Research on the Early Impact of Dobbs on Abortion, Births and Contraception: What We Know So Far

The US Supreme Court’s June 2022 decision in Dobbs v. Jackson Women’s Health Organization eliminated the federal constitutional right to abortion in the United States. This report provides a topline summary of the emerging body of research measuring the likely impact of the Dobbs decision on outcomes in four areas: abortion services and access, abortion incidence, incidence of births and contraceptive use. 

To locate peer-reviewed studies, we searched three academic databases (Google Scholar, PubMed and JSTOR) using the terms “abortion” AND (“Dobbs” OR “Roe”) and limited our summary to study findings published by April 30, 2024. Fewer than 10 peer-reviewed journal articles examining the impact of this legal decision had been published by that date (in part because the peer-review process can take months or years). Some studies were published in other formats, and we relied on internet searches, media coverage and institutional knowledge to locate the studies that had not been published in peer-reviewed journals. We also examined the references cited in research studies located by these searches. This report does not include every research publication we found (see Appendix below for a list of additional studies) and is limited to those most relevant to the four topic areas mentioned above. Our summary includes: 

• 9 articles published in peer-reviewed journals 
• 1 manuscript undergoing peer review and available via preprint 
• 13 online reports, discussion papers and policy analyses

Since April 30, 2024, additional studies have been published and many more are on the horizon. The studies summarized here reflect only the beginning of what will be a substantial body of research that provides valuable insights into how specific states’ policies affect their residents’ reproductive health and autonomy under changed conditions after the Dobbs decision. 

Abortion Services and Access

US-based online-only, or virtual, “clinics” emerged in response to the US Food and Drug Administration lifting the in-person dispensing requirement for mifepristone in 2021. These clinics mail medication abortion drugs to or within states where it is permitted after individuals have a consultation via phone, video, text or an online platform. Many online-only clinics were able to offer medication abortion at a lower cost compared with brick-and-mortar facilities. These developments made medication abortion more accessible for people living in states where they were allowed to receive these medications through the mail.

These findings come from four studies documenting the impact of Dobbs on where and how people access abortion care provided by a US clinician, including two policy analyses, one peer-reviewed study and one preprint publication.

• According to an analysis by the Guttmacher Institute, within one month of the Dobbs decision, 43 brick-and-mortar clinics in 11 states had stopped providing abortions.¹ A second analysis found that at 100 days post-Dobbs, there were 66 fewer clinics across 15 states providing abortion care,² the equivalent of approximately 8% of the 807 clinics known to be operating prior to Dobbs.
• One peer-reviewed study was able to estimate the impact of these clinic losses on accessibility of care. Rader et al. used census-tract data and information from a national database of brick-and-mortar abortion facilities to examine changes in driving time between January–December 2021 and September 2022.³ Average travel time to the nearest facility increased from 28 to 100 minutes, and the proportion of women who lived more than one hour’s drive from a facility increased from 15% to 33%. Increases in distance were greatest in the Southern states and most residents in Arkansas, Louisiana, Mississippi and Texas had to drive four or more hours to reach the nearest facility in September 2022.
• According to a preprint of a virtual-clinic landscape review from September 2022 to June 2023, there were at least 20 online-only clinics that mailed abortion drugs to 27 states and the District of Columbia.⁴ The median cost of a mailed medication abortion was $259, compared with $550 for a medication abortion at a brick-and-mortar facility in 2017.

Abortion Incidence

Clinician-Provided Abortions

Of the two ongoing research studies monitoring the national incidence of clinician-provided abortions post-Dobbs, #WeCount releases reports approximately every three months and had issued five reports as of April 2024. The Monthly Abortion Provision Study had published five policy analyses from October 2023 to April 2024 and continues to release new abortion incidence figures every month.

Monthly abortion data from all providers

The #WeCount project collects monthly data on the number of abortions provided at all known sources of clinician-provided care. Most of the information is obtained directly from providers; approximately 15% of the abortions are estimated.

• The first report covered the five months of April–August 2022, which included two complete months pre- and post-Dobbs. National monthly abortion totals declined 6% over that time in response to 22 states imposing partial or total abortion bans.⁵ 
• The third #WeCount report covered the 12-month time period of April 2022 through March 2023 and documented a seeming “rebound.” Average monthly abortion counts in January and March 2023 were higher than those in April and May 2022, despite total abortion bans in 13 states in 2023.⁶
• #WeCount was the first study to provide national estimates of the number of clinician-provided medication abortions supplied by online-only, or virtual, clinics. These data suggest that online-only clinics accounted for 4% of all clinician-provided abortions in April 2022; this proportion increased with every consecutive month and reached 11% in December 2022.⁷ Over the first six months post-Dobbs, online-only clinics accounted for an average of 9% of all clinician-provided abortions in the United States. The fourth #WeCount report suggests that this proportion stayed about the same through April, May and June 2023 (8–9%).⁸

Multiple states have implemented shield laws to provide legal protections for health care providers offering abortion care to people in states where it is banned. In 2023, medical professionals in five states were able to mail abortion drugs to individuals in states where abortion was banned and in states that prohibited or deterred the mailing of abortion drugs (e.g., required a state-mandated ultrasound).

• The fifth #WeCount report, covering the 18-month period of April 2022 through September 2023, included numbers of all abortions provided by online-only clinics starting in July 2023—the total provided to patients in states without abortion bans or restrictions on provision via telemedicine, plus those provided under the protection of provider shield laws. The monthly totals for online, clinician-provided medication abortions doubled between June and July 2023, from 7,110 to 14,110, and the latter level was roughly sustained through September 2023.⁹

Monthly abortion data based on samples of providers

The Guttmacher Institute’s Monthly Abortion Provision Study obtains monthly counts of abortions from repeated samples of all known sources of US clinician-provided abortions. The study uses a stratified sampling design and statistical modeling to generate national and state-level estimates based on the sampled data in combination with historical data on caseloads for all US abortion providers. The study covers the period starting in January 2023 and, when examining change over time, it uses the pre-Dobbs period of 2020 for comparison; that year was the last one with reliable national statistics on abortion incidence (also collected by the Guttmacher Institute).

• While 13 states had a total abortion ban during the first six months of 2023, the study documented substantial increases in abortions provided in states where it remained legal.¹⁰ The proportion of patients who crossed state lines for an abortion more than doubled, from one in 10 in 2020 to nearly one in five in the first six months of 2023.¹¹
• The Monthly Abortion Provision Study is able to provide state-specific estimates for the share of abortion patients coming to clinics from out of state. For example, in Illinois, which borders three states that banned abortion after Dobbs, the share of in-person abortions in the state provided to people from other states increased from 21% in 2020 to 42% in the first six months of 2023.¹²
• The study also documented an increase in abortions among residents in most states where it remained legal. As a result, the total number of abortions in the country increased 11% between 2020 and 2023.¹²
• The provision study has been able to measure the immediate impacts of new state-level abortion restrictions. For example, study data show that abortions in North Carolina declined 31% in one month after a requirement for in-person counseling 72 hours before the abortion and a 12-week abortion ban both went into effect in July 2023.¹³ Abortions in South Carolina declined 79% in one month in response to a six-week abortion ban implemented in August 2023.¹¹
• The study documented that medication abortions accounted for 63% of all clinician-provided abortions in 2023, up from 53% in 2020.¹⁴ (Medication abortions in 2023 included those provided by brick-and-mortar facilities and online-only clinics.)

Self-Managed Abortions

Two peer-reviewed studies documented changes in the incidence of self-managed abortion. As defined by the studies’ authors, self-managed abortions are those using abortion drugs obtained “outside the formal health care system”; these abortions are not included in totals contained in the research studies presented in the previous section on clinician-provided abortions.

• The first study, by Aiken et al., analyzed requests for abortion drugs made to the telemedicine organization Aid Access from residents in 30 states between September 2021 and August 2022.¹⁵ The analysis excluded the 20 states where Aid Access provided medication abortion by US clinicians at that time. The organization received 42,259 requests from individuals in those 30 states during that time period; average daily requests increased from 83 in the eight months prior to Dobbs to 214 in the two months after Dobbs. Requests per 100,000 female residents of reproductive age increased in all 30 states and were largest in Alabama, Arkansas, Louisiana, Mississippi and Oklahoma, all of which had banned abortion immediately following Dobbs. Notably, the study measured requests for abortion drugs and these do not necessarily equate with drugs mailed or used.

• A second study, also led by Aiken, reported on the volume of medications for self-managed abortion that were mailed during March–April 2022 and July–December 2022 by three types of organizations: telemedicine organizations (such as Aid Access), community networks (e.g., grassroots organizations that provide support to those looking for abortion options, including medication abortion) and websites that mail abortion drugs from outside the United States.¹⁶ The number of abortions provided via mailed drugs through these three source types increased by 27,838 more than what would have been expected based on pre-Dobbs trends (for a total of some 36,000–38,000 self-managed abortions). In the first months post-Dobbs, telemedicine organizations provided the majority of medication abortion drugs, but provision by community networks increased substantially and accounted for 51% of all monthly mailed medication abortions in the post-Dobbs study period.

Incidence of Births

One working paper (subsequently published in a peer-reviewed journal) examined changes in the incidence of births following Dobbs. Dench et al. used a synthetic difference-in-differences design and provisional birth data from the Centers for Disease Control and Prevention to estimate changes in the number of births during the first six months of 2023 in the 13 states that had banned abortion; the comparison group was the District of Columbia and 24 states that did not enact any abortion restrictions post-Dobbs.¹⁷

• The authors found a relative increase in births of an average of 2.3% in states with an abortion ban compared with the other states.
• The study also found births in states with an abortion ban increased most for women aged 20–24 (3.3%) and for Hispanic women (4.7%).

Contraceptive Use

We included six peer-reviewed studies that examined changes in contraceptive use, and we distinguished between permanent contraception (i.e., sterilization) and all other contraceptive methods. Five of the six studies examined changes in sterilization—two at the national level and three at specific health systems in states that were considered restrictive of abortion at the time of data collection. Two of the same studies looked at non-permanent contraception, plus a sixth study used survey data from women at family planning clinics in four states before and after Dobbs.

Permanent Contraception

• The most robust study, by Strasser et al., used medical claims from a large prescriptions and medical claims database (IQVIA) to examine trends in the number of monthly claims for vasectomies and tubal ligations between 2019 and 2022.¹⁸ The authors found that vasectomy claims increased over the study period, rising from 146,796 annually in 2019 to 198,212 in 2022. The authors observed a post-Dobbs jump that extended through the end of 2022. While there was a slight increase in the number of claims for tubal ligations shortly after Dobbs, overall numbers decreased over the study period from 103,547 in 2019 to 74,537 in 2022.
• Another study used electronic health records from academic medical centers (TriNetX) to examine trends in permanent contraceptive procedures among young adults aged 18–30 from January 2019–May 2022 to June 2022–September 2023.¹⁹ The researchers found that rates of both tubal ligations and vasectomies had been rising pre-Dobbs, but increases were even greater after Dobbs. Post-Dobbs increases in rates were statistically different from the earlier period for tubal ligations but not for vasectomies.
• Bole et al. used billing records from a large Midwestern academic health care system to document a significant increase in vasectomies, from 104 procedures per month in July–September 2018–2021 to 218 during the same months in 2022.²⁰
• Using electronic health records from the University of Michigan, Ann Arbor, Liang et al. found that requests for tubal sterilizations increased from 402 per year in 2019 to 658 in 2022.²¹ Request rates were significantly higher in May–September 2022 compared with the same months in 2019 and 2021, but then returned to pre-Dobbs levels for the remainder of the year.
• In the third study, Mitchell et al. compared sterilization procedure numbers for the first and second halves of 2022 within a multihospital system in Ohio and found a 36% increase in tubal ligations, from 725 in January–June 2022 to 989 in July–December 2022.²² Similarly, vasectomies increased by 33% over the period, from 1,193 in the first half of 2022 to 1,590 in the second half.

Non-Permanent Contraception

• The research study using data from an Ohio hospital system also examined procedures for long-acting reversible contraceptive methods and documented an 11% increase in IUDs and implants (combined) between January–June and July–December 2022, covering pre- and post-Dobbs periods.²²
• The study by Strasser et al. using the IQVIA database of monthly medical claims for 2019–2022 examined new prescriptions for pills, patches and rings, as well as claims for injectables, IUDs and implants.¹⁸ The researchers found overall declines in new contraceptive prescriptions (from more than 25 million in 2019 to fewer than 22 million in 2022), as well as drops in IUD visits (from 650,043 to 591,509, respectively) and implant visits (numbers not provided). There were slight increases in claims for all of these non-permanent methods shortly after Dobbs, but then the declines resumed.
• The final study, by Kavanaugh and Friedrich-Karnik, used cross-sectional data from women at two points in time (2021 and 2022–2023) in four states—Arizona, Iowa, New Jersey and Wisconsin—to examine pre- and post-Dobbs changes in access to and use of contraception.²³ In Arizona, Iowa and Wisconsin, individuals reported significantly higher levels of trouble or delays in accessing their preferred contraceptive method post-Dobbs (increases of roughly four percentage points). Respondents in three states (Iowa, New Jersey and Wisconsin) reported significantly higher levels of condom use post-Dobbs; no changes were reported in the use of any other methods in any of the four states.

Appendix 

Additional Studies Not Included in Review

We also reviewed the following eight articles. We did not incorporate them into our summary for several reasons, including because their content overlapped too much with the 23 selected studies or did not align with our four topic areas.

Advancing New Standards in Reproductive Health, Availability of Telehealth Services for Medication Abortion in the U.S., 2020–2022, 2023, https://www.ansirh.org/research/brief/availability-telehealth-services-medication-abortion-us-2020-2022.

Advancing New Standards in Reproductive Health, Trends in Abortion Facility Gestational Limits Pre- and Post-Dobbs, 2023, https://www.ansirh.org/research/brief/trends-abortion-facility-gestational-limits-pre-and-post-dobbs.

Alterio M et al., A geospatial analysis of abortion access in the United States after the reversal of Roe v. Wade, Obstetrics & Gynecology, 2023, 142(5):1077–1085, https://doi.org/10.1097/AOG.0000000000005329.

Beasley A et al., Pregnant Texans’ Interest in Other Models of Abortion Care After the Fall of Roe, Austin, TX: Texas Policy Evaluation Project, 2023, https://sites.utexas.edu/txpep/files/2023/01/TxPEP_Research_Brief_Mitigation_Strategies_17Jan.pdf.

Frederiksen B et al., A National Survey of OBGYNS' Experiences After Dobbs, San Francisco: KFF, 2023. https://www.kff.org/womens-health-policy/report/a-national-survey-of-ob….

Keefe-Oates B et al., Use of abortion services in Massachusetts after the Dobbs decision among in-state vs out-of-state residents, JAMA Network Open, 2023, 6(9):e2332400, https://doi.org/10.1001/jamanetworkopen.2023.32400.

Ohio Policy Evaluation Network, Abortion in Ohio Post-Dobbs: Unpacking the Numbers and Stories, 2023, https://open.osu.edu/wp-content/uploads/2023/02/Research-Brief_Abortion-in-Ohio-Post-Dobbs_February-2023.pdf.

Zhu DT et al., Public health and clinical implications of Dobbs v. Jackson for patient and healthcare providers: a scoping review, PLOS One, 2024, 19(3):e0288947, https://doi.org/10.1371/journal.pone.0288947.