OBJECTIVE To examine changes in availability of procedural abortion, especially in the second and third trimesters of pregnancy, since the U.S. Supreme Court ended federal protections for abortion in its Dobbs v. Jackson Women's Health Organization decision in 2022. METHODS We used the Advancing New Standards in Reproductive Health Abortion Facility Database, a national database of all publicly advertising abortion facilities, to document trends in service availability from 2021 to 2023. We calculated summary statistics to describe facility gestational limits for procedural abortion for the United States and by state, subregion, and region, and we examined the number and proportion of facilities that offer procedural abortion in the second or third trimester of pregnancy. RESULTS From 2021 to 2023, the total number of publicly advertising facilities providing procedural abortion decreased 11.0%, from 473 to 421. Overall, one-quarter of facilities (n=115) that had been providing procedural abortion in 2021 ceased providing services, and an additional 99 decreased their gestational limits. In contrast, 73 facilities increased their gestational limits, and 64 new facilities began providing or publicly advertising procedural abortion services. The number of facilities offering procedural abortion later in pregnancy decreased (327 to 309 providing 14 weeks of gestation or later, 60 to 50 providing 24 weeks of gestation or later), although the proportion of all facilities providing these services held steady. The greatest changes were in the South, where many facilities closed. CONCLUSION There have been substantial reductions in the number and distribution of facilities offering procedural abortion since the Dobbs decision, with critical decreases in the availability of later abortion services. Some facilities are positioning themselves to meet the needs of patients by opening new facilities, publicly advertising their services, or extending their gestational limits.

中文翻译：

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Dobbs v. Jackson Women's Health Organization 前后后期堕胎护理可用性的变化。


目的 研究自美国最高法院在 2022 年多布斯诉杰克逊妇女健康组织案的裁决中终止联邦对堕胎的保护以来，程序性流产的可用性变化，尤其是在妊娠中期和晚期。方法 我们使用生殖健康堕胎设施数据库的推进新标准，这是一个包含所有公开广告堕胎设施的全国数据库，来记录 2021 年至 2023 年服务可用性的趋势。我们计算了汇总统计数据，以描述美国以及各州、次区域和地区的机构程序性流产的妊娠限制，并检查了在妊娠中期或晚期提供程序性流产的机构的数量和比例。结果从 2021 年到 2023 年，提供程序性流产的公开广告机构总数下降了 11.0%，从 473 家下降到 421 家。总体而言，在 2021 年提供程序性流产的机构中，有四分之一 （n=115） 停止提供服务，另有 99 家降低了妊娠限制。相比之下，73 家机构提高了妊娠限制，64 家新机构开始提供或公开宣传程序性堕胎服务。提供妊娠晚期程序性流产的机构数量有所减少（327 至 309 家提供妊娠 14 周或更晚，60 至 50 家提供妊娠 24 周或更晚），尽管提供这些服务的机构比例保持稳定。最大的变化发生在南方，那里的许多设施都关闭了。 结论 自 Dobbs 决定以来，提供程序性流产的设施的数量和分布大幅减少，后期流产服务的可用性严重减少。一些机构通过开设新设施、公开宣传其服务或延长其妊娠限制来满足患者的需求。