Racial and ethnic disparities in birth rates following the Dobbs decision: a retrospective analysis by state abortion policy

OBJECTIVES: To assess trends in births by maternal race and ethnicity following the Dobbs v. Jackson Women's Health Organization (Dobbs) decision. METHODS: Retrospective analysis of the Centers for Disease Control and Prevention Natality Live Birth database with detailed geographical data available (2018-2023). States were classified by abortion policy environment based on the Center for Reproductive Rights' five-tier framework. For this analysis, states classified as hostile or illegal were grouped as restrictive, while those classified as expanded access or protected access were grouped as protective. We compared rates of births in restrictive vs. protective states before and after the Dobbs ruling on June 24, 2022, stratified by maternal race and ethnicity. The period from July to December 2022 was considered transitional and excluded from the analysis. RESULTS: The proportion of births among Hispanic patients in restrictive states increased by 12.8 %, while the proportion in protective states increased by 7.6 % (p<0.01). Rates of births among non-Hispanic White (NHW) and non-Hispanic Black (NHB) patients in restrictive states decreased by 3.8 and 5.6 %, respectively (p<0.001). Rates of births among NHW and NHB patients in protective states also decreased by 2.4 and 6.4 %, respectively (p<0.001). Changes for Asian/Pacific Islander and other racial groups were small (<1 % relative change). CONCLUSIONS: Following the Dobbs decision, birth rates in restrictive states increased most among Hispanic individuals, while non-Hispanic White and Black populations saw declines. These trends highlight racial and ethnic disparities in the impact of abortion restrictions.