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Abortion Restrictions Lead to Worse Outcomes in Maternal Health, Poverty, and More
July 1, 2025 6 minutes read
By Melinda Young
Restrictive abortion laws threaten the health of women and infants, particularly if they are part of a minority group, new research shows.1 Even before Roe v. Wade was overturned by the U.S. Supreme Court in June 2022 with the Dobbs v. Jackson Women’s Health Organization decision, restrictive state laws affected women’s health. Researchers found that state laws that more severely restricted abortion access in the time period of 2011-2019 were associated with worse maternal health outcomes for the most vulnerable women.1
These laws were called Targeted Restrictions on Abortion Providers (TRAP) laws. They made accessing abortion more difficult because of medically unnecessary and cost-prohibitive requirements for both providers and patients.1
“We looked only at severe maternal morbidity as defined by the Centers for Disease Control and Prevention (CDC),” says Savannah Adkins, PhD, a lecturer of economics at Bentley University in Waltham, MA.
The study found that TRAP laws appeared to affect foreign-born individuals. They had 15% higher odds of maternal morbidity when compared with U.S.-born individuals in states without TRAP laws.1 The TRAP laws greatly reduced abortion access by putting in place requirements that treated abortion clinics the same as medical surgery centers, even if the only abortions they provided were medication abortions. “Only one clinic in Mississippi was still offering abortions [before Dobbs],” Adkins notes.
“TRAP laws made it really difficult and cost-prohibitive to abide by, so clinics closed,” she adds. “With the Dobbs ruling, some states don’t have any abortion clinics, and that greatly reduced the access people have.”
Findings like this could be a harbinger of what researchers will find when the impact of the Dobbs decision is fully studied.
“I would probably hazard a guess that, if we did this same exact study in a post-Dobbs framework that we would find that the estimate is higher than what we found in this study,” Adkins says. “And I would probably guess that immigrants would potentially suffer higher maternal mortality, as well. That would be my hypothesis going into that study.”
Other literature has shown that anti-abortion legislation is associated with higher maternal morbidity for Black mothers, and it can affect children’s lives in profound ways, as well, she adds. “We found in our research into the impact of anti-abortion legislation for foster entries that the impact is much higher for Black children than white children,” Adkins explains. “Our study found an 11% increase in foster care entries in abortion-restrictive states, but it was not equal across different populations; it was only a 5% increase for white children and a 13% increase for Black children.”2
Since the Dobbs decision, more than a dozen states have made it extremely difficult for women to obtain a legal abortion — even to save their health and in cases of rape and incest. But a new study finds that legislative action in 2023 included 60 state bills — out of 153 total — that expanded access to abortion in some way.3
Using publicly available files from a legislative website, investigators looked at every bill introduced in the United States at state legislative sessions. They analyzed the bills’ content, identifying them as restrictive, expansive, or neutral to abortion access, says Jane M. Zhu, MD, MPP, an associate professor of medicine in the division of general internal medicine at Oregon Health & Science University in Portland, OR.
“Some states were quite active,” Zhu says. “There were targeted restrictive bills in 13 states, and one state, Montana, passed eight of these bills.” The volume of bills in 2023 made it challenging for OB/GYNs and other reproductive health providers to keep up with the changes, she notes.
They will have a good idea of which direction their states are moving: “Directionally, there is an indication of what way the state is moving towards in terms of becoming more abortion restrictive or more abortion protective,” Zhu says. New restrictions in eight states included legal punishment for providers who violated abortion laws.3 “This suggests [they have passed] one of the harshest penalties that could face providers for performing these procedures,” she adds.
Research shows that women’s reproductive health and autonomy are moving backward in the United States, which is one of only two nations (Poland is the other) worldwide where abortion access has gotten worse.4
The latest — not-yet-published data — show that nations are overwhelmingly moving toward liberalization of abortion, says Lisa Remez, senior writer and translation associate at the Guttmacher Institute in New York, NY. Remez answered questions via email.
“Two countries went in the opposite direction over the past five years: Poland removed the legal ground of fetal anomaly in 2021, and the U.S. Supreme Court’s 2022 Dobbs decision reversed 50 years of precedent by removing federal constitutional protections for abortion rights, allowing individual states to ban abortion,” Remez explains. “The result in the United States has been an evolving, chaotic landscape in which, as of May 2025, 12 states are enforcing total abortion bans with very limited exceptions.”
Guttmacher’s map lists 15 states with the most restrictive abortion policies. This includes three states — South Carolina, Florida, and Iowa — that have six-week bans.5
“The expansion of legal grounds for abortion took many routes over [2008-2019] — through legislation, penal-code reform, constitutional reform, and binding human rights treaties,” Remez says. “Among the 27 countries that added at least one legal ground for abortion from 2008 through November 2019, nine moved to allow abortion without restriction as to reason.”
Guttmacher now has more recent legal-change data, from December 2019 through February 2025, she notes. “Over these five years, the overwhelming trend, again, was toward liberalization: Since December 2019, 18 countries added legal grounds for abortion, but this time the majority — 11 — moved to allow on-request abortion,” Remez says.
History and research show what happens when nations move to restrict or ban abortions, and the evidence is clear that people continue to have abortions — however unsafe they become. “What happens when governments eliminate legal grounds is no secret, as making abortions illegal has never kept them from happening,” Remez says.
“But while imposing legal restrictions does not reduce the number of individuals seeking out abortion services, global evidence shows that it does increase the risk of unnecessary physical and emotional harm and may also result in criminalization and financial hardship,” she explains. “That is clear from decades of evidence from around the world. Moreover, restrictive abortion laws always disproportionately hurt the most vulnerable populations.”
Banning abortion poses more physical, emotional, and financial risks to people who seek an abortion but have to travel far to obtain one. For people who cannot travel, there can be worse options and outcomes, including giving birth under stressful and sometimes dangerous circumstances.
Researchers studied the effect of the Roe decision of 1973 on maternal health and found that there was a huge drop in maternal mortality after abortion was legalized nationwide.6 “We saw that people who were able to use [abortion could] control the timing of when they became mothers,” says Caitlin Myers, PhD, a professor of economics at Middlebury College in Middlebury, VT. Myers is a research associate with the National Bureau of Economic Research in Cambridge, MA.
“We saw increases in educational attainment and reductions in poverty,” Myers adds. “That was 50 years ago. The maternal mortality results are driven by Black women, and this is a population that was less likely to access a safe abortion when it was illegal.”
White women were more likely to obtain a discreet, safe abortion in those pre-Roe years. “And the women not able to obtain a safe legal abortion were also women who were facing higher health risks of carrying pregnancy to term,” Myers says. “Those for whom bans were a binding constraint were impacted by health [issues].”
The paper shows that abortions increased in many states after the Roe decision. It also led to a decrease in teen mothers and a 20% drop in marriages among teens, Myers says.6 “As we see in the data, the marriage effect is almost completely driven by a reduction in shotgun marriages, meaning marriages that were the result of a pregnancy,” she adds.
Melinda Young has been a healthcare and medical writer for 30 years. She currently writes about contraceptive technology.
References
1. Adkins S, Talmor N, Dechen T, et al. Association of restricted abortion access with maternal and infant health by maternal nativity: A difference-in-differences analysis. BJOG. 2025; Apr 10:10.1111/1471-0528.18164. [Online ahead of print].
2. Adkins S, Talmor N, White MH, et al. Association between restricted abortion access and child entries into the foster care system. JAMA Pediatr. 2024;178(1):37-44.
3. Aaron RM, Downey K, Rodriguez MI, et al. Provider-targeted abortion restrictions in the 2023 legislative session. Am J Obstet Gynecol. 2025; Apr 24:S0002-9378(25)00260-1. [Online ahead of print].
4. Remez L, Mayall K, Singh S. Global developments in laws on induced abortion: 2008-2019. Int Perspect Sex Reprod Health. 2020;46(Suppl 1):53-65.
5. Interactive map: US abortion policies and access after Roe. Guttmacher. May 21, 2025. https://states.guttmacher.org/policies/new-york/abortion-policies
6. Myers C. From Roe to Dobbs: 50 years of cause and effect of U.S. state abortion regulations. Annu Rev Public Health. 2025;46(1):433-446.
Researchers found that state laws that more severely restricted abortion access in the time period of 2011-2019 were associated with worse maternal health outcomes for the most vulnerable women.
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