241 - Adolescent Hospital Visits for Sexual and Reproductive Health Outcomes before and after the Dobbs Decision to Overturn Roe v. Wade

Publication Number: 3233.241

Christina Bonaparte, Keck School of Medicine of the University of Southern California, Los Angeles, CA, United States; Matt hall, Children's Hospital Association, Lenexa, KS, United States; Cheryl Lyn. Errichetti, Children's Hospital Los Angeles, Los Angeles, CA, United States; Monika Goyal, Children's National Medical Center, Washington, DC, United States; Lauren Chernick, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, United States; Elizabeth Hovel, Medical College of Wisconsin, Milwaukee, WI, United States; Vanessa McFadden, Medical College of Wisconsin, Milwaukee, WI, United States; Melissa Miller, Children's Mercy Hospitals and Clinics, Kansas City, MO, United States; Stephani Stancil, Children's Mercy Hospitals and Clinics, Kansas City, MO, United States; Abbey R. Masonbrink, Children's Hospital Los Angeles, Los Angeles, CA, United States

Background: In June 2022, the Supreme Court's decision (Dobbs) overturning Roe v. Wade resulted in increased sexual and reproductive healthcare (SRH) restrictions in some states. Studies show this may have reduced SRH access for adolescents.

.

Objective: To evaluate changes in adolescent SRH-related hospital visits post-Dobbs and compare by state abortion policies.

Design/Methods: We conducted a retrospective cohort study of adolescent pediatric hospital visits from June 2021-December 2024 and used an interrupted time series (ITS) analysis to measure the impact of Dobbs on SRH outcomes. The ITS study periods were pre-Dobbs (June 2021-May 2022), intervention time (June 2022), and post-Dobbs (July 2022-December 2024). This study took place in pediatric hospitals- including inpatient, observation and the emergency department- at 42 children's hospitals participating in the Pediatric Health Information System (PHIS) database. Participants included adolescents aged 11-18. Biologic females for related outcomes. Our exposure was state-level abortion policies. Outcomes included pregnancy diagnosis, STI testing and diagnosis, EC provision, or abortion, based on billing codes.

Results: Of 3,448,158 pediatric hospital visits, 1,615,389 (45.9%) occurred in abortion-restricted states while 1,900,645 (54.1%) occurred in non-restricted states. Of these, 0.4% (n=6488) had a pregnancy diagnosis, 25.4% (n=893225) had STI testing, 0.4% (n = 13402) had an STI diagnosis 0.3% (n=5127) had EC administered, and 0.0002% (n=842) received abortion care. ITS findings showed an increase in pregnancy visits in abortion-restricted states at the time of Dobbs (June 2022) (OR=1.26; 95% CI: 1.02-1.55; p=0.029). This is compared with non-restricted states where pregnancy visits decreased pre-Dobbs (OR: 0.98; 95% CI: 0.96-1; p=0.021) then slightly increased post-Dobbs (OR=1.03; 95% CI: 1.01-1.05; p=0.006). STI testing (OR=0.99; 95% CI: 0.99-1.00; p=0.027) and diagnoses decreased post-Dobbs (OR=0.98; 95% CI: 0.97-1.00; p=0.017) in restricted states. STI trends remained stable in non-restricted states (OR=1.03; 95% CI: 1.01-1.05; p=0.006). EC visits in abortion-restricted states decreased post-Dobbs compared to pre-Dobbs (OR=0.98; 95% CI: 0.96-1.00; p=0.028). No significant changes were observed for abortion.

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

Proportion of Monthly Adolescent Pediatric Hospital Visits for SRH Outcomes, Pre- and Post-Dobbs
Changes in the proportion of monthly inpatient and ED adolescent pediatric hospital visits for SRH needs and outcomes in abortion-restricted and non-restricted states, June 2021-December 2024. The vertical dotted line indicates the timing of the Dobbs decision (June 2022). Time periods are defined as Pre-Dobbs (June 2021-May 2022) and During-Dobbs (July 2022-December 2024).

Characteristics of Adolescent Visits at Pediatric Hospitals Pre- and Post-Dobbs


Interrupted Time Series of Adolescent Pediatric Hospital Visits Pre, During, and Post-Dobbs