What question did this study set out to answer?

The research aims to assess how abortion care changed in a hospital system following legislative alterations, particularly the Dobbs decision and SB20.

March 17, 2026Open Access

The impact of legislative changes on abortion care: A retrospective study of one hospital system in North Carolina

Key Points

The research aims to assess how abortion care changed in a hospital system following legislative alterations, particularly the Dobbs decision and SB20.
Conducted a quasi-experimental retrospective cohort study
Analyzed electronic health record data from July 2021 to June 2024
Compared in-state patients to out-of-state patients across three time frames: pre-Dobbs, post-Dobbs, and post-SB20
Used descriptive statistics and regression models for analysis
Grouped patients based on the timing of abortion care relative to policy changes.
The number of abortion-seeking patients increased after Dobbs and SB20 compared to before.
Out-of-state patients presented at higher gestational durations with average GDs of 14.9, 13.5, and 9.7 weeks respectively.
Out-of-state patients had 1.6 times higher odds of risk factors for complications than in-state patients (OR = 1.57, 95% CI 1.04–2.39).
Gestational duration was significantly influenced by time frame and residency (p < 0.001), but complications did not depend on these factors.

Abstract

• More patients sought abortion after Dobbs and SB20 than before Dobbs. • Patients traveling from out of state presented at significantly higher gestational durations. • Complication rates remained low overall but risk factors for complications were greater for out of state patients. • Barriers to abortion access, including legal restrictions, could negatively impact abortion-related morbidity and mortality. North Carolina is unique as a southeastern state that provides abortion access for the region and implemented a 12 week ban one year after the Dobbs decision. This study sought to compare demographics, gestational duration (GD), and clinical characteristics of abortion patients across three time frames corresponding to federal and state-level policy changes. We compared in-state to out-of-state patients at one North Carolina hospital system between July 2021 and June 2024. We conducted a quasi-experimental retrospective cohort study using electronic health record data, comparing patient characteristics and clinical outcomes across three distinct time periods. Analyses were stratified by residency (in-state versus out-of-state) to evaluate differential impacts over time. Patients were grouped by date: the year before Dobbs (July 2021-June 2022), the year after Dobbs (July 2022-June 2023), and the year after SB20 (July 2023-June 2024). We used descriptive statistics and regression models. Of 929 patients, 291 were pre-Dobbs, 306 were post-Dobbs, and 333 were post-SB20 with average GDs of 14.9, 13.5, and 9.7 weeks, respectively. Out-of-state patients were 1.6 (OR = 1.57, 95% CI 1.04–2.39) times as likely to have a risk factor for an abortion complication. Time frame and state of residence were significant predictors of GD ( p < 0.001) but did not predict complications. Despite a 12 week abortion ban in North Carolina, out-of-state patients continued to seek care at a significantly higher GD which is associated with a higher risk of complications in prior literature.

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