Dobbs v. Jackson Women’s Health Organization Ruling and Live birth Prevalence of Selected Birth Defects in the United States Restricted; Files Only
Solomon, Lena (Spring 2025)
Abstract
Abstract
Dobbs v. Jackson Women’s Health Organization Ruling and Live birth Prevalence of Selected Birth Defects in the United States
By Lena K. Solomon
Background: In June 2022, the Dobbs v. Jackson Women’s Health Organization decision overturned federal abortion protections, allowing states to implement bans that may influence access to pregnancy termination following prenatal diagnoses of major birth defects. This study assessed whether the Dobbs ruling was associated with changes in the prevalence of selected congenital anomalies including anencephaly, spina bifida, and Down syndrome among live births in the United States. It also examined whether maternal insurance
status modified this association.
Methods: We used restricted-use natality data from the National Vital Statistics System, including 10,863,648 live births from 33 U.S. states between 2018 and 2023. States were classified as exposed if they implemented a complete or six-week abortion ban between September 1, 2021, and August 25, 2022 (n = 14 states). The unexposed group included 19 states that maintained protective or no-ban policies (n = 19 states). A difference in differences approach was used to estimate changes in birth defect prevalence before (2018-2021) and after (2022-2023) the Dobbs ruling in exposed versus unexposed states. Stratified analyses examined maternal insurance as an effect modifier. A sensitivity analysis compared conceptions in 2018 and 2022 to 2023 to exclude the COVID-19 pandemic period.
Results: The Dobbs ruling was not associated with statistically significant changes in the prevalence of anencephaly (estimate: -0.06, 95% CI: -0.26, 0.14) or Down syndrome (estimate: -0.14, 95% CI: -0.70, 0.43). Spina bifida prevalence declined in exposed states and approached statistical significance (estimate: -0.18, 95% CI: -0.37, 0.00; p = 0.06). Stratified results showed a greater decline in spina bifida prevalence among publicly insured individuals compared to those with private or other insurance types, though interactions were not statistically significant.
Conclusions: This analysis did not find strong evidence that post-Dobbs abortion bans broadly changed the prevalence of selected birth defects. However, the observed decline in spina bifida and differences by insurance status support continued surveillance of birth outcomes in response to changing reproductive policies.
Table of Contents
Table of Contents
CHAPTER I – BACKGROUND AND LITERATURE REVIEW..................................................1
CHAPTER II ..................................................................................................................8
Methods........................................................................................................................9
Results.........................................................................................................................12
Discussion....................................................................................................................14
References....................................................................................................................18
Tables...........................................................................................................................22
CHAPTER III - PUBLIC HEALTH IMPLICATIONS..............................................................28
About this Master's Thesis
| School | |
|---|---|
| Department | |
| Subfield / Discipline | |
| Degree | |
| Submission | |
| Language |
|
| Research Field | |
| Keyword | |
| Committee Chair / Thesis Advisor |
Primary PDF
| Thumbnail | Title | Date Uploaded | Actions |
|---|---|---|---|
|
|
File download under embargo until 15 May 2026 | 2025-04-24 15:56:29 -0400 | File download under embargo until 15 May 2026 |
Supplemental Files
| Thumbnail | Title | Date Uploaded | Actions |
|---|