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

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.