Abortion and Inequality

With the overturn of Roe v. Wade, 1 in 4 women will now need to drive more than 200 miles to get an abortion. Low-income and majority Black counties suffer the most.

Kanisha is a VP at Healthcare Foundry focused on developing new built-for-purpose healthcare ventures in the US. We’re thrilled to have her as our newest guest writer.

When the US Supreme Court overturned Roe v. Wade in Dobbs v. Jackson, the effects were felt disproportionately across the country. In the less than three months since the ruling, 12 states have banned abortions, including 2 that have banned them after six weeks of pregnancy. More restrictions are likely on the horizon.

While much has already been written about the impact that the decision will have on certain states, we wanted to dig into the communities that are about to face the deepest challenges. 

Source - NYTimes

These new laws have left millions of Americans without access to abortion care.

⬅️ Prior to Dobbs, fewer than 1% of women of reproductive age lived 200+ miles from the nearest abortion clinic.

➡️ After the decision, 25% of women now live more than 200 miles away.

⬅️ Prior to Dobbs, 9% of women traveled out of state to receive abortion care. 

➡️ After the decision, this number is expected to significantly increase. In 2020, in the 26 states where abortion has been or will likely be banned post-Dobbs, 15% of residents seeking abortion care traveled out of state; nearly half traveled to states that have banned or significantly restricted abortion access.

Travel distance matters

🚗 🛫 Research by Caitlin Myers shows that the longer the distance to the nearest abortion clinic, the fewer women make the trip. While travel distance affects all women, the impact is more pronounced for Black women and for women aged 15-24. 

The further you have to drive, the less likely you are to get an abortion

Confusion & cruelty

Nancy Davis, a 36-year-old mother of three from Baton Rouge, Louisiana, was 10 weeks pregnant when she and her partner received the heartbreaking news that her fetus was diagnosed with Acrania, a condition in which the fetus does not form a skull, meaning her baby would die shortly after birth. Her doctor recommended Davis terminate the pregnancy. However, the clinic she was referred to had closed. 

Nancy Davis speaks at press conference in Louisiana – Source: CNN

She returned to the referring hospital, which refused to terminate her pregnancy due to confusion over whether her case would be compliant with Louisiana’s incredibly strict abortion laws. Davis, with few options in Louisiana, decided to travel to Florida; she started a GoFundMe to raise funds for her care & travel. 

Denying abortion care exacerbates inequalities

💸 💳 👩‍👧‍👦 Eliminating abortion care creates significant down-stream socioeconomic impacts. The Turnaway Study assessed the impact of abortions received and denied amongst women with comparable financial & social circumstances. Subsequent research has shown that women who were denied abortion care also experienced:

• An increase in household poverty including being more likely to have difficulty covering basic living expenses (food, housing)

• Lower credit scores, increased debt, and increased number of public financial records (bankruptcies, evictions)

• Higher likelihood of being a single parent (see American Inequality’s analysis of Single Parenthood & Inequality)

Researchers also found that carrying unwanted pregnancies to term? led to serious health consequences for the mother, including more threatening pregnancy complications (eclampsia, postpartum hemorrhage).

While some state abortion laws have claimed to mitigate this critique by allowing exceptions for the “life of the mother,” medical professionals are finding it incredibly difficult to ascertain when they are legally permitted to end a pregnancy. As a result, anti-abortion policies will force people to undergo medically traumatic pregnancies.

Black women face the biggest hurdles

Restrictive abortion policies have also been linked by researchers to higher rates of maternal mortality, disproportionately impacting women of color - Black women have maternal mortality rates 3x higher than white women. Abortion restrictions based on gestational age, for example, have been found to increase the maternal mortality rate by 38%. Unintended pregnancy also leads to higher risks for the child, including pre-term birth and low birthweight. This disproportionately affects Black mothers and children.

Low-income communities will get caught in healthcare traps

Restrictive abortion laws also have knock-on effects for other forms of healthcare. Clinics that perform abortions often provide other forms of reproductive healthcare and primary care at no or reduced cost. These services are more often used by lower income women and women of color. As a result of the Dobbs decision, these reproductive health clinics will continue to close, exacerbating inequities in access to care. 

Anti-abortion is not pro-family

🙅‍♀️ Women who live in states with severe abortion restrictions also face a myriad of overlapping inequities. These states have worse access to maternity care, limited Medicaid expansion, and worse child wellbeing scores:

Maternity care is insufficient in counties that will be most impacted by Dobbs

📊 1,095 counties in the US are maternity care deserts, defined as counties where maternity healthcare services are limited or absent. 49% of the 3,143 U.S. counties (home to 8.2% of all women), lacked an obstetrician–gynecologist. These regions are poised for a crisis, as the number of women who may require prenatal care increases in counties where care is hard to find.

Prenatal care is critical to the health of the mother and child. Babies whose mothers did not have access to prenatal care are 3x more likely to have a low birth weight and 5x more likely to die. Mothers without prenatal care were also 3-4x more likely to die from pregnancy complications.

🩺 Medicaid coverage is most limited in states with anti-abortion policies: Medicaid is a critical insurer for pregnant people, covering 42% of births and serving women postpartum who would otherwise be un- or under-insured. States that have chosen not to expand Medicaid overlap significantly with those that restrict abortion. Further, these states also have some of the strictest requirements for pregnant women who wish to access Medicaid coverage. The paradox of underinvesting and limiting access to health coverage, while simultaneously banning abortion, perpetuates the unequal treatment of low-income women by the government and healthcare system.

🧑‍🎓 States that have the most restrictive abortion policies have the worst child wellbeing scores: Brookings assessed child wellbeing based on data that accounts for economic, educational, health and wellbeing state expenditures per child. They found significant overlap with restrictive abortion policies and higher rates of child poverty, worse educational outcomes and significantly lower spend per child.

Source - Brookings

The Path Forward

Despite Dobbs’s significant blow to abortion access, there remain multiple ways to support abortion care in the US at the local, state, and national level:

Local:

• 💰 Donate to abortion funds and clinics: Abortion funds provide critical financial and logistical support to women seeking abortions, and have become even more important as women have to travel to find care. Many clinics that provide abortion care also accept donations - those that continue to operate in hostile state environments and those that will support women traveling out of state would benefit from ongoing financial support.

State:

• 🗳 Pass pro-abortion ballot initiatives and elect pro-abortion state officials: As abortion law has been pushed to the states, state elections have become battlegrounds for abortion access.  Luckily, more than 60% of Americans support legalizing abortion. On August 2, 2022, Kansans voted against a constitutional amendment to eliminate the right to an abortion. In November 2022, four states will have abortion rights directly on the ballot (CA, MI, VT, and KY). More states will have elections for state supreme court members, state legislators, governors, and attorneys general, who all have control over implementing or rejecting abortion restrictions. 

Federal:

• 🏛 Leverage the powers of the federal government: While the Biden administration and Congress have been attempting to mitigate the impact of Dobbs through executive orders and by supporting efforts to codify Roe, the federal government has other ways of supporting abortion access. The VA has committed to providing abortion care for its patients regardless of state laws. HHS is exploring means of preserving access, including Medicaid 1115 waivers, protections for providers, privacy protections, and anti-discrimination efforts. In addition, the Administration could consider leveraging preemption (i.e., federal law will preempt conflicting state laws) to protect access to drugs used in medication abortion. This would be done with the FDA’s regulatory authority.

Denying abortion care access disproportionately strips low-income women and women of color of their bodily autonomy and opportunities for economic freedom. Without local, state, and federal reforms protecting abortion access, the health and well-being of millions of mothers and children will be at risk for decades to come.