The Dobbs Decision and Maternal Health: Using Real-World Data to Unveil the Effect on Abortion Access and Pregnancy Outcomes [ID 1642]

INTRODUCTION: Following the Dobbs v Jackson ruling in 2022, half of all women in the United States reside in states with limited or no access to abortion services. However, the full effect of the Dobbs decision on reproductive care and decision making is still unfolding in real time. METHODS: We analyzed medical records from 66 health systems in a nationally federated electronic health record analysis platform called TriNetX to identify two cohorts of pregnant individuals: 1) women with positive pregnancy diagnoses from 2017 to 2022, and 2) women with positive pregnancy diagnoses from 2022 to 2024. Cohorts were propensity score matched by age and race and generated two random cohorts of n=1,213,879 from each period. Outcomes included rates of 1) procedural abortions (CPT: 1009003), 2) pharmaceutical abortions (mifepristone, misoprostol), and 3) combined procedural and pharmaceutical abortions. RESULTS: The post- Dobbs cohort showed a decline in procedural abortions from 2.36% to 2.27% (hazard ratio [HR] 1.14; odds ratio [OR] 0.96; 95% CI [0.94–0.98]; P <.0001), alongside an increased utilization of pharmaceutical abortions from 18.80% to 20.57% (HR 1.61; OR 1.126; 95% CI [1.119–1.133]; P <.0001), and overall abortion services from 20.52% to 22.23% (HR 1.56; OR 1.11; 95% CI [1.10–1.11]; P <.0001). CONCLUSIONS/IMPLICATIONS: Abortion utilization post- Dobbs has increased, and results indicate increased use of mifepristone/misoprostol. Understanding the effects of the Dobbs decision can inform future health care policies and ensure that reproductive rights are safeguarded, ultimately improving patient autonomy and maternal health outcomes.