By Marissa Ditkowsky, Ashley Emery, and Katherine Gallagher Robbins
Nearly two years later, the Supreme Court’s decision to overturn Roe v. Wade continues to undermine disabled people’s reproductive freedom and dignity, threaten their economic security, and endanger their health and lives.
Disabled people need and deserve access to abortion to exercise full autonomy over their own bodies and lives on their own terms. Yet disabled people, particularly disabled women and disabled people of color, have long faced systemic challenges to accessing abortion care; asserting their right to make decisions about whether, when, and how to have children; and parenting their children safely – free from discrimination and violence. This structural oppression is grounded in the enduring reverberations of eugenics – especially the Court’s decision to allow the forced sterilization of disabled people in Buck v. Bell, which has never been expressly overturned. Today, attempts to control disabled people’s bodies, attack their reproductive choices, and ban abortion care reflect this horrific legacy of reproductive control, especially for disabled women of color.
The Dobbs v. Jackson Women’s Health Organization decision has only compounded the longstanding barriers to abortion care that disabled people face, including provider discrimination and lack of training or experience with disabled patients, guardians dictating decisions about their reproductive care, denials of care and assistance among religiously-affiliated service providers and intermediate care facilities, transportation difficulties, inaccessibility in health care facilities, and layers of economic obstacles to affording the costs of care. Now, National Partnership for Women & Families research shows that more than 3 million disabled women of reproductive age live in states that have banned or are likely to ban abortion – exacerbating the grim reality of reproductive coercion and inequities in the health care system that distinctly impact disabled people.
New analysis from the National Partnership for Women & Families reveals the harms that Dobbs has unleashed for disabled women. We find that:
- More than 3 million disabled women of reproductive age (15-49) live in the 26 states that have banned or are likely to ban abortion since Dobbs. That accounts for more than half of all disabled women in the U.S. Restrictions on abortion care are part of a broader set of policy choices that systematically oppress disabled people, especially disabled people of color, creating a web of compounding barriers to health equity and democracy access.
- Roughly 6 in 10 Black disabled women and 6 in 10 American Indian/Alaska Native disabled women live in these states.
- More than half of disabled women in the Midwest and nearly 90 percent of disabled women in the South live in states that have banned or are likely to ban abortion. At the same time, the South has the highest rates of disability in the country.
- More than half of all disabled women who are economically insecure live in states that have banned or are likely to ban abortion. Disabled women are more likely than white nondisabled men to live in poverty, with disabled women of color experiencing particularly high rates of poverty. Furthermore, women who are denied abortion care are significantly more likely to be pushed deeper into poverty as a result.
- Close to 6 in 10 disabled women living in institutional group quarters, which include jails, prisons, intermediate care facilities, and nursing facilities, live in these 26 states.
- The majority of disabled women who are already mothers live in the 26 states that have banned or are likely to ban abortion. Research indicates that denying mothers access to abortion care has negative impacts on the economic security and development of their existing children.
- The majority of disabled women across each disability type – those with cognitive, visual, hearing, independent living, self-care and ambulatory difficulties – live in states that have banned or are likely to ban abortion.
- Nearly 6 in 10 disabled women veterans in the U.S. live in states that have banned or are likely to ban abortion. This abortion access crisis has far-reaching impacts on disabled veterans’ health and lives, especially given the military sexual trauma epidemic and numerous other barriers to care. Though the U.S. Department of Veterans Affairs (VA) has expanded access to abortion in certain cases, federal bans on TRICARE (the military health insurance program) coverage of abortion and on abortion provision in military treatment facilities put care out of reach for many.
Dobbs’ Impact on the Health, Safety, and Economic Security of Disabled People
In the last two years, many disabled people have not been able to receive the abortion care that they have sought, with severe, negative consequences for their futures, health, and economic security. Dobbs deepened legal, logistical, and financial constraints on disabled people’s abortion access, heightening the risks of abortion bans to disabled people and their families, especially for multiply marginalized disabled people.
The restrictive landscape of state abortion bans puts disabled people at risk of harm, and even death, by exacerbating existing disparities pregnant disabled people face. Abortion bans increase exposure to pregnancy risk and worsen the ongoing crisis in maternity care, compromising patient access to all obstetric and gynecological care. Disabled women are at 11 times greater risk of maternal mortality and face an increased risk of maternal morbidity. Disabled people frequently receive care from health care practitioners who lack knowledge or comfort in managing their pregnancies, which increases the already heightened risk for complications. The lack of disabled medical professionals with diverse lived experiences contributes to this concern. Similarly, Black and Indigenous women and birthing people are more likely to die from pregnancy-related causes than their white counterparts, and abortion bans will only continue to worsen conditions for Black and Indigenous disabled people. These disparities are not an accident or coincidence; deliberate policy choices that are keeping people of color in poverty, establishing barriers to affordable and high-quality health care, affecting educational opportunities, and limiting access to safe and affordable housing, among other factors, play a role in pregnancy risk. The disparities that these policies drive are compounded by the abortion bans and likely bans, under which 60 percent of both disabled Black and American Indian/Alaska Native women live.
Given the increased economic resources required to access abortion care post-Dobbs, disabled people who face barriers to economic security are also particularly likely to bear the brunt of abortion bans. Disabled people – especially multi-marginalized disabled women – have long faced financial barriers to accessing abortion. Dobbs has only intensified these hurdles for the majority of disabled women who are economically insecure living in states that have banned or are likely to ban abortion. Seeking abortion care out-of-state can require lodging, transportation, child care, and other resources that many economically insecure disabled women simply cannot afford. Transportation access and safety concerns, mobility challenges, and travel-limiting disabilities layer onto these concerns and can be prohibitive for disabled people that need to leave their state for abortion care.
Research has found that people who were denied an abortion were significantly more likely to fall into poverty. Disabled women, in general, are more likely to work in low-wage, part-time, or service positions and face pay disparities due to employment discrimination, occupational segregation, and employers’ ability to pay disabled people subminimum wages. Disabled people may also be subject to strict asset and/or income limits if they receive Supplemental Security Income (SSI), Medicaid and/or Home- and Community-Based Services (HCBS) to live and work in their communities. At the same time, policies disincentivize recipients from working to supplement these benefits. Low and unfair wages undermine disabled people’s ability to make decisions about their own health and reproductive lives and how to make a better life for themselves and their families – challenges that the abortion bans that have proliferated in the wake of Dobbs only worsen.
Disabled People in Institutional Settings Face Increased Attacks on Bodily Autonomy
Dobbs has only exacerbated disparities in abortion access for disabled people in institutional settings. A striking 58.5 percent of disabled women in institutional group quarters live in states that have banned or are likely to ban abortion. Disabled people are disproportionately represented in jails and prisons. Half of those in women’s state prison on a given day have a disability, and four percent of women who enter women’s prisons – disproportionately women of color – report having been pregnant at admission. The health and safety of pregnant people – especially disabled people – who are incarcerated is at risk, as a consequence of failures in screening and care inherent in our carceral system. In states that have banned or are likely to ban abortion since Dobbs, these failures are even more likely to be life-threatening.
Dobbs has only further diminished the bodily autonomy of many disabled people in institutions. The U.S. health care system pushes many disabled people into institutions. Inadequate funding for Home- and Community-Based Services (HCBS) leaves disabled people unable to live and work in their communities. Disabled people may remain in institutions for years while on HCBS wait lists, meaning that even if someone is eligible for HCBS, they do not receive appropriate supports. Out of states with the top 25 longest HCBS wait lists, 60 percent are states that have banned or are likely to ban abortion post-Dobbs. For disabled people who live in any kind of institutional setting, especially disabled women of color, Dobbs has only escalated barriers to abortion care.
People with Varying Disabilities Experience Unique Barriers to Abortion Care
It is imperative to emphasize that the disabled community is not monolithic – people with different types of disabilities, and even those with the same disability, may need different supports or face unique obstacles to abortion care, especially post-Dobbs. Fifty three percent of women with hearing difficulties live in ban states. Deaf and Hard-of-Hearing women experience communication challenges with health care providers who are not fluent in American Sign Language (ASL) or do not have qualified interpreters, and there is little reliable information in ASL about abortion access following the overturning of Roe. Dobbs has also further stymied abortion access for those with cognitive difficulties. Over half of women of reproductive age with a cognitive difficulty live in ban states. Health care providers have issues effectively communicating with people with intellectual disabilities about abortion and reproductive health care, often resorting to relying on family members, friends, or caregivers in a way that strips disabled people of their autonomy. Those with intellectual and developmental disabilities are also at a greater risk of maternal morbidity, and this risk has only risen with abortion bans.
People with mental health disabilities face stigma in trying to access abortion care, as well. Many states that have banned abortion post-Dobbs have no exceptions related to mental health to protect the life or health of the pregnant person. Furthermore, many bans do not include exceptions for rape and incest, and those that do contain narrow, unworkable provisions that cut survivors off from care. While all disabled women are more likely than nondisabled women to experience sexual assault and intimate partner violence, people with multiple disabilities and intellectual disabilities experience sexual assault at even higher rates. These risks magnify bodily autonomy concerns for disabled people who are subject to abortion bans and expose them to compounded trauma.
Given the severity of Dobbs’ far-reaching harms on disabled people, we urge state and federal policymakers to do everything in their power to expand access to sexual and reproductive health care, including abortion, and mitigate systemic challenges to disabled people’s bodily autonomy. Disabled people will not be able to truly experience equitable access to reproductive health care or assert their reproductive rights until we take steps to address structural drivers of health inequities and combat discriminatory attacks on their self-determination. It is essential that our national policy captures the ways in which disability shapes access to reproductive health care and responds to those lived experiences – dismantling legal, logistical, and financial barriers to care; rectifying regressive policies that inhibit disabled people’s decision-making about reproductive health care and parenthood; and asserting an inclusive vision for protecting the health and freedoms of those most affected by abortion restrictions and reproductive oppression.
Authors’ note: Many in the disability community have reclaimed identity-first language (i.e., “disabled”) to acknowledge disability as a critical part of identity. However, not all members of the disability community prefer identity-first language. Others may prefer person-first language (i.e., “person with a disability”). Preferences may also vary by disability. The National Partnership uses identity-first and person-first language interchangeably. However, the National Partnership will always honor the language a disabled person chooses for themselves.
Methodological note: We classify a state as having banned or being likely to ban abortion if they meet at least one of the following criteria: (1) there is “trigger” ban that took effect post-Dobbs; (2) they have gestational limits banning abortion between six and twenty weeks; (3) there is an abortion ban with legal challenges pending in state courts; and (4) there have been significant legislative attempts to ban abortion, even if such attempts have not yet resulted in a ban or a state court has overturned a ban. As of the publication date of this analysis, these states are Alabama, Arizona, Arkansas, Florida, Georgia, Idaho, Indiana, Iowa, Kentucky, Louisiana, Mississippi, Missouri, Montana, Nebraska, North Carolina, North Dakota, Ohio, Oklahoma, South Carolina, South Dakota, Tennessee, Texas, Utah, West Virginia, Wisconsin, and Wyoming. See Six Months Post-Roe, 24 States Have Banned Abortion or Are Likely to Do So: A Roundup; Tracking the States Where Abortion Is Now Banned.
This impact analysis uses the 2018-2022 American Community Survey accessed via IPUMS USA, University of Minnesota. We use a five-year dataset to have a sufficient sample size to analyze state-level data. Racial categories in this analysis exclude women who identify as Latina and/or Hispanic, who are analyzed separately. People are identified as having a disability in this analysis if they responded that they have difficulty in one or more of the following realms: vision, hearing, cognitive, ambulatory, self-care, and independent living. People may have multiple disabilities. This is a limited definition of disability that excludes a portion of disabled people. For more information on how disability is measured in the American Community Survey please see the U.S. Census Bureau’s report How Disability Data are Collected from The American Community Survey. For details on which states fall in which region see this IPUMS definition of regions. Institutional group quarters include things like correctional facilities, nursing facilities and mental hospitals. See additional details at this IPUMS definition of group quarter type. While people across the income spectrum may have difficulty making ends meet, in this analysis we define “economically insecure” as living in a family below 200 percent of the federal poverty line. This analysis defines “mother” as having at least one own child (including step, adopted, or biological) under the age of 18 in the household. Due to data limitations, there are mothers who are not included in this definition, including those who have non-resident or older children or those whose children have passed away. Not all women of reproductive age have the potential to become pregnant – many of them may not be able to for medical reasons or they may not participate in sexual activities that could result in pregnancy.
Due to data limitations, this analysis does not include people who do not identify as women but may become pregnant, including transgender men and nonbinary people. The 1.6 million transgender people 13 and older and 1.2 million LGBTQ nonbinary people age 18-60 in the U.S. are deeply impacted by Dobbs. Many transgender and nonbinary people can become pregnant and are directly impacted by this ruling. The harms are more severe for transgender and nonbinary people of color, those who are disabled, and others who are members of multiply marginalized communities. The transgender and nonbinary communities are not mutually exclusive.
The authors are grateful to Shaina Goodman, Sharita Gruberg, Molly Kozlowski, Mettabel Law and Meera Rajput for their review and thoughtful comments.
