Abortion trends in Southern Illinois after the Dobbs v. Jackson Women's Health Organization decision.

Background: The Dobbs v. Jackson Women's Health Organization (Dobbs) decision in June 2022 significantly changed the landscape of abortion care in the United States. Characterizing the changes in regional abortion provision is imperative to understanding the impact of Dobbs on patients seeking abortion and the clinics providing care.

Objective: To examine changes in gestational duration, one-way driving distance, and abortion volume pre- and post-Dobbs.

Study design: This retrospective cohort study used clinic-level administrative data to examine changes in abortion provision from June 2021 to June 2023 at two outpatient abortion clinics in Southern Illinois. We included all induced abortions performed up to 23 weeks, 6 days gestational duration. We compared patient characteristics between pre- and post-Dobbs using appropriate bivariate tests. To account for underlying trends over time, we used segmented regression analyses to examine changes in mean gestational duration (weeks) at time of abortion, mean one-way driving distance (miles) from patients' home zip code to the clinic, and number of abortions before and after the Dobbs decision. We conducted segmented regressions stratified by one-way driving distance, race, and Area Deprivation Index national percentile to explore disparities in access after Dobbs. All segmented regressions adjusted for seasonal variation and controlled for autocorrelation.

Results: In total, 29,165 abortions occurred during the study period: 11,631 pre-Dobbs and 17,534 post-Dobbs (51% increase). The monthly number of abortions increased by 349.2 (95%CI: 120.7, 557.8) post-Dobbs and remained stable. The mean gestational duration increased from 8.3±3.8 weeks pre-Dobbs to 8.9±4.0 in the 12 months post-Dobbs (p<0.001) and the proportion of abortions occurring at 12 weeks or later increased from 14.5% (n=1,689) to 18.1% (n=3,176), p<0.001. The monthly average gestational duration increased 1.1 weeks (95%CI: 0.6, 1.6) immediately post-Dobbs and subsequently decreased -0.1 weeks (95% CI: -0.2, -0.1) over time. The mean one-way driving distance pre-Dobbs was 82.87 ± 132.34 miles and increased to 193.95 ± 206.50 post-Dobbs (p<0.001). The monthly mean one-way driving distance increased 108.0 miles (95%CI: 93.2,122.8) post-Dobbs and then decreased over the remainder of the study period (-6.9 miles, 95%CI: -8.2, -5.5).

Conclusions: At two abortion clinics in Southern Illinois, the 12-month period post-Dobbs was associated with a substantial increase in abortion volume, a small increase in gestational duration, and patients traveling farther for care compared to pre-Dobbs. These findings highlight the impact on patient care caused by the rapidly changing abortion landscape in the U.S.