How will the reversal of Roe v. Wade affect American women?

The US Supreme Court’s decision to remove constitutional protections on access to abortions will have significant effects on women and their families. Research shows that the reproductive, social and economic lives of those who are poor, young and/or black are likely to be most damaged.

In a 5:4 decision on the case of Dobbs v. Jackson Women’s Health Organization, the Supreme Court of the United States voted to overturn Roe v. Wade, a landmark ruling in 1973, which established guaranteed federal constitutional protections of abortion rights.

Dobbs hands the decision of access to abortion back to individual states. The ruling set in motion a series of anti-abortion legislation – known as ‘trigger bans’ – in a number of states across the country. It is estimated that at least 25 states will move to ban abortion as quickly as possible (Guttmacher Institute, 2022).

This is despite the majority of US adults believing that abortion should be legal in all or most circumstances (61%), according to a recent survey (Pew Research Centre, 2022).

Some of these state laws will prohibit abortions, allowing exceptions only in cases where the life of the mother is at risk or if the foetus has a fatal abnormality (New York Times, 2022). Nevertheless, there have already been reports that restrictive laws may delay treatment for pregnancy complications, putting women’s lives in danger (Texas Tribune, 2022).

Figure 1: US abortion policies and access after Roe

Source: Guttmacher Institute, 2022

In submitting the Dobbs case, the state of Mississippi claimed that ‘there is simply no causal link between the availability of abortion and the capacity of women to act in society’, and thus that access to abortion has not affected ‘the ability of women to participate equally in the economic and social life of the Nation’ (Supreme Court of the United States, 2021).

In reality, the ruling will directly affect the lives of millions of women in the United States and will have a profound impact across society. This is backed up by a large body of research evidence on the impact of abortion access, not only on births but also on the economic wellbeing and health of those who are affected.

This research makes use of the fact that abortion access has varied across US states and compares what happened in states that expanded (or restricted) abortion access with what happened in states where abortion access stayed the same.

For example, five states and one district had already revoked their abortion prohibitions many years before the Roe v. Wade ruling (Myers and Welch, 2021). This allowed researchers to compare changes in outcomes related to fertility, education and wellbeing in the ‘repeal’ states at the point at which they removed abortion restrictions to changes in the rest of the country.

The states in which abortion access did not change act as a ‘control’ to account for alternative confounding effects that may have affected fertility and women’s lives at the time of Roe v. Wade. Using this approach, the researchers can be more confident that they have identified the causal effect of abortion access.

The findings from this research provide evidence that there is a causal link between the availability of abortion and the capacity of women to act in society – and gives an insight into what may happen as a result of the Dobbs ruling in states that ban or further restrict access to abortion.

Who is most likely to access abortion?

In 2020, 930,160 abortions took place in the United States (14.4 per 1,000 women), an 8% increase from three years previously. Accompanied by a 6% decline in births, these patterns indicate that fewer people were getting pregnant and among those who did, a greater proportion chose to have an abortion (Guttmacher Institute, 2022).

Of the 6.1 million pregnancies in the United States in 2011, 2.8 million were unintended, which equates to roughly 45%. Of these, 27% were ‘wanted later’ and 18% were ‘unwanted’ for other reasons (Guttmacher Institute, 2019).

Although these figures convey a relatively high demand for abortions across the US population, there are clear demographic disparities in the incidence of unintended pregnancies. Recognising these differences enables informed decision-making by policy-makers and underlines any inequalities that may be present in the context of abortions in the United States.

These inequalities reflect differences in social, economic, ethical, institutional and political landscapes, which in turn affect women’s choices, abortion access and, ultimately, outcomes related to fertility, education and wellbeing (Guttmacher Institute, 2019).

Traditional estimation methods to find the rate of unintended pregnancy among different groups of women factor in all women in the population, irrespective of whether or not they are sexually active.

Using these methods, rates of unintended pregnancy are found to be highest among women aged 20-24 – 81 per 1,000 women. But when women who are sexually inactive are excluded, the age group with the highest rate of unintended pregnancies is 15-19 year-olds (Finer, 2010).

Cohabiting women have a higher rate of unintended pregnancy – at 141 per 1,000 women – compared with unmarried non-cohabiting women – 36-54 per 1,000 women – and married women – 29 per 1,000 women (Finer and Zolna, 2010). In 2016, over half (59%) of women who had abortions already had a child (Guttmacher Institute, 2016).

Non-Hispanic black women are more than twice as likely to have an unintended pregnancy – 79 per 1,000 women – than non-Hispanic white women – 33 per 1,000 women (Finer and Zolna, 2010).

Three-quarters of abortion patients in the United States are poor or low-income, and nearly half live below the US federal poverty line (Guttmacher Institute, 2016). This is striking as only one in seven women aged 15-44 (the childbearing age range) in the United States live in families with incomes below the federal poverty line (March of Dimes, 2022).

Figure 2: Abortion patients who are poor or low-income

Source: Guttmacher Institute, 2016

It follows that ease of access to abortion services may be an important determinant of the trajectory of women’s reproductive, economic and social lives.

How does abortion access affect women’s reproductive, economic and social outcomes?

Birth rates

Using the analytical method discussed above, one study estimates that legalising abortion (Roe v. Wade) resulted in a 4-11% reduction in births in the repeal states relative to the rest of the United States. It showed that the effects on fertility were around three times greater for adolescents and women of colour (Levine et al, 1999).

Further research indicates that legalising abortion resulted in a 34% decline in the number of women who become teen mothers, with even larger effects for black teenagers (Myers, 2017).

Researchers have also looked at the effect of practical restrictions on access to abortion in the United States, particularly variations in travel distance as a result of facilities closing. This work suggests that, on average, a travel distance increase from 0 to 100 miles cuts abortions by 20.5%, consequently raising births by 2.4%. An increase from 100 to 200 miles lowers abortion rates by 12.7% and increases births by 1.6% (Myers, 2021).

Other studies also show that travel distance is a significant factor in seeking abortion among all ages and ethnic backgrounds, particularly young and black women (Myers, 2021; Venato and Fletcher, 2020; Lindo et al, 2020).

In light of the Supreme Court decision, stricter abortion legislation may also appear in the form of mandatory waiting periods between consultation and procedure. One study finds that requiring two appointments reduces abortions (by 8.9%) and delays those that still occur, causing second-trimester abortions to rise by 19.1%. This also increases births by 1.5% (Myers, 2021). As of June 2022, 27 US states had enforced mandatory waiting periods, 13 of which require two in-person visits (Guttmacher Institute, 2022).

These outcomes vary considerably across different groups of women. Those in their twenties are roughly three times more likely to be affected by waiting periods requiring two trips than women in their thirties. Similarly, non-Hispanic black women experience greater effects (2.5 times) from providers requiring two trips than non-Hispanic white women (Myers, 2021). County-level data indicate that these results are notably larger in low-income areas and they are amplified by longer travel distances.

Marriage

Several studies show that having access to abortion delays both first births and first marriages (Myers, 2017; González et al, 2018; Brooks and Zohar, 2021). In particular, abortion access without parental involvement decreases the probability of ‘shotgun’ marriages by approximately 50% among young women, according to US data (Myers, 2017).

In addition to reducing the number of women who became teen mothers, the legalisation of abortion also led to a 20% decline in teen brides. This effect was larger for black teenagers (Myers, 2017).

A recent study from Israel – where abortion is legal – looked at the effects of expanding free abortion: it found that early unintended parenthood fell by 11-14 percentage points and subsequent marriages dropped by 11 percentage points among young women (Brooks and Zohar, 2021).

Economic outcomes

The Israeli study also found that the expansion of free access to abortion led to a shift from full-time to part-time employment and to better paid part-time jobs among the women who were previously working part-time (Brooks and Zohar, 2021). This could be explained by the reported increase in the share of mothers who entered an academic institution as a result of the policy reform and therefore needed more flexibility.

In addition to higher college enrolment, the researchers also observed increases in post-high school professional training and a higher probability of sitting the Israeli matriculation exam in a given year. Despite the observations being short-term, the study also reports that the new policy resulted in around a 17% increase in annual income regardless of the woman’s employment status (Brooks and Zohar, 2021).

Research that captures the long-term effects of the 1970s abortion legalisation in the United States on educational attainment, labour market participation and earnings for female adolescents offers similar results.

While the results for white women are minimal or insignificant, increases in the employment rate, high school graduation rate and college enrolment due to the abortion reform are more pronounced among young black women (Angrist and Evans, 2000).

Albeit imprecisely measured, one study finds that access to abortion increased college enrolment by 100%, college graduation by two to three times and employment status by 44% for black women (Jones, 2021).

Another study finds an increase of around 2% in the probability of a woman being employed in states that legalised abortion prior to Roe v. Wade (Kalist, 2004). Again, these results show a particularly strong effect among black women.

Impacts on children

Women’s access to abortion services can also affect the average conditions into which children are born. Although evidence on the effect of abortion access on child abuse and neglect is limited, one study that examines variations in the timing of abortion legalisation across US states following Roe v. Wade finds that the legalisation reduced the number of recorded cases of child maltreatment by approximately 10% for every subsequent cohort (Bitler and Zavodny, 2004). It nevertheless reports an inconsistent relationship between the number of reported cases and abortion restrictions imposed after the legalisation.

Another study finds that a child born due to poor access to abortion would have faced a 50% higher risk of living in poverty, a 60% higher probability of being raised by a single parent and a 40% higher chance of dying before reaching the age of one (Gruber et al, 1999).

This research indicates that abortion access improves overall outcomes of entire generations (Ananat et al, 2009).

Health

As has been highlighted by medical professionals and pro-choice campaigners, safe access to abortion is also vital for women’s health. According to the United Nations, unsafe abortions result in approximately 47,000 deaths every year. These are primarily in developing countries and among members of socio-economically disadvantaged and marginalised populations (United Nations, 2021).

But limiting access, as has happened in the United States, will be likely to increase the incidence of unsafe procedures. Research shows that following Roe v. Wade, pregnancy-related death and hospitalisation due to complications from unsafe abortions plummeted (Cohen, 2009).

Indeed, other research has shown that access to legal abortion reduced maternal mortality among non-white women by 30-40%, although this had little impact on overall or white maternal mortality (Farin et al, 2021).

In addition, a recent study estimates that banning abortion in the United States would lead to a 21% rise in the number of pregnancy-related deaths overall, and a 33% increase among black women (Stevenson, 2021).

Conclusion

Access to abortion directly affects the birth rate and has significant ripple effects on the social and economic outcomes of women and their families.

The effects – on education, employment and health – are felt more acutely by certain groups. Black, young and poor women are much more likely to be negatively affected by a lack of access to abortion.

Evidence tells us that restricting abortion access – whether through laws or creating financial or other obstacles – can have harmful effects on society’s most disadvantaged women. Conversely, research shows that legalising access to abortion can lead to women gaining higher education levels and better employment.

The Supreme Court decision to revoke Roe v. Wade is both an issue of women’s rights but also of racial and socio-economic inequality.