The Dobbs decision has led to renewed interest in understanding impacts of reduced abortion access on maternal and child health. Yet restrictive, complex, and varying abortion laws existed decades before Dobbs; understanding their impact can inform abortion policies that improve health in today’s landscape. The Legal Epidemiology of Abortion Policy (LEAP) Study uses rigorous legal coding and data analysis methods to examine relationships between state-level abortion policies from 2005-2021 and maternal, birth, and infant outcomes.

Individual-level outcome data from vital statistics records (n= 64,742,938 births for birth outcomes; n=59,200,696 births for infant mortality) were analyzed to assess relationships between state abortion restrictions, birth outcomes, and infant mortality. Analyses by type of restriction include individual-level control variables, state- and year- fixed effects, and state-specific time trends, and account for clustering by state of residence.

Several state abortion restrictions were associated with adverse birth and infant outcomes. Six-week, 20-week, and third trimester abortion bans were associated with increased preterm birth (aORs respectively: 1.05[1.01, 1.10]; 1.03[1.00, 1.06]; and 1.06[1.02, 1.11]). 20-week bans were also associated with increased infant mortality (aOR 1.35[1.11, 1.63]). Prohibiting Advanced Practice Clinicians (APCs) provision of aspiration abortions was associated with increased low birthweight (aOR 1.03 [1.02, 1.05]) and preterm birth (aOR 1.08 [1.05, 1.11]); prohibiting APC provision of both medication and aspiration abortion was associated with increased preterm birth (aOR 1.07[ 1.02, 1.11]. Requiring abortion providers to have hospital staff or admitting privileges was associated with increased infant mortality.

Abortion policies under Roe still failed to protect infant health.

Background: In the aftermath of the Dobbs decision, contraception remains a critical tool for exercising reproductive autonomy. Uncertainty around abortion access and restrictive healthcare policies, however, complicate decision-making. This study explores how Black women navigate contraceptive decision-making and their desire to maintain control over reproductive futures in an uncertain political climate.

Methods: In-depth interviews were conducted with Black women in Ohio, exploring their experiences with birth control in the post-Dobbs era. Using a phenomenological approach, data were analyzed to examine the emotional, social, and personal factors influencing contraceptive decision-making. Thematic analysis was used to identify common themes, including the persistence of contraceptive use despite adverse side effects,

Results: Despite negative experiences with birth control, including mood changes, weight gain, and physical discomfort, participants chose to continue or initiated use of contraception as a strategy to maintain reproductive control. Concerns over unplanned pregnancy and limited abortion access motivated them to endure discomfort, viewing contraception as a means of maintaining autonomy amidst uncertainty and healthcare system challenges.

Conclusion: This study highlights how personal beliefs and lived experiences, intertwined with political and healthcare factors, shape contraceptive decision-making among Black women in Ohio. It underscores the need for personalized, patient-centered counseling to improve contraceptive satisfaction and support reproductive autonomy. Tailored approaches can empower women to make informed choices that align with their needs, ultimately fostering better health outcomes and addressing the diverse challenges posed by restrictive policies and healthcare practices.

Medicaid expansion has improved healthcare access, yet in the post-Dobbs era, abortion restrictions threaten reproductive rights, emphasizing the need for enhanced contraceptive services. This study examines how state-level Medicaid expansion and abortion policies impact contraceptive access and utilization among reproductive-aged female Medicaid enrollees. I compare contraceptive utilization and federally qualified health center (FQHC) availability across three state groups: (1) Medicaid-expanded states with abortion protections (2) Medicaid-expanded states with abortion restrictions, and (3) non-expanded states with abortion restrictions. Data from the Centers for Medicare & Medicaid Services, Kaiser Family Foundation, and Health Resources and Services Administration inform this analysis. Findings indicate that Medicaid expansion significantly increases enrollment among females ages 15–49. Surprisingly, states that expanded Medicaid but restrict abortion report higher contraceptive utilization rates than both their abortion-protective and non-expansion counterparts. Despite similar Medicaid beneficiary-to-FQHC ratios, Medicaid-expansion, abortion protective states have fewer FQHCs per beneficiary. These results highlight Medicaid’s essential role in contraceptive access and reveal unexpected patterns in restrictive policy environments. Given current threats to Medicaid and reproductive healthcare, safeguarding Medicaid’s future is critical for sustained contraceptive access.

With state abortion laws in flux post-Roe, access depends both on legal status and individual awareness of these laws. We assessed people's knowledge of abortion laws, and their confidence in being able to access a needed abortion, in three Mountain West states.

We conducted cross-sectional surveys with representative samples among residents of Utah, Idaho, and Nevada in 2022 and 2024. Rurality was condensed into three categories using Rural-Urban Continuum Codes: 1) urban areas, 2) non-metro areas with >5K residents, 3) and non-metro areas with <5K residents. A binary variable assigned correct knowledge of state abortion laws. We compared knowledge and confidence in ability to get an abortion by year and rurality using chi-square tests. We assessed changes in knowledge of state abortion law by year and rurality using logistic regression. All analyses were adjusted for survey data.

Respondents were less likely to cite their state’s correct abortion policy in 2024 than in 2022 (aOR: 0.85 (0.71, 1.01), p=0.07). Individuals in non-metro areas with <5K residents were significantly more likely to know their state’s abortion law (aOR: 1.57 (1.12, 2.19), p=0.01). Confidence in the ability to get a needed abortion in all three states was lower in 2024 than 2022 (14.9% vs. 20.5%, p=0.00). Confidence was higher in areas with <5k residents compared to urban (25.9% vs. 17.5%, p=0.00).

As reproductive health and autonomy continues to face increased hostility, it is paramount that individuals, especially in states with restrictive policies, have accurate information about their rights and ability to access care.

Abortion ballot initiatives have a significant impact on state abortion policy. For instance, in 2024, Nebraskans simultaneously voted on one ballot initiative restricting abortion after the first trimester and one protecting abortion rights until fetal viability and Colorado’s initiative established a state constitutional right to abortion throughout pregnancy and public funds to be used for abortion. We fielded a longitudinal survey (before and after the election) in Nebraska (N₁=1,346) and Colorado (N₁=1,738) and conducted post-election in-depth interviews with a sub-sample of survey participants in both states (N=40). We examined people’s awareness and knowledge of their state’s ballot initiative(s), their attitudes and feelings regarding abortion and the ballot initiative(s), their voting intentions (wave 1), and actual voting behavior (wave 2). In the post-election interviews, we explored people’s rationale for their ballot initiative vote and the extent that messaging may have influenced their voting decision.

According to survey data, most people (76.3% NE; 65.6% CO) were aware of their state’s ballot initiative. However, far fewer could describe details regarding the initiatives, and few were aware of their state’s current abortion laws (36.3% NE; 23.6% CO). Nebraskans reported both positive and negative sentiment toward the initiatives whereas people in Colorado were generally more positive about the ballot initiative. Analysis of interview data is ongoing. Initial assessments suggests that people’s long-standing beliefs regarding abortion drove their voting decisions, with messaging rarely influencing people’s decision to vote or their voting direction. We will discuss implications for abortion ballot initiatives as mechanisms to augment abortion access.

Background: Abortion restrictions have documented health consequences, disproportionately affecting marginalized communities. While research has explored the toll on obstetrician-gynecologists, less attention has focused on the broader reproductive health workforce – including family and emergency medicine physicians – who provide most of the reproductive care in under-resourced areas. Understanding how restrictions impact this wider group is critical to sustaining the workforce and protecting public health.

Objectives: To explore how restrictive abortion policies affect the reproductive health workforce, change training, and impact care delivery.

Methods: We conducted 30 interviews with obstetrician-gynecologists, family medicine physicians, and emergency medicine physicians across eight states with partial or full abortion bans (May 2024 – March 2025). Interviews were analyzed using an inductive thematic approach.

Results: Concern about continued practice and erosion of the future workforce emerged. Restrictions made participants question staying in their state; some cited concerns about personal safety while others felt morally obligated to remain, mentioning provider shortages and “a commitment to serving...this population before Dobbs.” Some family medicine physicians stopped providing prenatal care due to fear of legal repercussions. Participants who train residents said limits on what they can teach threaten new physicians’ competence. Many perceived that fewer obstetrician-gynecologist residents preferred to train or stay in restrictive states and fewer family medicine trainees planned to offer prenatal care. Trainees were described as “less confident” in managing routine reproductive care, threatening their workforce readiness.

Conclusions: Abortion restrictions strain the reproductive health workforce—especially those serving under-resourced areas—by disrupting care and training, potentially worsening health disparities.

Following the Supreme Court's 2022 Dobbs v. Jackson decision, state ballot initiatives have become a key avenue for deciding state abortion rights. In the 2024 election, Nebraska had two competing ballot initiatives: one limiting abortion to the first trimester, except in cases of medical emergency, incest, or sexual assault and another protecting the right to abortion until fetal viability. The more restrictive measure passed making Nebraska the first state since the Dobbs decision to pass a ballot measure limiting abortion before viability. In Colorado voters approved a ballot initiative establishing a state constitutional right to abortion throughout pregnancy and allowing public funds to be used for abortion, making Colorado the only state to pass a ballot measure expanding abortion rights beyond the bounds of the Roe v. Wade standard. We administered a two-wave survey in Nebraska (N₁=122) and Colorado (N₁=279) to members of SSRS’s probability panel assessing people’s awareness and knowledge of their state’s ballot initiatives, attitudes regarding the initiatives, voting intentions, and actual voting behavior.

Across the initiatives we identified discrepancies between voting intention and behavior for 17-34% of participants. The Colorado measure had the lowest discrepancy (17%), while Nebraska's failed protective measure had the highest discrepancy (34%). In our presentation we will explore which subgroups exhibited the highest levels of discrepancy between intention and behavior. We will conclude with the methodological implications of our findings for research examining voting intention and behaviors and the potential implications for advocacy strategies related to influencing voter behavior on reproductive health access.

Background: Limited access to safe abortion and post-abortion care is a global problem. Frontline health workers (FLHWs) often lack any training on abortion methods. The stigma associated with abortions increases provider-hesitancy. Digital tools such as mobile apps can support efforts to train providers and improve access to care.

Methods: For over 50 years, Hesperian Health Guides creates and shares practical health information in print, and more recently, for free online and as mobile apps. Hesperian’s apps: Safe Abortion, Family Planning and Safe Pregnancy and Birth offer practical information that is private and can be used entirely offline after download

The Safe Abortion App is available in 11 languages and provides up-to-date medical information, and practical suggestions vetted by FLHWs and abortion doulas during cyclical usability testing. The app is used in more than 200 countries and territories to support abortion seekers and providers alike.

Training sessions on the Safe Abortion app were provided to nurses, midwives, doctors and medical students in Rwanda, Uganda, Colombia, Ecuador, Guatemala, Honduras and Mexico during 2023-2025. Providers shared feedback after the sessions.

Results: Providers reported increased confidence in speaking to patients and providing abortion care after training. Nurses, who often lack any abortion training, said the simple explanations and normative language helped them speak with patients, and over half of those sharing feedback 3 months after training used the app to initiate abortion conversations with peers.

Conclusion: Mobile apps can increase providers’ understanding and capacities to offer safe abortion and post-abortion care.

Background: Several states have mandated medication abortion services on public university campuses. Understanding the process for passing and implementing such legislation can help advocates in other states expand access.

Methods: We conducted in-depth interviews and focus groups (FGs) with advocates, implementation experts, college staff, and legislative partners in California, New York, and Massachusetts (n=22). We asked participants about challenges, strategies, and lessons learned. Our team created and iteratively refined a case memo template for rapid qualitative analysis; two members completed each case memo. Memos were consolidated within states and themes identified across states.

Results: Student advocates partnered with allies from campuses and communities. Key challenges were policymaker and campus resistance, lack of health centers on campuses, safety concerns for students receiving medication abortion, clinic security concerns, and student advocacy leadership turnover. Such challenges were addressed by advocates applying pressure at all stages, securing funding for campuses to improve safety measures, and identifying successors to ensure student leadership continuity. Participants described the importance of student storytellers in legislative hearings, research studies to demonstrate need, and modest funding for advocacy organizers and implementation. The national political context also mobilized legislators. Less demanding mandates, such as the readiness plan requirement in Massachusetts, allowed for easier campus collaboration but risked non-provision of medication abortion. Advocates and implementation experts felt that mandates should have accountability and consequences embedded in the policy language.

Conclusions: Advocates can use these findings to tailor their approach to promoting legislation that will ensure access to medication abortion for college students.