiving abortions at later gestational ages and more often with surgical abortions.
- Abortion Provision and Delays to Care in a Clinic Network in Washington State After Dobbs (JAMA Network Open, May 29, 2024). Clinics near the total-ban state of Idaho performed more procedural abortions, with an average week increase in gestation.
- Trends in interstate abortion travel to Oregon following the Dobbs court decision (Contraception, June 17, 2024). After Dobbs, 14.3% of abortions in Oregon were out-of-state residents versus 9.6% pre-Dobbs. Out-of-state individuals were more likely than Oregon residents to have abortions after the first trimester.
- Impact of the Dobbs decision on abortion services from a large tertiary center in Oregon (Contraception, August 2024). Abortion care at Oregon Health & Science University in Portland increased.
Some racial and ethnic groups are disproportionately affected by bans
- Race and Ethnicity of Reproductive-Age Females Affected by US State Abortion Bans (JAMA, May 1, 2024). Reduced access to reproductive health care is associated with racial and ethnic disparities in pregnancy-related morbidity and mortality in the U.S.
Medication abortions increased
- Requests for self-managed medication abortion provided using online telemedicine in 30 US states before and after the Dobbs v Jackson Women's Health Organization decision (JAMA, Nov. 1, 2022). Online abortion pill requests from the nonprofit Aid Access increased, especially among patients residing in states with total bans. Aid Access an online telemedicine service providing self-managed medication abortion.
- Provision of Medications for Self-Managed Abortion Before and After the Dobbs v Jackson Women's Health Organization Decision (JAMA, March 25, 2024). Medication abortions increased by an estimated 27,838 instances in the six months following Dobbs.
Vasectomies are on the rise
- Rising vasectomy volume following reversal of federal protections for abortion rights in the United States (International Journal of Impotence Research, Feb. 14, 2023). More men, especially younger men and men without children, sought vasectomies. "While longer-term data are needed, findings indicate that men are invested in maintaining reproductive autonomy for themselves and their partners," researchers wrote.
- Comparison of Childless and Partnerless Vasectomy Rates Before and After Dobbs v. Jackson Women's Health Organization (American Journal of Men's Health, May/June 2024). At UC San Diego Health, the portion of vasectomies performed in childless and partnerless men - a group that is disproportionately susceptible to postprocedural regret - increased after Dobbs.
Contraception is in greater demand but may be harder to get
- Tubal Sterilization Requests at a Single Institution Following the Supreme Court Decision to Overturn the Constitutional Right to Abortion ( JAMA, July 25, 2023). Sterilization requests at the University of Michigan increased from May through September 2022 (the period after the Dobbs decision was leaked) versus the same months in 2019 and 2021, but returned to baseline from October to December 2022.
- Has the fall of Roe changed contraceptive access and use? New research from four US states offers critical insights (Health Affairs Scholar, February 2024). Surveys in four states suggest that sexual activity declined, barriers to accessing contraception increased, reports of receiving high-quality contraceptive care decreased, and condom use increased.
- Changes in Permanent Contraception Procedures Among Young Adults Following the Dobbs Decision (JAMA Health Forum, April 12, 2024). Permanent contraception procedures increased abruptly among adults aged 18 to 30 years. The increase for female patients was double that for male patients.
- Contraception usage and workforce trends through 2022 (JAMA Network Open, April 15, 2024). National data show that although contraceptive usage increased initially in the month after Dobbs, all contraception types except vasectomy returned to overall downward trends through the end of 2022.
- Permanent and long-acting reversible contraception volumes at a multihospital system in Ohio before and after Dobbs. (Contraception, April 19, 2024). Uptake of permanent and long-acting reversible contraception increased in Ohio, a state that prohibits abortion after the detection of fetal cardiac activity.
- Use of Oral and Emergency Contraceptives After the US Supreme Court's Dobbs Decision (JAMA Network Open, June 26, 2024). Use of oral contraceptives, particularly emergency contraceptives, declined in states with the most abortion restrictions.
Abortion bans are associated with worse mental health
- Anxiety and Depression Symptoms After the Dobbs Abortion Decision (JAMA, Jan. 23/30, 2024). Living in a state with a trigger ban was associated with a small but significantly greater increase in anxiety and depression symptoms.
Women at high risk of pregnancy complications carry a disproportionate burden
- The Impact of New and Renewed Restrictive State Abortion Laws on Pregnancy-Capable People with Diabetes (Current Diabetes Reports, May 22, 2023). Of the 10 states with the highest percent of adult women living with diabetes - a condition that elevates the risk of pregnancy complications - eight have complete or six-week abortion bans.
- State restrictions on abortion are associated with fewer abortions in patients with high-risk cardiovascular conditions (Contraception, May 23, 2023). Women living in states that restrict abortion are less likely to receive abortions even if they have class IV cardiovascular conditions, which put them at high risk of maternal morbidity and mortality.
More infants die or have serious health problems
- Abortion Bans and Resource Utilization for Congenital Heart Disease (Obstetrics & Gynecology, September 2023). Bans will generate an estimated 53.7% more single-ventricle cardiac defects leading to hundreds of intensive procedures and 102 neonatal deaths annually.
- Abortion Restrictiveness and Infant Mortality: An Ecologic Study, 2014-2018 (American Journal of Preventive Medicine, Oct. 14, 2023). State abortion restrictions are associated with higher county-level infant mortality rates.
- Infant Deaths After Texas' 2021 Ban on Abortion in Early Pregnancy, (JAMA Pediatrics, June 24, 2024). Texas' ban on early abortions was associated with increases in infant and neonatal mortality in 2022.
Foster care may face greater demand
- Association Between Restricted Abortion Access and Child Entries Into the Foster Care System (JAMA Pediatrics, Nov. 6, 2023). State abortion restrictions were associated with an 11% increase in foster care entry from 2000 to 2020.
Fertility patients harbor fears
- Attitudes, concerns, and perceptions of patients undergoing fertility treatments in an abortion restrictive state in the aftermath of the Roe v. Wade reversal (Journal of Assisted Reproduction and Genetics, June 8, 2024). Patients undergoing in vitro fertilization in St. Louis, where abortion is restricted, worry about lack of control over what happens to their embryos and access to needed medical care.