Abortion Provision and Delays to Care in a Clinic Network in Washington State After Dobbs

Abstract

Importance: The Supreme Court decision Dobbs v Jackson Women's Health Organization (Dobbs) overturned federal protections to abortion care and altered the reproductive health care landscape. Thus far, aggregated state-level data reveal increases in the number of abortions in states where abortion is still legal, but there is limited information on delays to care and changes in the characteristics of people accessing abortion in these states after Dobbs.

Objective: To examine changes in abortion provision and delays to care after Dobbs.

Design, setting, and participants: Retrospective cohort study of all abortions performed at an independent, high-volume reproductive health care clinic network in Washington state from January 1, 2017, to July 31, 2023. Using an interrupted time series, the study assessed changes in abortion care after Dobbs.

Exposure: Abortion care obtained after (June 24, 2022, to July 31, 2023) vs before (January 1, 2017, to June 23, 2022) Dobbs.

Main outcome and measure: Primary outcomes included weekly number of abortions and out-of-state patients and weekly average of gestational duration (days) and time to appointment (days).

Results: Among the 18 379 abortions during the study period, most were procedural (13 192 abortions [72%]) and funded by public insurance (11 412 abortions [62%]). The mean (SD) age of individuals receiving abortion care was 28.5 (6.44) years. Following Dobbs, the number of procedural abortions per week increased by 6.35 (95% CI, 2.83-9.86), but then trended back toward pre-Dobbs levels. The number of out-of-state patients per week increased by 2 (95% CI, 1.1-3.6) and trends remained stable. The average gestational duration per week increased by 6.9 (95% CI, 3.6-10.2) days following Dobbs, primarily due to increased gestations of procedural abortions. The average gestational duration among out-of-state patients did not change following Dobbs, but it did increase by 6 days for in-state patients (5.9; 95% CI, 3.2-8.6 days). There were no significant changes in time to appointment.

Conclusions and relevance: These findings provide a detailed picture of changes in abortion provision and delays to care after Dobbs in a state bordering a total ban state. In this study, more people traveled from out of state to receive care and in-state patients sought care a week later in gestation. These findings can inform interventions and policies to improve access for all seeking abortion care.

Figure 1.. Changes in Weekly Number of Abortions and Out-of-State Patients Before and After the Dobbs v Jackson Women’s Health Organization Decision, January 1, 2017, to July 31, 2023

Vertical orange line indicates the Supreme Court Dobbs v Jackson Women’s Health Organization decision (June 24, 2022). The blue line indicates deseasonalized trends, the black line indicates estimated seasonality, the dotted line indicates the counterfactual, and the dots indicate the outcome (eg, weekly number of abortions).

Figure 2.. Changes in Delays to Care Before and After the Dobbs v Jackson Women’s Health Organization (Dobbs) Decision, January 1, 2017, to July 31, 2023

Vertical orange line indicates the Supreme Court Dobbs decision (June 24, 2022). A, Trend line includes all abortions (medication and procedural), which is therefore impacted by the increasing trends in medication abortion (which occur at earlier gestations) pre-Dobbs (see Figure 1C). B And C, gestational duration among just medication abortions (2B) and procedural abortions (2C) which shows changes in gestational duration while holding constant the type of abortion. The blue line indicates deseasonalized trends, the black line indicates estimated seasonality, the dotted line indicates the counterfactual, and the dots indicate the outcome (eg, weekly number of abortions).