The Impact of the Dobbs Decision on Access to Gender Diverse Care at a Midwest Academic Health Center

Abstract

Introduction. The Dobbs decision returned the regulation of abortion to individual states. In the Midwest, several legislative efforts have included restrictions on both abortion and gender-affirming care. Clinics that provide abortion services sometimes offer gender-affirming care. Given this intersection, recent laws restricting abortion may have unintended consequences for access to gender-affirming care in the Midwest.

Methods. Authors of this retrospective study analyzed medical records of patients seen at a Midwestern health center. We included patients 18 or older who attended a new patient visit at either the gender diversity clinic (GDC) or the general gynecology (GYN) clinic between July 1, 2021 and June 30, 2023. We used generalized estimating equations to assess changes in wait times and distance traveled pre- vs. post-Dobbs. Differences in new patient volume were analyzed using Poisson regression.

Results. We reviewed 5,260 charts, 4,552 from the GYN clinic and 708 from the GDC. Following Dobbs, the GYN clinic experienced a 6% increase in new patients, while the GDC saw a 21% increase (p<0.001). The average wait time for a GYN appointment increased by two days, whereas the wait time for GDC appointments decreased by 21 days. The average distance traveled by new GYN patients decreased by 6.3 miles (p<0.001), while distance for GDC patients increased by 2.5 miles (p=0.738).

Conclusions. Patients continue to seek gender-affirming care in the post-Dobbs landscape. Despite an increase in patient volume, wait times for gender diversity appointments decreased, likely reflecting expanded appointment availability around the time of the Dobbs decision.