The end of Roe, part 1: how banning abortion will make states worse off

The Supreme Court seems ready to use Dobbs v. Jackson Women’s Health to let abortion policy be a state concern. This decision will make abortion policy remarkably like slavery policy was a couple centuries ago. States will have wide latitude to ban and criminalize abortion or to protect access to and finance the procedure.

I’m assuming that some states will pass extreme laws on both ends of the policy spectrum but many legislatures won’t want to or won’t be able to do so. Most Americans won’t support extreme policies in either direction. Regardless of what states do, none will be able to keep their residents from accessing abortions. Many states that protect abortion are bracing for an influx of out-of-state patients, many corporations will pay for employees to travel for a safe and legal abortion. States may pay the cost of travel as well. While thousands of women living under abortion bans will still get the health care they need, access will even more than now be determined more by income, race, age, and residence than by what’s best for the woman and her family.

In this post I’m staying away from the moral and legal aspects (If it matters to the reader, I believe strongly in the right to an abortion and public funding for it if needed) and focusing on how decentralized abortion will policy will change the states and their residents. States that are likely to severely restrict abortion already have lower incomes, higher birth rates, and worse health outcomes for mothers and babies than the states that protect abortion. Research suggests that extreme policies are likely to widen those gaps and perhaps create new ones.

States that will ban abortion are already poorer and less healthy

To get a better understanding of what to expect at the state level once Roe is out of the picture, I used the Guttmacher Institute’s catalog of state abortion laws. According to Guttmacher, there are 23 states (which I call “Restrict” states) that have pre-existing abortion bans, “trigger” laws that limit or ban abortion in the absence of Roe, and/or limits or bans that courts have enjoined from taking effect. There are 16 states, (I call them “Protect” states) that legally protect the right to an abortion either up to viability or throughout pregnancy. That leaves 11 states (“Undetermined”) that have no existing legal position on abortion. Some of these, like Florida, can be expected to limit or ban abortion and others, like New Hampshire, will likely protect it. For now, though, I’m looking at these states as if they were all alike. Restrict states cover 42 percent of the U.S. population, Protect states 38 percent, and Undetermined states 20 percent.

The table below shows where Restrict and Protect states already differ in economic, demographic, abortion rates, and health outcomes. Restrict states have dramatically lower incomes, a higher proportion of Whites and lower proportion of Hispanics. They already have fewer abortions, less than half the average of Protect states, and more births. Restrict states are also worse places to have a child, with higher death rates for new mothers and both higher death rates and less insurance coverage for new babies. There are no meaningful differences in proportion of population that is Black, in any measures of crime, or in the share of abortions performed out of state. Undetermined states generally fall in between the two extremes, though they have higher White and lower Black populations than both Restrict and Protect states. (All state data can be found here.)

States that restrict abortion will have more births than they do now, and the consequences will be troubling

I know it seems obvious that restricting abortion should reduce abortions and increase births, but it’s always good to check your assumptions. In this case your assumptions are right. At an international level, strong restrictions can reduce abortions by 95 percent compared to where abortion is available on request.

Before Roe fertility rates were lower in states that legalized abortion, particularly among single and Black women. Legalization reduced birth rates for White women by about three percent and Black women by about five percent. National and state laws that increase access to abortion result in lower birth rates (see notes 51 and 61-66), with higher differences between nations than between U.S. states.

Abortion bans and restrictions are likely to reduce abortions for women in Restrict states and thus increase births. More births mean more health risks for mothers and infants. If we assume births increase by four to nine percent based on research discussed above, and current infant and maternal mortality rates in Restrict states, we can expect 400-1,000 infant deaths and 20-40 additional maternal deaths in these states each year.. Of the children who live through infancy, 4-9,000 will be uninsured and thus at greater risk of health problems throughout childhood. This won’t be important to anti-abortion activists, but it’s one example of bad life outcomes from purported pro-life policy.

Most of the additional children and mothers who die will be low income and minorities. Black and Hispanic women together make up more than half of abortion patients, as do low-income women. Black women already have by far the highest maternal mortality rate; the difference between White and Black infant mortality is greater than it was during slavery. That can only go up from here in Restrict states.

Women in states with abortion bans will be worse off economically, and so will their states

Women’s economic security and upward mobility are closely tied to the availability of abortion. By giving women the choice as to whether to have a child, legal abortion allows more women, especially Black women, to finish high school, go to college and work. (see notes 70-71).

Access to abortion also means lower dependence on government assistance. The Turnaway study, which compared women who could not access abortion to similar women who could, found that denying access to abortions increases women's participation in public assistance programs including the Supplemental Nutrition Assistance Program (SNAP), Temporary Assistance to Needy Families and nutrition benefits for mothers and young children (WIC). The impact is lasting; SNAP participation is significantly higher for women who had children five years after birth. While not addressed in the Turnaway study, Medicaid costs will likely grow in Restrict states, since every $1 spent on an abortion saves $4 in health and welfare costs for new mothers (see note 29).

Restricting abortion also damages economic prospects for the children we are

hellbent on saving. Unintended births, are associated with lower academic achievement and earnings and higher dependence on public assistance (see notes 74-76).

International research shows that countries with liberal abortion laws have higher incomes per person (though the authors do not claim that abortion laws cause better economies, nor rule that out) . As noted above, Protect states already have better economies than Restrict states, a gap that we might expect will widen.

Restrict states risk significant additional economic damage

It often feels like everything is political in our nation, and abortion is political dynamite, a uniquely American phenomenon. That means states that ban or restrict abortion need to be prepared for boycotts that can damage their economies, perhaps to the point they’ll have to rethink their abortion policies. That happened when Arizona refused to recognize the Martin Luther King holiday, when Colorado restricted local control over civil rights for the LGBTQ community, and when North Carolina restricted use of school bathrooms. With many customers and workers, especially younger ones, expecting corporations to be more politically active, states that restrict abortion should be concerned about more than losing some tourists and sporting events like these other states die. They can expect some businesses to shun them as well, with significant impacts on employment, consumer choice, and economic growth.

Crime may increase in Restrict states

One of the most interesting and hotly debated findings on abortion policy was made by Steven Levitt and John Donahue and included in Levitt and Steven Dubner’s book Freakonomics. Levitt and Donahue found that half the drop in crime in the 1990s could be explained by children not being born as a result of access to legal abortions. There were problems with the analysis and some claimed to refute this contention. In revisiting and updating the original work in 2020, however, Levitt and Donahue maintained that legal abortion reduced violent crime by 47 percent and property crime by 33 percent.

After Dobbs, many states will hurt both their residents and their future

The Supreme Court has taken away a fundamental right for women and families, and many states may do the same shortly. They will do so for moral and religious reasons but also for political ones. But state leaders and residents should also consider the practical implications of their decisions. States that ban or further restrict abortion can expect their women and children to be worse off economically and less healthy. As a result, their economies will be even less robust than they are now, both because of lost income and because of boycotts. They may even see a rise in crime. While Restrict states will have policies that better reflect their moral and political principles, they’ll be hurting their residents and their prospects for a prosperous future.