What Impact Has Repealing Roe v. Wade Had So Far?

The Issue:

There has been wide variation in abortion access across the United States since the June 2022 Supreme Court decision in Dobbs v. Jackson Women’s Health Organization. The ruling overturned Roe v. Wade and Planned Parenthood v. Casey and eliminated federal protection for abortion. While some states completely banned abortion immediately following the ruling, others implemented protections for abortion access. Early research has started to understand the impact of the Supreme Court decision and the subsequent abortion bans. These studies, along with other recent work looking into the effects of changes in driving distance to abortion providers and of other types of abortion restrictions, can illuminate the impact of the increasingly fractured landscape of abortion access in the United States.

Differences in access to abortion are contributing to a divergence in outcomes for women, infants, and families across different states.

The Facts:

• After Dobbs v. Jackson the number of states with total or near-total abortion bans increased. As of December 2024, 12 states have total abortion bans and 4 states (Iowa, Florida, Georgia, and South Carolina) have 6-week gestational age bans (see map). (A constantly updated record of state abortion regulations is found here). Most of the states that currently have a total abortion ban were states with triggered bans which went into effect immediately after the Dobbs v. Jackson decision.
• Despite the enactment of state abortion bans, the total number of abortions performed in the United States rose in the first full year since the Dobbs decision. There were 1,037,000 reported abortions in the formal healthcare sector in 2023, which is an 11% increase since 2020, according to estimates from the Guttmacher Institute. These data include only procedural and medication abortions provided at brick-and-mortar health facilities and medication abortions provided via telehealth and virtual providers in the United States. Every state without a total ban – except for Arizona, Georgia, Indiana, and Wisconsin — saw an increase in the number of abortions performed within the formal US health care system as compared to 2020 levels.
• The rise in abortions is characterized by a notable increase in travel across state lines to receive abortion care and increased use of medication abortion. States without a total abortion ban saw a 26% increase in abortion in 2023 as compared to 2020, with larger increases occurring in states that border states with a total abortion ban such as Illinois (71%), New Mexico (256%), Virginia (77%), and North Carolina (41%). As a reflection of interstate travel, 22 states and Washington DC have passed Shield Laws, which protect health care providers who perform abortion from legal consequences from states that ban abortion. In states without a total abortion ban, 63% of all abortions in 2023 were medication abortions — a pregnancy termination protocol that typically involves taking two different drugs, Mifepristone and misoprostol. The increased use of medication abortion has likely been spurred in part by the increase in telehealth medication abortions (see here). 
• States with abortion bans experienced an increase in births. In the period that followed the Dobbs v. Jackson ruling, states with a total abortion ban saw a 2.3% increase in births relative to the natality they would have experienced if no abortion ban had been enforced, according to one study. This increase translates to about 1.2 additional births per 1,000 women. The effects were largest for Hispanic women and women ages 20-24 as well as for states were the total ban made interstate travel more costly (i.e. Texas and Mississippi). The finding of this study is consistent with research that concluded that states that previously implemented laws that targeted restrictions on abortion providers — such as admitting privileges and detailed building specifications, which often force abortion providers to stop performing abortions — saw a 3.5% increase in births among teens (see here). 
• Existing studies suggest that increasing distance to abortion providers is one of the factors contributing to the increases in births experienced by abortion ban states. The total abortion bans immediately enforced following the Dobbs decision increased the distance that individuals must drive to obtain an abortion for almost a quarter of US women in reproductive age. An analysis of county-level travel distances to abortion facilities and resident abortion rates from 2009 through 2020 finds that a 100-mile increase in the driving distance to the nearest abortion provider reduces abortion by 19.4% and increases birth rates by 2.2%. There is a diminishing effect, however, as the next 100-mile increase only reduces abortion by an additional 12.8% and increases births by an additional 1.6%. Non-Hispanic Black women and young women’s abortion and birth rates are the more responsive to the increase in distance. 
• Studies have found adverse health effects on infants in states with the most stringent abortion restrictions. When Texas implemented a ban on abortions after embryonic cardiac activity could be detected in 2021, there was a much larger increase in infant deaths relative to the rest of the country, and particularly a much larger increase in deaths attributable to congenital anomalies. By comparing the trends in Texas with those of otherwise similar states without such abortion restrictions, researchers determined that there was a 12.7% increase in infant deaths above expectation after the ban, driven primarily by an increase in deaths of infants with congenital defects (see here). 
• There is evidence that maternal health can also be impacted by changes in abortion access. The best recent evidence that being denied a wanted abortion can have negative impacts on maternal health comes from Colombia, where the effect of being denied an abortion increased maternal deaths by 2.5 percentage points (mostly due to unsafe abortion procedures). The study also found that, compared with similar women who were able to obtain an abortion, the women who were denied an abortion experienced more health issues up to 15 years later. In the United States, new research finds that targeted regulations on abortion providers implemented prior to Dobbs were associated with an increase in rates of pregnancy-associated hypertension and chronic hypertension. While trends in anxiety were similar in restricted and unrestricted states before Dobbs, after the Dobbs decision individuals living in states with restricted access to abortion are 7.4% more likely to report experiencing moderate or severe anxiety compared to individuals living in states without abortion restrictions (see here).
• Restrictions on abortion have been linked to negative outcomes that impact families over a longer time horizon. Women who were denied a wanted abortion and subsequently gave birth were more likely to receive government subsidies, be below the federal poverty line, be unemployed post-birth five years later, and also to experience financial distress than their non-birthing counterparts a decade later. A 100-mile increase in travel distance to an abortion facility due to restrictions on abortion providers imposed between 2011 and 2018, was associated with a 28.1% increase in child maltreatment reports, primarily driven by increases in child neglect and physical abuse. 
• Some people are responding by moving out of states where abortion is banned. There is emerging evidence that abortion bans are having an effect on domestic moving trends: increasing population outflows from states with abortion bans over and above what comparable abortion-protecting states experience. Using postal address change forms, one study finds that the 13 states that immediately implemented a total abortion ban after the Dobbs v. Jackson decision were losing 36,000 residents per quarter as of the second quarter of 2023 due to the bans. The effect is largest for single-person households, likely reflecting a larger effect for younger adults (see here). Moreover, there are indications that abortion bans could be playing a role in the decision of where recent graduates of medical schools apply for their medical residence. The Association of American Medical Colleges reports that there has been a reduction in applications to residency programs in states with total abortion bans for the two cycles post Dobbs v. Jackson.