The Impact of an Abortion Ban on Prenatal Screening and Testing for Fetal Anomalies

Diagnosing and managing fetal anomalies is an essential component of prenatal care, as they are the leading cause of infant mortality and exhibit stark racial disparities. While most patients diagnosed with a fetal anomaly choose to have an abortion, those who continue their pregnancy require additional clinical management and planning for delivery and neonatal care. Early evidence has shown that abortion bans increase infant mortality, driven by more births with congenital anomalies. However, there is little evidence on how abortion bans are impacting use of screenings and tests to identify these anomalies. This project would generate the first population-level evidence of the impact of an abortion ban on use of routine screening and testing for fetal anomalies, overall and in populations facing additional challenges accessing care. We will use all-payer claims data from Arkansas, which banned abortion at any gestational age immediately after the Dobbs vs. Jackson Women’s Health Organization Supreme Court Decision on June 24, 2022. We will use Arkansas’ all-payer claims data from 2022-2023 and an interrupted time series design to measure changes in rates of utilization of genetic screening, tests, and diagnostic ultrasounds following the abortion ban. Aim 1 will use these data to measure changes in use of these services statewide and Aim 2 will use a stratified analysis to examine differential changes by source of insurance, county rurality, and county-level race and ethnicity.