Induced Abortion and Out-of-State Travel Among Insured Women Before and After the Dobbs v. Jackson Women's Health Organization Decision

Abstract

OBJECTIVE: To quantify changes in abortion rates and out-of-state travel for abortion among insured women before and after the Dobbs v. Jackson decision. METHODS: This was a cross-sectional analysis of IQVIA's anonymized, patient-level preadjudicated medical claims on induced medication or procedural abortions among 43.1 million insured women of reproductive age (15–49 years) in the United States. We used information from the Guttmacher Institute to stratify states based on post-Dobbs abortion access policy: 1) legal with protections, 2) legal with restrictions, 3) partial ban, and 4) full ban. The main outcomes were 1) total number and rate of abortions per 100,000 women of reproductive age and 2) proportion of women with out-of-state abortions before (July–December 2021) and after (July–December 2022) Dobbs. RESULTS: Between January 2021 and December 2022, a total of 212,875 women of reproductive age (mean±SD age 28.1±6.5 years) had at least one induced abortion. In a comparison of the pre-Dobbs period with the post-Dobbs periods, there were increases in both the total number of women with at least one abortion (from 54,634 to 57,017) and the rate of abortions (from 121.7 to 137.7/100,000). Increases in abortion rates were driven primarily by states where abortion is legal with protections (from 278.5 to 328.5/100,000), whereas abortion rates declined slightly in states with partial (from 16.1 to 15.0/100,000) and full (from 7.2 to 6.8/100,000) abortion bans. Increases in the percentage of women traveling out of state to obtain an abortion were observed only in restrictive states and were greatest in states with full abortion bans (27.4% before Dobbs to 53.4% after Dobbs) (P<.001). CONCLUSION: There was a modest increase in abortion rates among insured women nationally after Dobbs, with modest increases in abortions among residents of states with protective abortion policies and increases in out-of-state abortions among residents of full- and partial-ban states.