Roe v. Wade Overturn Triggers Slight Increase in Abortions

Disclaimer

In examining the consequences of overturning Roe v. Wade, InfoEpi Lab does not address arguments for or against the legality, as it is not relevant to this analysis. Instead, we focus on the impact of policy changes at the state level and the obligation of states to address predictable and actualized harm. Both international and US laws recognize certain responsibilities for governments to prevent and address harm caused by their policies.

Multiple human rights organizations, including Human Rights Watch and Amnesty International have criticized the United States regarding potential human rights violations:

In the US, human rights violations occur when states pass laws that explicitly criminalize performing abortions and when state officials misuse other laws to surveil, investigate, arrest, detain, and prosecute pregnant individuals based on the perceived impact of their actions on their pregnancy.

Summary

In the November 2023 report “The Effects of the Dobbs Decision on Fertility,” researchers Daniel Dench, Mayra Pineda-Torres, and Caitlin Myers looked at the impact of a major U.S. Supreme Court decision on fertility rates across the United States. The Dobbs v. Jackson Women’s Health Organization case, decided in June 2022, led to the most substantial change in abortion access in the country in over 50 years.

KFF Abortion Policy Tracker

This review examines the impact of the landmark decision and concludes with the policy implications.

Key Findings

• Nationwide Abortion Rates Unchanged or Increased: Despite state bans, the total number of abortions nationwide increased. Abortions increased slightly (by 0.2%). One potential explanation is the increased access to telemedicine abortions and increased access in states where abortion remains legal.

• Increase in Births in States with Abortion Bans: In the 13 states that immediately banned abortion following the Supreme Court’s decision, there was a modest increase in births. The increase was about 2.3% or approximately 32,000 more babies than expected in the first six months of the year. The increase in birth rates was most pronounced among Hispanic women (4.7%) and women aged 20-24 (3.3%). There was no increase in births among teenagers aged 15-19, perhaps because of their greater likelihood to seek abortions via telemedicine.

• Variable Effects Based on Geography: The increase in births varied by state. States like Texas and Mississippi, which are surrounded by other states with abortion bans, saw the largest increase in births. The increased distance from the surrounding states, also banning the procedure, may explain this difference. Distance to a facility was also associated with a demand for self-managed abortion.

• Expansion of Abortion Pills: The use of abortion pills, involving mifepristone followed by misoprostol, is legal in 37 U.S. states and is the most common method for early pregnancy termination. There has been an uptick in women ordering abortion pills from overseas, particularly in states with bans, suggesting these pills act as a substitute for traveling to states where abortion is legal. Other reporting indicates significant numbers of abortion seekers are traveling to neighboring states.

Visualize the Data

• Inconsistent Arguments in Questioning the Safety of Medication Abortion: The percentage of abortions from medication has steadily risen since 2000. Recently the safety of medication abortion has been called into question, but the arguments have been notably inconsistent, applying a standard not used for other medications on the market. The two-pill regimen has a 99.6% success rate with no complications. Around 0.4% of cases have serious complications and the mortality rate associated with use is below 0.001%. For comparison, this translates to 0.65 deaths per 100,000 medication abortions versus maternal mortality rates from 19.1 deaths to 55.4 deaths per 100,000 births, depending on the demographic.

Surprising Elements

• Despite increased restrictions, the study did not find a significant increase in births among teenagers, which conflicts with the expectation younger women might be more affected by abortion bans

• The slight increase in national abortion rates, despite significant legal restrictions in many states, was unexpected. While it’s true that more women are giving birth in states with bans, it is also true that even more are getting abortions.

• With states legalizing the mailing of abortion pills to states with bans and increasing infrastructure for telemedicine abortions, there may be a further increase in abortion rates.

Policy Implications

Overall, the data shows that while the overturning of Roe v. Wade led to a modest increase in births in states with abortion bans, it did not reduce abortion rates nationwide. Instead, it has created a geographical divide in access and a shift towards alternative methods of obtaining abortions. Even states that did not border those with bans on abortion such as Massachusetts, saw more people following the bans.

Further complicating the situation is the failure of states to address predictable harms that may flow from policy changes following the overturn of Roe V. Wade. Policies should address the concrete outcomes research has found among women denied an abortion. Nearly all outcomes can be addressed with significant investment and evidence-based policy.

• The existing children of women who were denied an abortion saw worse outcomes, poorer development, and poorer maternal bonding.

• Other research has found that these women are less likely to support themselves even several years later and are more likely to file bankruptcy. They may have poorer health, and are also at a higher risk for violence.

• States opting to ban legal abortion should mobilize funds and create dedicated housing to support women fleeing violence, fund early education programs to address the worse outcomes for existing children, and offer financial support with few obstacles to application and approval.

• Education improves the outcomes of children even when the mother does not work outside the home. States that have enacted bans likely to worsen the outcomes of existing children should invest in education for the children and mothers.

States enacting policies that limit and drive away healthcare providers must heavily recruit and perhaps even fund the education of care providers who care for high-risk pregnancies and labor and delivery in locations with no access to care. A failure to do so will almost certainly increase maternal and infant mortality.

• The shortage of obstetricians and gynecologists in states with bans is likely to worsen with time, potentially worsening infant and maternal mortality.

• Recent surveys show that abortion bans have affected medical student program preferences, with an overall decline in the number of people seeking to work in obstetrics, urology, and potentially also emergency medicine.

• The state should provide help for low-income women who must travel a great distance to receive care while pregnant and expand Medicaid coverage to this end. States enacting bans overwhelmingly chose not to expand Medicaid, despite the research showing a return on investment in multiple areas including the state economy.

A single state-level policy has many consequences, and the potential human rights violations and predictable harms obligate the state to intensively address them. Evidence-based policies and significant financial investment can address nearly every negative consequence. States selecting this path have a duty to invest and address the consequences of that decision.

Source

Dench, D., Pineda-Torres, M., & Myers, C. (2023). The Effects of the Dobbs Decision on Fertility (IZA DP No. 16608). Institute of Labor Economics (IZA)