U.S. sees 26,000 fewer abortions since Roe reversal

Photo: Luis Alvarez/Getty Images

Almost exactly one year ago the U.S. Supreme Court issued a decision in the Dobbs v Jackson's Women's Health Organization case that effectively overturned the Roe v Wade precedent enshrining the right to abortion access. In the year since, there were nearly 26,000 fewer abortions performed in the U.S. as compared to the pre-Dobbs average.

That's according to data collected by the Society of Family Planning, which also found that in the two months before Dobbs the average monthly number of abortions provided by clinicians in the U.S. was 81,730, while in the nine months after Dobbs, the average monthly number of abortions was 79,031.

In the nine months following the Dobbs decision, an average of 2,849 fewer abortions were provided in the U.S. each month compared to April 2022. But because Texas already had a six-week ban in place, this figure is an underestimate, the SFP report found. If Texas did not have a ban in place, and pre-Dobbs numbers for April and May were similar to those months in 2021, the average monthly number of abortions in the U.S. would have been 83,835. The nine months following the Dobbs decision would have seen 4,912 fewer abortions per month for a cumulative total of 44,210 fewer abortions over the nine-month period.

Abortion had been increasing in the U.S. since 2017, and abortion rates were increasing in the months before the Dobbs decision, according to the report. The national abortion rate decreased from 13.4 per 1,000 women of reproductive age in April 2022 to 12.6 per 1,000 women for the monthly average of abortions in the nine months following the Dobbs decision.

Interestingly, while the overall number of abortions decreased, abortions provided by telehealth providers increased from an average of 4,025 abortions per month in the two months before the Dobbs decision (5% of all abortions), to an average of 7,461 abortions per month in the nine months following Dobbs (9% of all abortions). This change represents an increase of 85% in the number of abortions provided from virtual-only services, comparing post- to pre-Dobbs.

WHAT'S THE IMPACT?

The impact of Dobbs has differed by state abortion policies. The number of states where abortion was completely banned increased from nine states in July 2022 to 13 in March 2023, and unsurprisingly, states with abortion bans have experienced the greatest reductions in numbers of abortions. Overall, in states with total abortion bans, there have been 65,920 fewer clinician-provided abortions in the months since the Dobbs decision than would have been expected compared to April 2022.

This change represents a decrease of 100% in the number of abortions, comparing April 2022 and March 2023 in states where abortion was banned.

States where abortion with six-week abortion bans were in effect saw a cumulative total of 15,720 fewer abortions provided by a clinician.

The public health implication is that the greatest declines in the number of abortions occurred in the same states with the greatest structural and social inequities in terms of maternal morbidity and mortality and poverty. Thus, the impact of the Dobbs decision is not equally distributed, the report said. People of color and people working to make ends meet have been impacted the most. This inequity is corroborated by other studies, including one finding that after Dobbs, Black, Indigenous and other people of color experienced the greatest increases in travel time to abortion facilities.

THE LARGER TREND

Lawyer Matthew Fisher, general counsel for Carium, said at the HIMSS23 annual conference in Chicago in April that the Dobbs decision has created confusion and difficulty around the sharing of health data and patient information.

Federal agencies have concerns, he said. The Department of Health and Human Services' Office of Civil Rights (OCR), which enforces HIPAA, was initially concerned that law enforcement would request protected health information (PHI). An organization or entity's recourse in that instance would be to take advantage of a linguistic vagary in the privacy rule, whereby it says that an entity "may" disclose that information.

One of the trickiest areas, legally, concerns the Emergency Medical Treatment and Labor Act (EMTALA). The part of the law that's relevant to reproductive health revolves around the idea that an emergency department has an obligation to stabilize a person's condition before discharge, without regard for insurance status. HHS came out with interpretive guidance saying this type of care might involve medication that may now be illegal in the state they're in, because loss of pregnancy is a risk.

Twitter: @JELagasse Email the writer: Jeff.Lagasse@himssmedia.com