For Colleen McNicholas, a physician in Missouri, the impact of the Dobbs v. Jackson Women’s Health decision can already be keenly felt.
The Planned Parenthood in St. Louis where she works — the last operating abortion clinic in the state — has halted all abortion appointments since the Supreme Court overturned Roe v. Wade, stripping Americans of their constitutional right to an abortion. For now, McNicholas is advising patients on alternative options in other states, including Illinois, where there’s another clinic just 15 miles away. That location, she notes, is increasingly serving people from as far away as Texas and Mississippi.
“We are doing what we can to help patients understand their own reality,” McNicholas told Vox. “We’re figuring out how they can pay for a procedure, figuring out what’s going to happen to their family when they are trying to access that care, how to get them resources to pay for child care.”
These are difficult questions. Already, many people have had to seek abortions out of state, or put them on hold. At least some will likely have to carry unwanted pregnancies to term. And given disparities in health care access, Black women, young women, and low-income women are among those disproportionately expected to bear the burdens of these new restrictions, which could mean greater poverty, and even a greater likelihood of death down the line.
“This decision is structural violence,” says Boston University health law professor Julia Raifman. “The US already has higher maternal mortality than many countries. This will exacerbate that. The US already has higher child poverty than many countries. This will exacerbate that.”
The data, ultimately, backs up Raifman’s assertion.
Tens of millions of women are directly affected by this decision
Missouri is one of nine states where a ban or near ban on abortion was set to go into effect since Roe was overturned, and as many as 17 other states could soon follow suit. (Notably, several bans have been put on hold because of legal challenges that have been filed.) About 33.7 million women, or about half of reproductive-age women (defined as those between 15 and 44, in this analysis) in the US, live in states where there are poised to be new restrictions.
About 13.9 million have already lost their rights to legal abortion where they live, or are about to lose them, in most cases in less than a month. Another 6.8 million face early-term restrictions. And 13.1 million women live in states where anti-abortion legislation has been proposed, or where a Republican-led state legislature may pursue future restrictions.
The number of people who will have to carry their pregnancies to term is tougher to estimate, though numbers from previous years may offer some clues. According to data from the CDC, about 255,000 legal abortions took place in 2019 in the states where abortions are now banned or likely to be banned. While some women may still be able to stop a pregnancy at an abortion facility in a neighboring state, some won’t be able to do that.
Middlebury College economics professor Caitlin Myers looked into the data on access to abortion facilities around the country, and predicted in May that about 24 percent of women who’d like an abortion would be unable to reach a provider in the affected states, under the new laws, and that three-quarters of those women would give birth in the first year after a Roe reversal. Myers’s analysis assumes one-fourth of abortion seekers who can’t get out of their state might be able to get the procedure through other means.
Assuming that the number of people seeking abortions in the affected states in the next year is the same as those who got abortions in 2019 (the most recent year for which we have data), about two in 10 women hoping to stop their pregnancy would have to give birth in the next 12 months.
The calculation is a general estimate. People in the same state can still have very different lived experiences depending on how far away the nearest facilities are.
While people in states with abortion bans are most directly affected by these laws, activists emphasize that everyone across the country will feel the repercussions, with those in blue states expected to see delays in care due to an influx of new patients. McNicholas notes that the Illinois clinic nearest to Missouri, for example, has already seen a surge of interest and will likely face staffing pressures. Currently, they’re operating for eight hours a day and seeing 50 to 60 patients, but she expects they’ll be taking on 10- to 12-hour days soon.
Low-income women, young women, and Black women will be disproportionately impacted by these bans
According to Myers’s model, the people who are most likely to be forced to carry a pregnancy to term are those who can’t afford to travel to a facility out of state.
Per her research, three factors determined whether a person could still access an abortion: travel distance, neighboring states’ policy environments, and clinic locations in those states. Essentially, the two in 10 women who would end up giving birth are the ones who didn’t have the time or financial resources to seek care elsewhere. It could cost more than $1,000 in medical expenses to obtain an abortion alone without insurance, and that’s not factoring in food, travel, lodging, and child care.
“Whether someone is forced to continue a pregnancy or forced to leave their state, if you’re living paycheck to paycheck, either of these can seem impossible,” says Kimberly Inez McGuire, the executive director of URGE, a reproductive justice organization dedicated to mobilizing young people.
Due to health care gaps — including a lack of access to contraception — Black women, Latina women, low-income women, and younger women are also among the groups that have had higher abortion rates in the past — and are among those most likely to be harmed by these bans.
Such gaps are tied to longstanding disparities. As Vox’s Fabiola Cineas explained, Black women are more likely to live in “contraception deserts,” or places where barriers to obtaining contraception are higher. They’re also less likely to receive formal sex education and less likely to use prescription contraception, which is more effective compared to other methods. Many of these dynamics are due to inequities in health insurance coverage, since it’s more difficult and expensive to obtain birth control without it.
Black women in Southern states — where abortion bans are already starting to take effect — have the lowest health insurance coverage rates of all Black women, Cineas writes. And even for people who have health insurance, there are discrepancies in coverage: Only 30 states currently require insurance providers to cover prescription contraception, including just four of the states that ban or restrict abortions.
Because of these health care gaps, Black women have been consistently the most likely to get abortions among all racial groups, and were almost four times as likely to get an abortion as white women in 2019, according to data from the Guttmacher Institute and the CDC.
“The disparity can be explained by inequities in rates of unintended pregnancies, as well as other factors: unequal access to quality family planning services, economic disadvantage, and distrust of the medical system,” Cineas explains. In addition to health care access issues, Black women are also more likely to face discrimination when they do receive medical care, leading some to be skeptical of such services and others to receive inadequate treatment when they do seek them out.
Latina and other minority women have also been more likely to get abortions, and have done so at twice the rate of white women, given similar health care inequities.
Low-income women were substantially overrepresented among those seeking abortions as well, according to a 2014 survey of abortion patients by the Guttmacher Institute. This dynamic is also tied to contraceptive access and unintended pregnancies, with low-income women having higher rates of unintended pregnancies compared to higher-income women.
About 49 percent of people seeking abortions had a family income below the federal poverty line, which was $19,790 for a three-person household in 2014. The higher-income group — those who made more than twice that much — was underrepresented; every four in 1,000 women in that group had abortions.
Younger, unmarried women are also more likely to have unintended pregnancies and seek abortions. The majority of women obtaining legal abortions in 2019 were in their 20s, and over 85 percent were unmarried.
Finally, people who are already parents are also more likely to pursue an abortion: 60 percent of those who have an abortion already have at least one child, while 40 percent do not.
While women of all means will be affected by the end of Roe, people who are members of one or more of these groups are the most likely to feel the impact of these restrictions, given compounding health care disparities and economic pressures they may encounter. Because of this reality, many activists and officials have decried the abortion bans and restrictions as an explicit attack on these already-vulnerable groups, including Sen. Elizabeth Warren (D-MA).
“It’s going to fall on the women who are poor,” she said last year when the Court was hearing oral arguments in the Dobbs case. “It’s going to fall on the women who already have children and cannot leave; it’s going to fall on women who are working three jobs; it’s going to fall on young, young girls who have been molested and may not know they are pregnant until deep into the pregnancy.”
Fewer abortions mean higher poverty rates and higher maternal mortality rates
The impact doesn’t stop at abortion access, either, and is likely to be long-term, sweeping, and dire. Research has shown that losing access to legal abortion means that more women will die, that more families will live in poverty, and that society will bear larger consequences in the decades to come.
As the New England Journal of Medicine’s editors wrote just after Dobbs was handed down: “Restricting access to legal abortion care does not substantially reduce the number of procedures, but it dramatically reduces the number of safe procedures, resulting in increased morbidity and mortality.”
It’s a statement backed by data. In a recent study, a group of researchers from Boston College and McGill University analyzed maternal mortality data in 38 states and Washington, DC, between 2007 and 2015. They found that in the 18 states where Planned Parenthood clinics decreased by 20 percent, the maternal mortality rate increased by an average of 8 percent.
This impacted Black women the most, who were three times more likely to die than white or Latina women as these clinics were shuttered, an exacerbation of decades of structural disparities resulting from losing access to abortions.
Maternal mortality is already a major problem in the US. In 2018, there were 17 maternal deaths for every 100,000 live births — a ratio more than double that of most other high-income countries. That number has been on the rise for more than three decades. Meanwhile, the rate of abortions has decreased in the past 10 years. Now, the scientific community worries that maternal deaths will become even more common.
The lasting effects
For those forced to give birth, that experience will also have lifelong impacts.
A landmark study known as the Turnaway Study, led by professor Diana Greene Foster at University of California San Francisco, followed 1,000 women seeking abortions over 10 years. One group was turned away when they got to abortion clinics for exceeding the gestational limits; the other group received their abortions.
Six months later, women who were denied an abortion were three times more likely to be unemployed than women who were able to access an abortion. After a year, they were less likely to have aspirational future plans. By the fifth year, they were four times more likely to live in poverty.
“Being denied access to abortion pushes people and families into poverty. We know that,” says Inez McGuire. “If we’re looking at large-scale denials of abortion access, we are seeing more and more people being forced into economically precarious circumstances.”
The impact affects not just parents but their children as well. Taking the data from the study, researchers from University of California assessed how children of parents who were denied an abortion fared compared to those who were able to obtain one. They found that children of women unable to receive an abortion experienced poorer maternal bonding at an early age than did children of those who received an abortion — the mothers were more likely to say that the babies stressed them out. Poor maternal bonding at early infancy could lead to lower social competence later, when children reach school age. These children were also more likely to live in poorer households.
Since low-income women, young women, and existing parents are overrepresented among those seeking an abortion, cutting access to such care likely means that there will be a greater number of younger and larger families living in poverty.
What’s more, as Vox’s Dylan Scott has reported, the states that have banned or restricted abortion access post-Roe often lack social services that support children and families, particularly those who are poor.
Several places with some of the most aggressive bans — including Texas and Alabama — have not expanded Medicaid and do not offer paid family leave. According to a CNN analysis, most states expected to impose stricter abortion restrictions rank poorly when it comes to factors related to the well-being of children and parents, including access to prenatal care and enrollment in early childhood education.
The decision to roll back abortion care only adds to existing policy gaps and will have wide-ranging consequences, experts say.
“The Supreme Court ruling will spare no one,” says Morgan Hopkins, the interim executive director of All Above All, an abortion rights advocacy group. “This is now a nationwide crisis where even if you’re in a state that has not banned or restricted abortion access, the ripple effect will impact you and be felt far and wide.”