(777) The impact of denying abortion access to individuals who are incarcerated: a cost-effectiveness analysis

No mandatory standards exist for provision of reproductive healthcare in United States (US) jails and prisons, historically creating a system for inequitable access to abortion. The June 2022 Dobbs v. Jackson Women’s Health Supreme Court decision that eliminated constitutional protections for abortion access further exacerbated this inequity in carceral settings. This study investigates the influence of abortion access on outcomes for pregnant individuals who are incarcerated with unintended pregnancies.

Study Design:

The outcomes and cost-effectiveness associated with providing abortion services in prisons and jails were evaluated using a decision-analytic model. Clinical outcomes included mortality, intrauterine fetal demise, pre-term birth, neonatal death, cesarean delivery, and re-incarceration. The likelihood and financial burden of caring for an incarcerated pregnant person and the costs of abortion care were considered. The cost-effectiveness threshold was set at $100,000/QALY and model inputs were derived from the literature.

Results:

Our theoretical cohort included 6,373 pregnant individuals who are incarcerated with unintended pregnancies. Access to abortion services led to 507 fewer preterm births, 2,111 fewer cesarean sections, 35 fewer neonatal deaths, and 10 fewer episodes of re-incarceration (Table 1). Access to abortion while incarcerated within jails and prisons resulted in a cost reduction of $136,129,893 and an increase in 161 QALYs, a dominant strategy.

Conclusion:

Providing access to abortion for pregnant individuals who are incarcerated is a cost-effective strategy, reducing adverse maternal and fetal outcomes and improving quality of life. Importantly, access to abortion also reduces re-incarceration, an outcome that incurs significant individual and societal economic burden. With no mandatory standards for abortion care within US carceral settings and in the context of restrictive abortion laws, these findings may inform policies that improve outcomes for this vulnerable population.