Abstract
IMPORTANCE: Since the Supreme Court's 2022 decision in Dobbs v Jackson Women's Health Organization, state legislatures have enacted laws severely restricting abortion. Facility case studies have reported post-Dobbs increases in patient volume and gestational length at abortion. OBJECTIVE: To understand changes from before to after the Dobbs decision in the overall volume of callers and gestational length of their pregnancies at a large, regional abortion fund. DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional study used data from monthly caller records (June 2016-June 2024) from the District of Columbia Abortion Fund (DCAF) using interrupted time series analyses with segmented regression. DCAF serves the Washington, DC, area, which is unique in its absence of gestational restrictions, service availability, and proximity to states with post-Dobbs restrictions. Data were analyzed from November 2024 through August 2025. EXPOSURE: Time in months, with change points and discontinuities after the Dobbs decision. To contextualize trends, change points and discontinuities were examined at the onset of the COVID-19 pandemic, the enactment of a 6-week abortion ban in Texas, and the enactment of a 12-week ban in North Carolina. MAIN OUTCOMES AND MEASURES: Overall call volume and gestational length of callers, measured dichotomously (first trimester vs ≥13 weeks) and continuously (weeks' gestation). RESULTS: Among 43 351 DCAF caller records, 31% had pregnancies at 13 weeks' gestation or greater. After the Dobbs decision, there was a sudden and substantial reversal of a prior 6-year trend of increasing call volume, as indicated by both an immediate drop (from 721 to 663 callers per month; coefficient, -10.7% [95% CI, -16.8% to -4.7%]), and a continued decrease over the subsequent year (coefficient, -12.7% [95% CI, -13.6% to -11.6%] per month). Concurrently, there was a sharp increase in the proportion of callers whose pregnancies were at 13 weeks' gestation or later, from approximately 22% just before Dobbs to 32% the month after the Dobbs decision (odds ratio [OR], 1.61 [95% CI, 1.39 to 1.87]); this increase continued (OR per month, 1.07 [95% CI, 1.06 to 1.09]), reaching a peak of 53% per year post-Dobbs. Both trends reversed after the enactment of North Carolina's 12-week ban. CONCLUSIONS AND RELEVANCE: In this cross-sectional study of caller records at a large abortion fund, there were immediate and lasting changes in the volume and gestational length of callers following the Dobbs decision, suggesting differential redistribution of access or care-seeking by trimester and/or delays in presentation for care.