The Dobbs Decision’s Cost to Women and Families

With the U.S. Supreme Court’s decision in Dobbs v. Jackson Women’s Health Organization, the court ended the constitutional right to an abortion. As a result, extreme politicians in states across the country have already put abortion bans into place. This decision will make it so that millions of women and people who can become pregnant¹ across the country cannot access legal abortions, and many will not be able to access abortions at all.

The consequences will be dire, impacting women of color, disabled women, and low-income women the most. Research conducted by the National Partnership for Women and Families found that among those that are of reproductive age, 15 million women of color and nearly 3 million women with disabilities live in the states that have already banned, or are likely to ban, abortion. Their analysis finds that nearly 57 percent of all Black women, and 53 percent of all women with disabilities, live in these states. Forcing women to endure an unwanted pregnancy is going to materially threaten the economic security of women and families across the country, with a disproportionate impact on women experiencing intersecting forms of discrimination.

This dangerous situation for these women is a result of deliberate policy choices grounded in a history of racism, sexism, ableism, and attempts to hoard power and resources by those who already have them. Abortion access was already inequitable under Roe v. Wade, with states having constitutionally legal abortion restrictions, such as TRAP laws, which limited women’s access to care. But with the Dobbs decision looming, many states also passed trigger laws, which were automatically enacted once the decision was handed down, banning abortion or creating greater restrictions on abortions.

The Dobbs decision represents yet another blow to women’s reproductive freedom, part of the long-term effort by conservatives to restrict abortion access and make it harder for women to obtain economic security. It is not a coincidence that the same states made it harder for women to access abortion in legal ways prior to Dobbs are the ones least likely to have other policies in place that support women’s economic security. For example, research from the Institute on Taxation and Economic Policy shows women living in states where abortion is or will be banned are far less likely to have access to key government safety net programs to aid their economic well-being, such as refundable earned income tax credits, child tax credits, expanded Medicaid, high-quality affordable child care, and universal pre-K. Similarly, none of the states restricting abortion offer paid family and medical leave and only one offers paid sick time.

Denying women access to abortion can impact their economic security in multiple ways. Without the ability to choose when to be a mother, women can see careers upended at a moment’s notice, severely impacting their participation in the labor force and their overall earnings comparative to men. Furthermore, restricting access not only will make seeking abortion care directly more costly, but also will force more women into motherhood, which bears many direct costs for them and their families. Based on decades of research during the half-century between the Roe and Dobbs decisions, it is possible to assess and roughly calculate some of the costs to women and the economy when abortion access is restricted.

How Abortion Restrictions Impact Labor Force Participation and Comparative Earnings

Barriers to abortion translate to barriers to women’s labor force participation and earnings. In states with abortion restrictions, the women’s labor force participation rate is 1.25 percentage points lower than in states without restrictive abortion policies (see Table 1). While a difference of a little over 1 percent may seem small, that amounts to millions of working-age women without jobs—and without the economic freedom that comes with them. In those same states, men’s labor force participation rates are similar to those of men in other states, suggesting that abortion restrictions are uniquely impacting women’s outcomes. On the flip side, the Institute of Women’s Policy Research finds that eliminating abortion restrictions nationwide could increase labor force participation for women by 1.15 percent and earnings by 9.12 percent. Those increased earnings could help close the gender wage gap.

Table 1

Decades of research have shown that access to abortion increases women’s labor force participation by allowing them to control when and whether they have children. This effect is most pronounced for Black women and teenagers, because they are more likely to seek abortion care due to the ways systemic racism creates barriers to accessing health care, such as contraception. Access to abortion care, therefore, is a critical tool toward ensuring young women and Black women have autonomy over their education and career pathways. Specifically, research has found that abortion access increases the rates at which women complete postsecondary credentials. Since education remains one of the key drivers for upward economic mobility, reproductive justice is essential for women to be able to pursue well-paying career pathways.

Critically, the ability to have an abortion can have long-term impacts on women’s economic security. Research building on the Turnaway study has found prolonged negative financial impacts on women who are unable to access abortions. Women who are denied abortion were more likely to be experiencing poverty for years after being denied care.

Moreover, research on the “motherhood wage penalty” finds that there is not only a gender wage gap, but a motherhood wage penalty. Women’s incomes are reduced by 15 percent per child under the age of 5, controlling for other factors. The earnings loss is even higher among low-wage workers and women of color. Additionally, new research finds that women’s reduced hours and lower earnings persist over time. Partly, this wage gap is due to career choices women are often forced to make when they have children as a result of the lack of a care infrastructure and cultural norms. Women, more often than men, will reduce hours, take significant time off, quit jobs, or turn down other opportunities for advancement, after having a child.

The motherhood penalty impacts the gender wage gap. States with more abortion restrictions generally have a higher gender wage gap than states without restrictions. As shown in Figure 1, the eight states with the highest gender wage gaps all restrict abortion access, and the eight states with the lowest wage gap protect abortion access.² It is clear that improving access to abortion is a critical element toward ensuring economic equality in the long term for women and their families.

Figure 1

As always, it is critical to note that, given structural inequities through occupational segregation, historical policies, and structural racism, Black women face even larger wage gaps. Looking at two neighboring states illustrates the compounding effects that abortion restrictions can have on these issues. For example, South Carolina and North Carolina, which have similar Black populations and median household incomes, have significantly different wage gaps for Black women. Black women in North Carolina are paid 32 cents less per dollar compared to white men. Meanwhile, Black women in South Carolina are paid 45 cents per dollar less than white men.³ Ensuring economic equality in the United States will require the freedom for women to decide when and how to have children.

Direct Costs of Abortion Restrictions for Women and Families

In addition to the impact on labor force participation and earnings, abortion restrictions have direct costs for women and families. Some costs from abortion restrictions, such as the mental health costs associated with losing bodily autonomy, are challenging to quantify. However, there are many concrete costs attributable to the restriction of abortion that are easier to enumerate, including the costs of travel, health care, and the many expenses involved in raising children.

A pregnant person seeking an abortion in a state with restrictions will have to travel to other states to receive an abortion—if they are able to. An abortion itself may cost around $500, out-of-pocket. Because the Hyde Amendment prohibits federal Medicaid funds from covering abortion, people seeking abortion care often have to pay higher out-of-pocket costs than other types of health care. Some states allow state Medicaid funds to cover abortion care. Moreover, states regulate private insurance coverage, further determining access to health care coverage that includes (or excludes) abortion care. Other significant costs associated with abortion care are travel costs, including: airfare or gas, child care (since most abortion patients are parents), and hotel costs. Additionally, for the many women without access to paid leave, taking time off work to access medical care can pose an added cost burden of lost wages. All of these travel costs can add thousands of dollars to the cost of an abortion.

Furthermore, some states are adding additional direct financial penalties connected to the criminal justice system. Alarmingly, South Carolina directly criminalizes the person who has the abortion, and includes a $1,000 fine for women who self-manage abortions. Other states, such as Missouri, have considered a ban on those who travel for abortion as well, with financial penalties for those who violate it.

Health care costs for women will rise as well. Pregnancy is one of the leading cost drivers of women’s health care costs when they are of reproductive age. A recent study by the Financial Health Network found that a mere 11 percent of Black women and 7 percent of Latina women are considered “financially healthy.” Additionally, 41 percent of Black women have outstanding medical debt. This could be partially driven by inequities in health insurance coverage. 9.6 percent of Black Americans are uninsured, compared to 5.2 percent of white Americans. Ensuring that women are able to plan for a pregnancy is critical to ensuring that families are having children when they want and are prepared for them.

For women of color and white women alike, forcing pregnancy is forcing financial insecurity due to the high costs of pregnancy and child raising. The direct health care costs associated with pregnancies that end in birth are associated with birth and postpartum care. Even with insurance, the average out-of-pocket cost of pregnancy, childbirth, and postpartum care is $2,854, while insurance pays an average of $16,011.

Moreover, the glaring lack of a robust care economy means that having children has substantial economic consequences. The cost of raising children can be an average of $13,000 a year over the course of childhood—that’s a total of $233,000. These costs include housing and feeding children, costs for childrens’ health care, and costs related to children’s education up through high school. The lack of paid family and medical leave leads to even greater costs. Analysis from the Center for American Progress has shown that U.S. families lose out on $20.6 billion in lost wages due to the lack of paid family medical leave. Only eleven states have paid family medical leave, meaning that for many women, leaving the workforce for a pregnancy will result in lost wages. Additionally, the lack of paid sick leave makes it harder for women to access needed care during pregnancy.

Lastly, the child care crisis in the United States has been particularly apparent during the COVID-19 pandemic. Child care costs an average of $16,000 a year for an infant. For some, this cost is so prohibitively high that it keeps women from working. The goal of enumerating these costs is to shed light on the intersections between reproductive justice and economic security. Having and raising children must be a choice that women make for themselves. The direct costs of having children are high, but pale in comparison with the indirect costs of abortion restrictions.

Looking Ahead

Reproductive justice is inextricable from family economic security. Investing in the nation’s care economy to strengthen economic security, including child care and paid leave, was necessary before the decision in Dobbs v. Jackson Women’s Health Organization. The urgency for these investments is even more significant now. Without these policies, forced pregnancies will lead to a generation of children and families that are coerced into a life of poverty due to their lack of abortion access. The economic impacts, alongside the impact on health and wellbeing, of the lack of a care infrastructure and abortion bans will be devastating.

1. Throughout this commentary we use the term “women” as an inclusive shorthand for all who can become pregnant. This includes nonbinary, intersex, two-spirit, and transgender people who can experience pregnancy.
2. The states restricting abortion also have made other policy decisions that hold women back from earning more, so the impact may be cumulative rather than causal and warrants further research.
3. Author’s analysis of 2019 American Community Survey, 5-year estimates.

Tags: equal pay, dobbs v. jackson women's health organization