The United States Supreme Court's ruling on the Dobbs v Jackson Women's Health Organization case in June 2024 revoked constitutionally guaranteed access to abortion for women. Since the ruling, 14 US states have placed a complete ban on abortions, while others have banned abortion during the 6 to 18 weeks gestation period. In the US, minoritized people and people of low socioeconomic status suffer from disproportionately low access to safe abortions - a situation made worse by the geographical barriers created by post-Dobbs abortion restriction policies. However, people who support post-Dobbs restrictions insist that the policies can help protect children, women and families.
In a recent study published in the American Journal of Public Health, Dr. Nigel Madden and colleagues from Northwestern University Feinberg School of Medicine examined the relationship between state policies or legislation around abortion and programs designed to support children, women and families. They found that states adopting the most restrictive abortion policies after the Dobbs ruling also lacked the most public infrastructure to support access to reproductive health care and family social services. The findings suggest an interesting contradiction between the stated goals of states with restrictive post-Dobbs abortion policies and their willingness to ensure the welfare of children, women and families through medical or social programs.
"In our analysis, states with the most severe abortion restrictions have the least comprehensive and least inclusive public infrastructure to support access to reproductive health care and family social services. It would seem in these states that the abortion opponent, pro-life attitude not only begins at conception but ends there as well," notes Dr. Madden, the lead author of the study.
The researchers divided the US states into three groups based on the severity of abortion restrictions, assessed through publicly available data published by nonpartisan organizations as well as the states themselves. Analysis of insurance data revealed that states with the most restrictive abortion policies have the lowest median percentage of women insured by Medicaid and the highest median percentage of uninsured women. Additionally, data collected by researchers also showed that states with severe abortion restrictions have more significant limitations on access to reproductive health care and state-sponsored support programs.
"In general, states with more severe abortion restrictions are more likely to have limitations on access to reproductive health care, are less likely to implement policies that support families, have lower enrollment in state-funded assistance programs, and require that women and families be poorer to qualify for these programs compared with the least restrictive state group" explains Dr. Madden. "The most restrictive states are also less likely to have policies that allow pharmacists to prescribe contraception, another barrier to access to general reproductive health care and reproductive autonomy," she observes.
Counties that lack hospitals offering obstetric care, birth centers, obstetricians, gynecologists or certified nurse midwives are designated as "maternity care deserts." These areas offer minimal medical assistance to expectant mothers. The researchers found that in states with the most restrictive abortion policies, 9.8% of the population of reproductive age lives in a maternity care desert, compared to just 0.3% in the least restrictive group. Moreover, the study also revealed that states with the most severe post-Dobbs abortion restrictions are highly restrictive in providing paid parental leave after childbirth.
"Notably, the United States is one of the only high-income countries without a national paid family caregiving or medical leave policy and, as of the writing of this essay, only 14 states have passed state-mandated paid family and medical leave policies. Of these 14 states, 11 (78%) are in the least restrictive state group. Of the states with the most restrictive abortion bans, none has a mandatory paid family and medical leave policy," Dr. Madden notes.
The lack of access to reproductive health care and support programs for pregnant women, new mothers and families affects disadvantaged populations the most. Combined with a lack of access to safe abortions, inadequate medical and social support after pregnancy can further impact the health of minoritized people and people of low socioeconomic status.
"Although it may not be surprising that the most politically conservative states with the most restrictive post-Dobbs abortion policies are also the most socially and financially conservative with regards to reproductive health, the degree to which these states fail to support their most disadvantaged populations warrants immediate attention and action," Dr. Madden concludes.
