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Abstract

Background:

Abortion bans and restrictions may have ripple effects on other forms of sexual and reproductive health care such as contraception provision. While only a small proportion of publicly supported sexual and reproductive health clinics offer abortion care, many are likely experiencing direct and indirect impacts of the June 2022 Dobbs versus Jackson Women’s Health Organization Supreme Court decision.

Materials and Methods:

We analyzed data from a national survey of 446 clinics conducted between November 2022 and December 2023 to understand provision of pregnancy options counseling, miscarriage management, and abortion, as well as perceived changes in patient demand for contraception, abortion referrals, and pregnancy options counseling. We examined these measures comparing clinics by abortion legal restrictiveness (more restrictive n = 178; less restrictive/protective n = 268).

Results:

Almost one-quarter of clinics reported an increase in patients requesting intrauterine devices or implants, and one-fifth reported an increase in the proportion of patients seeking contraceptive services. Clinics in more restrictive states reported lower proportions of pregnancy options counseling and miscarriage management provision than sites in less restrictive/protective states. Higher proportions of clinics in more restrictive states reported decreases in time spent counseling patients seeking abortion and the number of referrals made for abortion compared to less restrictive/protective states. Open-ended data mirror the survey findings, with respondents describing changing pregnancy options counseling practices and serving more out-of-state patients.

Conclusions:

State restrictions on abortion care in the wake of Dobbs have had spillover effects on a range of reproductive health services reported by publicly supported sexual and reproductive health clinics.

Introduction

Publicly supported sexual and reproductive health clinics provide essential sexual and reproductive health services to millions of people in the United States each year (in 2016, 6.1 million women were served by these clinics).¹ Publicly supported clinics provide contraceptive services such as contraceptive method counseling, provision, prescriptions, and follow-up support. In addition to contraceptive services, many of these sites also provide other critical sexual and reproductive health services including Pap tests, pelvic exams, sexually transmitted infection testing and treatment, pregnancy tests, and pregnancy options counseling. Many patients who receive contraceptive and sexual and reproductive health services at a publicly supported clinic report that the site is their usual source of medical care.²

These clinics offer free or reduced-cost contraceptive services to the general population and receive federal, state, or local funding through programs such as Medicaid or the federal Title X program, which is devoted to supporting the provision of contraceptive and related services. In 2022, Title X-funded clinics served 2.6 million patients for family planning services.³ Patients who rely on publicly supported clinics for contraceptive care are more likely to be young, Black or Hispanic, immigrants, low-income, or uninsured.² While some publicly supported clinics are specialized sexual and reproductive health clinics (e.g., Planned Parenthoods), most are federally qualified health centers (FQHCs), community health clinics (CHCs) or FQHC look-alikes, public health department clinics, and hospital clinics providing a mix of general health services along with sexual and reproductive health care. FQHCs, as defined by the Health Resources and Services Administration (HRSA), serve underfunded areas, offer reduced-fee services, provide comprehensive services, and qualify for funding and enhanced Medicaid reimbursement. FQHC look-alikes meet the eligibility requirements but do not receive HRSA grant funding.⁴ As of 2015, FQHCs comprise over half of all known publicly supported sexual and reproductive health clinics in Guttmacher’s database, while health departments and hospital or other clinics each represent approximately 20%, and Planned Parenthoods represent roughly 6% of publicly supported sexual and reproductive health sites.⁵

This network of clinics has experienced considerable disruption in recent years from both the 2019 Title X Rule enacted under the Trump administration (repealed in 2021 by the Biden administration) and the COVID-19 pandemic.^6

–11 Researchers and advocates have speculated these disruptions will continue as these sites are affected by the Supreme Court’s 2022 decision in Dobbs versus Jackson Women’s Health Organization, which overturned Roe versus Wade and allowed states to restrict abortion.¹² These effects are expected despite fewer than 10% of publicly supported sexual and reproductive health clinics providing abortion care as of 2015.¹³

In the wake of the Dobbs decision, abortion access has been decimated in many parts of the country as abortion services and legality continue to shift in various states. As of November 2024, 13 states have instituted total bans on abortion with very limited exceptions. In addition, eight states restrict abortion through bans at 6, 12, 15, or 18 weeks of gestation and through a host of other restrictive policies.¹⁴ The legal status of abortion fluctuated as restrictive and protective laws were enacted, overturned, and/or blocked by courts and other policy making bodies.^15,16

There are realized and anticipated effects on sexual and reproductive health services as a result of Dobbs. For instance, there have been reports of increased patient interest in intrauterine devices (IUDs), implants, and sterilization, as people reconsider the type of contraception they want to use.^17

–22 Providers may need to change their counseling and referral practices for pregnant patients as abortion care becomes inaccessible for in-person care in certain geographic locations.²³ There may also be spillover effects on health services that are similar to abortion, such as miscarriage management, with sites withholding care due to concerns regarding the legal status of certain procedures and medications.^24

–27 Wait times for care may increase as demand for contraception shifts,²⁸ and facilities that do offer abortions may limit their range of other services to meet the current moment. At the same time, medication abortion has become more widely available in recent years (with latest estimates at 63% of all abortions),²⁹ particularly as the COVID-19 pandemic led to the adoption of telehealth protocols for medication abortion access.³⁰

To understand how publicly supported sexual and reproductive health clinics have been affected by the Dobbs decision and how these impacts differ between clinics in states that imposed abortion restrictions in the wake of Dobbs and those that have not, we conducted a national survey of publicly supported clinics providing contraceptive services from late 2022 to late 2023.

Materials and Methods

Sampling and recruitment

These analyses are part of a national survey of publicly supported sexual and reproductive health clinics. The sampling universe was derived from the Guttmacher Institute’s sexual and reproductive health clinic database, which includes all known publicly supported sexual and reproductive health sites (approximately 10,000) in the United States. Publicly supported sexual and reproductive health clinics are sites where contraceptive counseling, education, and services are provided and at least some patients receive free or reduced-fee care; contraceptive services include contraceptive counseling and education, prescribing of methods, or direct provision of methods for the purpose of preventing pregnancy. Sampling for the study was based on clinic types (FQHCs, Planned Parenthoods, hospitals, health departments, and other sites including CHCs) and Title X funding status. The final population of surveyed clinics was 2,146 sites. Fielding of the survey began in November 2022 and ended in December 2023. We confirmed contraceptive service provision with a screening question asking if the clinic provided contraceptive services as of November 1, 2022. Members of the fielding team attempted to contact each sampled site a minimum of two times via email, phone, and/or mail, depending on available contact information for the site. The fielding team made an average of five contact attempts per site.

We intended for the surveys to be filled out by clinic staff (e.g., clinic directors, administrators) working at publicly supported sexual and reproductive health clinics; the survey was only available in English. We used Qualtrics, an online survey platform, to program and host the survey. Participation was voluntary; respondents had the option to choose not to answer any questions or stop taking the survey at any time. Respondents were offered a $50 gift card as remuneration for their participation; near the end of the fielding period, the remuneration amount was raised to $100 to increase participation. An abbreviated version of the survey (the key questions survey) was offered to respondents who declined to participate because they were short on time. The average survey completion time was 31 minutes. Study procedures were deemed exempt by the chair of the Guttmacher Institute’s Institutional Review Board. As we were recruiting Planned Parenthood clinics, we registered the study with the Planned Parenthood Federation of America (PPFA).

Measures

Provision of pregnancy-related services

We asked whether sites provided, referred, or did not provide or refer several pregnancy-related services at the time of the survey, including pregnancy options counseling (providing information to pregnant patients on parenting, adoption, and abortion), miscarriage management, procedural abortion, and medication abortion.

Perceptions of Dobbs-related changes

We asked one grid question about whether several items increased, stayed the same, or decreased; respondents could also select prefer not to answer. The items included seven contraceptive-related items: number and proportion of patients seeking contraceptive services, proportion of patients requesting a few contraceptive methods (tubal ligations or vasectomies, emergency contraception, IUDs or implants), wait times for new patients seeking contraception, stocking issues for contraceptive methods, and four pregnancy-related items: number of abortion and miscarriage referrals, and time spent counseling patients seeking abortion.

Open-ended Dobbs questions

We also asked three open-ended questions about Dobbs due to the exploratory nature of this study: what services were added or expanded due to Dobbs, what services were reduced or eliminated due to Dobbs, and any other ways the clinic has been impacted by Dobbs.

Abortion restrictiveness

We grouped states based on abortion restrictiveness according to the Guttmacher Institute’s map of the United States abortion policies as of April 2024. At that point in time, 21 states were categorized as most or very restrictive on the map, meaning abortion was completely banned with limited exceptions or was banned at 18 weeks of gestation or earlier and imposed mandatory waiting periods or other restrictions. These states were collapsed to “more restrictive” for our study (AL, AR, AZ, FL, GA, ID, IN, KY, LA, MS, MO, NC, ND, NE, OK, SC, SD, TN, TX, UT, and WV).¹⁴ In addition, we included as “more restrictive” two states where bans were enacted or enforced during part our fielding period: Wisconsin had no abortion providers during much of our fielding period due to legal uncertainty regarding the state’s pre-Roe ban, and Ohio enacted and subsequently blocked a six-week ban. We included these with “more restrictive” because we expected that the proposal and enactment of restrictions result in changes in demand for and provision of relevant health care services even when bans do not remain in effect. The remaining 27 states and the District of Columbia were collapsed to “less restrictive/protective” (AK, CA, CO, CT, DE, DC, HI, IL, IA, KS, ME, MD, MA, MI, MN, MT, NV, NH, NJ, NM, NY, OR, PA, RI, VT, VA, WA, and WY). These states restrict abortions at later gestational duration or do not restrict abortion based on gestational duration, and do not impose in person waiting periods. Some states considered to be less restrictive/protective may have restrictions on telemedicine provision of abortion that were not reflected in this categorization.

Analyses

For the provision of pregnancy-related services, six respondents skipped the entire grid and were considered missing for these items. We grouped sites that reported that they refer, do not provide or refer, or prefer not to answer for each item as “did not provide” compared to sites that reported providing each service. We asked a separate question about whether the clinic offers medication abortion by telemedicine. Twenty-seven respondents selected prefer not to answer for this question, which we included as “did not provide” for each service compared to sites that reported providing the service.

For the perceptions of Dobbs-related changes, 56 respondents skipped the entire grid and were considered missing for these items. Low percentages of clinics indicated a decrease (<5%) or responded prefer not to answer (<8%) to the seven contraceptive-focused items, so we aggregated all response categories other than increased to highlight the differences between states where abortion access is more and less restricted. For the measures focused on abortion and miscarriage management, we saw more variation in the distribution of responses among the overall sample, with a notable proportion responding prefer not to answer for the items (21–41%), so we did not aggregate responses for these items.

Quantitative analyses were performed using Stata 18. All cases were weighted for sampling ratios and nonresponse to reflect the universe of publicly funded sexual and reproductive health providers at the time the sample was drawn. We used descriptive statistics to summarize the data, including sample characteristics, response rates, patient demand for methods, provider counseling and referral practices, and service availability. We compared data between groups of states where abortion is more and less restricted using chi-squared tests to determine if differences were statistically significant at p < 0.05; we included confidence intervals for selected estimates. We also analyzed the open-ended responses about top challenges and Dobbs impacts by conducting a thematic analysis of responses.

Results

Of our sample of 2,146 clinics, 257 clinics were determined to be ineligible for the survey because the site had closed or had stopped providing contraceptive services by November 1, 2022; 446 clinics completed the survey, 122 refused to participate, and 1,321 never responded despite multiple contact attempts. The overall response rate among eligible clinics was 24%, and this varied by several clinic characteristics. The response rate was 46% for Title X-funded clinics; by clinic type the response rate was 53% for Planned Parenthoods, 34% for health departments, 21% for hospitals/other clinics, and 11% for FQHCs. However, we weighted by clinic type to represent the universe of publicly funded sexual and reproductive health clinics; we also adjusted standard errors for clustering at the state level.

Sample characteristics

Among the weighted sample, FQHCs account for the largest proportion of the sample (54%), followed by health departments (23%), hospitals or other organization types (18%), and Planned Parenthoods (6%) (Table 1). Most clinics in the weighted sample received Title X funding. Overall, fewer clinics were in more restrictive abortion states (38%). However, health department sites were more evenly distributed, with just over half (52%) located in more restrictive states.

Table 1.

Distribution of Respondent Clinics by Clinic Type and Title X Funding Status, Overall and by Abortion Legality

Characteristics	N	%	Abortion legality
Characteristics	N	%	% More restrictive	% Less restrictive/ protective	Total
Clinic type
Health department	129	23	52	48	100
Planned Parenthood	140	6	35	65	100
FQHC^a	89	54	35	65	100
Hospital/other	88	18	34	66	100
Total	446	100	38	62	100
Title X funding status
Receives	305	59	40	60	100
Does not receive	141	41	37	63	100
Total	446	100	38	62	100

FQHC, federally qualified health center.

Provision of abortion and pregnancy-related care

Overall, three-quarters of sites reported providing nondirective pregnancy options counseling, although a lower percentage in more restrictive states did so than in less restrictive/protective states (63%, 95% CI: 51%−74% vs. 83%, 95% CI: 73%−90%) (Table 2). A lower proportion of sites in more restrictive states reported providing miscarriage management on site compared to those in less restrictive/protective states (20%, 95% CI: 12%−31% vs. 43%, 95% CI: 34%−54%). Lower proportions of sites in more restrictive states reported providing and referring for procedural abortion and providing medication abortion compared to those in less restrictive/protective states (1% vs. 6%, 44% vs. 72%, 3% vs. 19%, respectively). No clinics in more restrictive states reported offering medication abortion via telemedicine, where 9% of sites in less restrictive/protective states did (95% CI: 0%−18%).

Table 2.

Percentage of Sites Providing Abortion and Pregnancy-Related Services, Overall and by Abortion Legality (n = 416)

Services	%
Services	Overall	More restrictive	Less restrictive/ protective
Pregnancy options counseling	75	63	83*
Miscarriage management
Provides	34	20	43*
Refers	55	60	52
Procedural abortion
Provides	4	1	6*
Refers	61	44	72*
Medication abortion
Provides	13	3	19*
Refers	53	45	58
Via telemedicine	6	0	9*

*Significantly different from more restricted at p < 0.05. Notes: Table does not include respondents who completed the key questions survey [n = 24]. Medication abortion via telemedicine was asked in a separate question and due to differential missing values, n = 422. Some states considered to be less restrictive/protective may have restrictions on telemedicine abortion that were not reflected in this categorization.

Reported changes to contraceptive and pregnancy-related care resulting from Dobbs

Patient requests for IUDs and implant were the most reported contraceptive-related changes among our sample, with almost a quarter of sites reporting an increase in these contraceptive methods, though not all methods were asked about individually (Table 3). In addition, almost one-fifth of all sites reported an increase in the proportion of all patients seeking contraceptive services. We did not find differences by abortion restrictiveness for any of these measures.

Table 3.

Percentage of Sites Reporting Dobbs-Related Changes in Select Contraceptive Services, Overall and by Abortion Legality (n = 390)

Contraceptive services	Overall		More restrictive		Less restrictive/protective
Contraceptive services	% Increased	% Did not increase	% Increased	% Did not increase	% Increased	% Did not increase
Number of patients receiving contraceptive care in a typical week	14	86	17	83	12	88
Proportion of all patients seeking contraceptive services	16	84	19	81	14	86
Proportion of contraceptive patients requesting tubal ligation or vasectomy	10	90	12	88	9	91
Proportion of contraceptive patients requesting emergency contraception (for immediate use or for when needed)	13	87	13	87	14	86
Proportion of contraceptive patients requesting IUD or implant	22	78	27	73	19	81
Wait times for new patients seeking contraception	5	95	6	94	5	95
Stocking issues for IUDs or implants	9	91	11	89	7	93

IUDs, intrauterine devices.

For the items related to abortion and miscarriage management, few clinics reported that these services increased or decreased, with most reporting that they remained the same or that they preferred not to answer the question. The distribution of responses differed between sites in more restrictive and less restrictive/protective states for all the items (Table 4). In addition, a higher proportion of clinics in restrictive states chose the “prefer not to answer” option than those in less restrictive/protective states, with more than half selecting this response for both questions about the abortion referrals (in-state and out-of-state). In more restrictive states, lower proportions of clinics reported that the number of abortion referrals to in-state and out-of-state providers stayed the same compared to less restrictive/protective states. Higher proportions of clinics in more restrictive states reported decreases in time spent counseling patients seeking abortion and the number of referrals made for miscarriage management compared to less restrictive/protective states.

Table 4.

Percentage of Sites Reporting Dobbs-Related Changes in Select Abortion or Other Pregnancy-Related Care, Overall and by Abortion Legality (n = 390)

Dobbs-related abortion services	Overall				More restrictive				Less restrictive/protective
Dobbs-related abortion services	% Increased	% Same	% Decreased	% Prefer not to answer	% Increased	% Same	% Decreased	% Prefer not to answer	% Increased	% Same	% Decreased	% Prefer not to answer
Number of abortion referrals to in-state providers	4	52	9	36	1	28	17	54	7	68	3	23*
Number of abortion referrals to out-of-state providers	5	48	6	41	6	29	10	55	4	61	4	31*
Number of referrals made for miscarriage management	2	75	2	21	2	58	3	38	2	87	1	10*
Time spent counseling patients seeking abortion	5	63	4	28	2	42	9	46	7	77	1	15*

*Significantly different from more restricted at p < 0.05.

Open-ended reports of service changes in response to Dobbs

Of the 446 respondents, 61 indicated that their site planned to add or expand services because of the Supreme Court’s Dobbs decision, while only six (all in restrictive states) noted that they were eliminating or decreasing services. The most prevalent themes among the open-ended responses describing service expansions were among clinics in less restrictive/protective states, with responses that centered on abortion access. These responses described expanding the health care professionals who can provide abortion (e.g., “We immediately trained our chief medical officer to be able to provide abortion services up to our state limit”), increasing gestational age limits, and generally expanding abortion services. Several sites, all in less restrictive/protective states, also reported efforts to expand access to medication abortion and to increase abortion navigation services.

Several sites (in both more restrictive and less restrictive/protective states) reported expanding contraception-related services, in particular adding vasectomy or vasectomy consultations, while others described expanding their staffing or hours of operation as well. Among the six respondents who indicated service reductions, the responses described eliminating abortion provision and, in two cases, no longer providing pregnancy options counseling that includes abortion.

In the open-ended question about the impact of the Dobbs decision, we received over 80 responses from participants describing a related change. One prevalent theme that emerged from sites in less restrictive/protective states was an increase in out-of-state patients seeking abortions (e.g., “As predicted, we are seeing an increase in patients traveling hundreds of miles from neighboring states to access abortion care”). Another theme was compliance with new abortion restrictions. For instance, one respondent described, “Before the decision, our state gestational age limit for abortion services was 20 weeks. Now we cannot provide abortion services past the point of cardiac activity. This has impacted our ability to provide abortion access to patients significantly.” Respondents in states where abortion bans were implemented in the wake of Dobbs indicated changing counseling practices, such as, “Abortion is illegal in [state]. Therefore, we do not discuss abortion with patients.” Other respondents, in both less and more restrictive states, described an increase in patient questions about abortion and increased patient anxiety.

Notably, few respondents mentioned changes to contraceptive services in their write-in responses (n = 7, from both less and more restrictive states). Of those, some described an increase in patients seeking contraceptive methods they deemed to be longer-acting and highly-effective, such as IUDs (e.g., “We did experience an increase in requests for long-acting methods of contraception after the Dobbs vs. Jackson Women’s Health Organization decision”).

Discussion

These results provide insight into how the Supreme Court decision to overturn Roe has affected a wide range of health care delivery at publicly supported sexual and reproductive health clinics. Most notably, the Dobbs decision led to impacts on pregnancy options counseling, contraceptive care, and pregnancy-related services.

Provision of nearly all pregnancy-related care was lower among sites in more restrictive states than in those in less restrictive/protective states. We found the same low proportion of sites provided procedural abortion compared to the proportion reported in the 2015 survey with clinics.¹³ However, medication abortion has become more widely used for abortion provision in recent years, with nearly two-thirds of abortions provided via medication in a recent study.^29,31 Our findings indicate that provision of medication abortion has increased among publicly supported sexual and reproductive health clinics in recent years as well. In our sample, 13% of sites reported providing medication abortion, compared to 8% of clinics in 2015.¹³ The proportion offering medication abortion was 19% among sites in less restrictive/protective states, indicating that some sexual and reproductive health clinics are expanding access to this service in states where abortion is broadly legal. Furthermore, responses to our open-ended questions also indicated that some clinics in less restrictive/protective states have worked to expand abortion services in the wake of Dobbs. This expansion of services could contribute to recent data that indicates that abortion rates in the United States have not declined overall since Dobbs.³²

While the majority of sites reported providing nondirective pregnancy options counseling to pregnant patients, we found a lower proportion did so in more restrictive states; this is likely due to confusion about legality of abortion access and abortion referrals. Providing nondirective pregnancy counseling is a crucial component of sexual and reproductive health care and is a current requirement for Title X-funded sites. While some states have passed laws prohibiting pregnancy options counseling that is inclusive of information on abortion in the wake of Dobbs,^33,34 most states with abortion bans have not directly addressed how this applies to options counseling. Furthermore, there is evidence that abortion bans have wider-ranging chilling effects on reproductive health care beyond abortion,³⁵ and therefore, our study adds to the evidence base on how pregnancy options counseling has been affected across the network of publicly funded sexual and reproductive health clinics.

Nearly a quarter of sites reported experiencing an increase in patients requesting long-acting reversable contraception such as IUDs and implants as a result of Dobbs. However, we did not find any significant differences between states based on state-level abortion restrictiveness on any of the contraceptive services or items on the survey. Almost all sites provided these services, which is expected considering our sample was made up clinics that should be providing a broad range of contraceptive services.¹³ Notably, the proportion of clinics in more restrictive states reporting increases on these items were generally higher than in less restrictive/protective states, although the differences were not statistically significant. More research should be done to investigate how contraceptive services have or have not changed because of Dobbs. It could be that clinics had separate contraceptive and abortion services that enabled them to shield the contraceptive services from the impacts of Dobbs, or that some clinics shifted to providing contraceptive services when they lost the ability to provide abortion services.

Respondents reported working to expand abortion access where possible, such as through increasing the providers trained in abortion provision and increasing access to medication abortion. More research is needed to further understand how sexual and reproductive health clinics and patients are impacted by abortion restrictions, as state and federal policies continue to shift.

The proportion of clinics responding “prefer not to answer” to the abortion items is striking, ranging from 21% to 41%, compared to 8% or less for the contraceptive items. While survey items were designed to be widely applicable regardless of abortion provision pre- or post-Dobbs, clinics that do not provide abortion services may have selected “prefer not to answer” instead of selecting “same” because the item was not considered applicable to them. Alternatively, sites may have been hesitant to answer these questions, lacked clarity on the changes, or experienced so much recent flux in the provision of these services that the answer choices were not sufficient.

Clinics in more restrictive states were more likely to report decreasing abortion referrals, miscarriage management provision, and pregnancy options counseling than clinics in less restrictive/protective states. In addition, a lower proportion of clinics in more restrictive states indicated that they provide miscarriage management, which may stem in part from confusion surrounding what care is covered by abortion bans and the ambiguity between miscarriage and abortion care.³⁶ These results demonstrate how abortion restrictions, including laws that potentially criminalize providers for aiding patients in obtaining abortion care elsewhere, limit the provision of essential services beyond providing abortions.

Our study has several limitations. In particular, our measures examine provider perceptions of impact rather than concrete evidence of changes, as respondents were not expected to pull actual numbers of patients served or demographic breakdowns, so additional research is needed to triangulate provider perceptions with other data sources. Furthermore, some of the respondents directly performed clinical care, while others were administrators, and therefore their responses may not be fully reflective of changes occurring to patient care. Our sample size did not allow us to disaggregate our results by clinic type and Title X funding status, and future research should be done with a larger sample to account for declines in response rates. We expect nonresponse bias in these results due to the low response rate. In addition, although FQHCs comprise the largest proportion of publicly supported sexual and reproductive health clinics in the overall universe, we had the lowest response rate for this clinic type, so the responses of individual FQHCs were heavily weighted in our results. Our results are also limited by the fact that our data collection effort occurred between November 2022 and December 2023, a period of rapid change for sexual and reproductive health services. For example, a site may have completed the survey before a ban was enacted or after a ban was nullified, and their responses might have been substantially different if it had been filled out during a different time during the fielding period. Our data do not allow us to disentangle the reason for reported changes in contraceptive provision (i.e., whether sites reported changes in number of contraceptive patients seen in a week due to changes in patient demand for services, changes in clinic capacity, both, or something else). We also do not know how many or which of these sites provided abortions pre-Dobbs, only if they reported providing abortion services at the time of the survey, so we cannot use this data to estimate the loss of services.

Conclusions

Publicly supported sexual and reproductive health clinics are an important source of contraceptive and other sexual and reproductive health care. In the wake of Dobbs, many states have imposed new restrictions on abortion care, which is affecting these clinics even though most are not abortion providers. Sites reported increases in patients requesting IUDs and implants and increases in patients seeking contraception generally. In addition, sites in states with more restrictive abortion policies reported lower provision of essential care such as nondirective pregnancy options counseling and miscarriage management. Our results further suggest a chilling impact on research participation as a result of Dobbs, with large proportions of sites in more restricted states choosing not to answer pregnancy-related questions. Efforts to limit access to abortion have spillover effects for clinics’ ability to provide other essential sexual and reproductive health services. When states attempt to or succeed in limiting access to abortion care, access to related essential sexual and reproductive health services are also impacted.

Footnotes

Acknowledgments

The authors gratefully acknowledge critical feedback and contributions from the following colleagues: Ava Braccia, Joerg Dreweke, Amy Friedrich-Karnik, Jennifer Frost, Liza Fuentes, Candace Gibson, Madeleine Haas, Rachel Jones, Megan Kavanaugh, Tamrin Ann Tchou, Laura Lindberg, Lauren Mitchell, Bashiru Mohammed, Priscille Osias, Dawun Smith, and Mia Zolna. The findings and conclusions in this article are those of the authors and do not necessarily reflect the views of PPFA, Inc.

Authors’ Contributions

A.V.: Conceptualization, methodology, formal analysis, writing—original draft, writing—review and editing, and supervision. J.M.: Conceptualization, methodology, investigation, data curation, formal analysis, writing—original draft, writing—reviewing and editing. M.K.: Conceptualization, methodology, data curation, formal analysis, writing—original draft, writing—reviewing and editing.

Author Disclosure Statement

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this article.

Funding Information

This study was made possible by grants to the Guttmacher Institute from two anonymous donors and by the Office of Population Affairs (OPA) of the U.S. Department of Health and Human Services (HHS) as one component of a financial assistance award from OPA totaling $2.25 million. For the Clinic Survey component, about 10% was funded by OPA and 90% funded by nongovernment sources. The contents are those of the authors and do not necessarily represent the official views of, nor an endorsement, by OPA, HHS, or the U.S. Government. The findings and conclusions in this report are those of the authors and do not necessarily reflect the positions and policies of the donors.

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Effects of the Dobbs Decision on Publicly Supported Sexual and Reproductive Health Clinics: Results from a National Study

Abstract

Background:

Materials and Methods:

Results:

Conclusions:

Introduction

Materials and Methods

Sampling and recruitment

Measures

Provision of pregnancy-related services

Perceptions of Dobbs-related changes

Open-ended Dobbs questions

Abortion restrictiveness

Analyses

Results

Sample characteristics

Provision of abortion and pregnancy-related care

Reported changes to contraceptive and pregnancy-related care resulting from Dobbs

Open-ended reports of service changes in response to Dobbs

Discussion

Conclusions

Footnotes

Acknowledgments

Authors’ Contributions

Author Disclosure Statement

Funding Information

References