(257) Impact of the Dobbs Decision on Racial and Socioeconomic Disparities in Congenital Anomaly-Affected Births

Objective:
Since its passing in 1979, the Hyde Amendment has demonstrated to disproportionately affect women of color and low-income individuals. The recent Dobbs decision has raised concerns of worsening these existing disparities through either outright banning abortion or implementing early gestational limits. Therefore, the objective of this study is to assess the impact of Dobbs decision on various socioeconomic and racial groups by examining the incidence of live births with congenital anomalies or chromosomal disorders.

Study Design:
This was a population-based cohort study of all live births complicated by congenital anomalies or chromosomal disorders using data from the U.S. Natality Vital Statistics Database from 2019-2023. Differences between specific socioeconomic and racial cohorts in the incidence of live births with congenital anomalies or chromosomal disorders before and after Dobbs were examined using univariate analysis.

Results:
Among 46,490 total anomaly-affected live births, 35,279 (0.34%) occurred pre-Dobbs and 11,211 (0.33%) post-Dobbs. Overall incidence remained stable across insurance type (private vs. WIC) and education level. However, significant racial variation emerged. The proportion of Hispanic individuals among anomaly-affected births increased significantly post-Dobbs (21.8% vs. 24.0%, p< 0.001), while representation remained stable among White and Black populations. There was a modest decline in anomaly-affected births among those with some college education (19.3% vs. 18.1%, p=0.012), but no change was noted for those with WIC coverage (31.8% both pre- and post-Dobbs, p=0.950).

Conclusion:
While overall rates remained stable, the increased incidence of anomaly-affected births among Hispanic individuals post-Dobbs suggests emerging disparities tied to abortion restrictions. These findings underscore the need for policy and clinical strategies that address inequities in reproductive healthcare access.