Adolescent Hospital Visits for Sexual and Reproductive Health Outcomes After the Dobbs Decision.

Abstract

Objective: To evaluate changes in adolescent sexual and reproductive health (SRH)-related hospital encounters post-Dobbs and compare by state abortion policies.

Methods: We conducted a retrospective cohort study of adolescent pediatric hospital encounters from June 2021 to December 2024 and used an interrupted time series analysis to measure the impact of Dobbs on SRH outcomes. Encounters included any hospital encounter of patients aged 11 to 18 years from 42 children's hospitals nationwide. SRH outcomes included pregnancy diagnosis, sexually transmitted infection (STI) testing and diagnosis, emergency contraception (EC) provision, or abortion, based on billing codes.

Results: Of 3 448 158 pediatric hospital encounters, 1 584 397 (45.9%) occurred in abortion-restricted states. In abortion-restricted states, there was an increase in pregnancy diagnosis during encounters at the time of Dobbs (June 2022) (odds ratio [OR], 1.26; 95% CI, 1.02-1.55; P = .029). Encounters with STI testing (OR, 0.99; 95% CI, 0.99-1.00; P = 0.027), STI diagnoses (OR, 0.98; 95% CI, 0.97-1.00; P = .017), and EC (OR, 0.98; 95% CI, 0.96-1.00; P = .028) decreased post-Dobbs compared with pre-Dobbs in restricted states. Of 1 863 761 (54.1%) pediatric hospital encounters in permissive states, pregnancy encounters decreased pre-Dobbs (OR, 0.98; 95% CI, 0.96-1.00; P = .021) and then slightly increased post-Dobbs (OR, 1.03; 95% CI, 1.01-1.05; P = .006), whereas STI trends in testing and diagnosis remained stable across all 3 time periods.

Conclusion: In abortion-restricted states post-Dobbs, we found a 26% increase in the odds of pregnancy-related encounters, as well as a decrease in STI testing, diagnosis, and EC administration. Further efforts are needed to offset the disparate risk for outcomes for youth living in abortion-restricted states.