Issue Brief
State Abortion Bans Threaten Nearly 7 Million Black Women, Exacerbate the Existing Black Maternal Mortality Crisis

May 2024
Maternal Health | Reproductive Rights

By Camille Kidd, Shaina Goodman and Katherine Gallagher Robbins

Nearly two years later, the decision to overturn Roe v. Wade continues to significantly harm millions of people across the nation, impeding their access to abortion, disrupting their economic futures, and putting their health and even their lives at risk. The impact of this decision is particularly harmful for women of color, who are less likely to have access to high-quality, culturally competent health care and face greater economic barriers to getting abortion care.

The Dobbs decision has unique impacts on Black communities.In this analysis, Afro Latinas and multiracial Black women are included in the overall number of Black women. Results in this analysis may differ from other National Partnership analyses on this topic which analyze Latinas and multiracial women separately. Black women, girls and gender expansive people have a rich array of diverse experiences that are shaped by race, class, gender, sexual orientation and gender identity, disability, geography and more. Black women operate within political, cultural and economic systems that continue to be shaped by centuries of discrimination, bias and systemic oppression – including in the context of reproductive health and pregnancy. Black women have also developed cultures and practices of leadership, resistance, and joy. All of these factors inform the range of Black communities’ lived experiences, including their ability to achieve Reproductive Justice – the right to have children, the right to not have children, the right to raise children in a safe and healthy environment, and the right to sexual expression and pleasure. The systems and policies that harm Black communities, including inequitable access to health care, limited access to paid leave, discriminatory health care practices and more, have led to a maternal health crisis for Black women. These same barriers undermine access to abortion care, and have only been exacerbated by abortion bans that have been or are likely to be enacted in the wake of the Dobbs ruling.

New analysis from the National Partnership for Women & Families and In Our Own Voice: National Black Women’s Reproductive Justice Agenda reveals the harmful impact of Dobbs on Black women. We find that:

  • More than 6.7 million Black women – 57 percent of all Black women ages 15-49While people of many ages can become pregnant, in this analysis we use ages 15-49 to align with the Guttmacher Institute, the World Health Organization, and others. 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. – live in the 26 states that have banned or are likely to ban abortion.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 Abortion Bans Across the Country.
  • More than 58 percent of all Black women who live in these 26 states are already mothers.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. Black mothers are especially likely to be their family’s primary or sole breadwinner, making their income especially important to their families. Research shows that when mothers cannot access abortion care, the economic security and development of their existing children is negatively impacted.
  • Nearly 2.7 million Black women living in these states are economically insecure.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. Women with low incomes are especially impacted by state bans as they are more likely to lack access to the necessary funds to travel to another state for abortion care. Furthermore, women who are denied abortion care are significantly more likely to be pushed deeper into poverty as a result. Research finds that Black women’s labor market outcomes are especially impacted by the availability of abortion.
  • Among Black women veterans, 114,000 live in states that have or are very likely to ban abortion after Dobbs. While the U.S. Department of Veterans Affairs (VA) has acted to expand access to abortion care, not all veterans are eligible for or utilize VA health care.
  • Nearly 57 percent of disabled Black women live in these 26 states.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. Disabled people already face barriers and discrimination in accessing health care and disabled people of color experience a “double burden” compounded by their intersecting identities. Disabled people seeking abortion care face these same barriers, worsened by stereotypes and stigma regarding the sexuality of people with disabilities. Dobbs has compounded these problems by adding additional costs and accessibility barriers to care.
  • More than one-third of Afro Latinas and 44 percent of multiracial Black women live in states that have banned or are likely to ban abortion after Dobbs. Living at the intersection of myriad racial and ethnic identities creates particular barriers for these women, as different communities face diverse barriers related to a range of factors including discrimination, access to reproductive care, geography and more.

Abortion bans exacerbate the Black maternal health crisis

Abortion bans and the harms caused by Dobbs are especially egregious in light of this country’s ongoing maternal health crisis. Black women and birthing people have the highest rates of maternal mortality in the country, and are three times more likely to die in childbirth as compared to white women. Black women are also disproportionately affected by severe maternal morbidity – unexpected outcomes in labor and delivery (e.g., hypertension and anxiety) that result in significant short- or long-term consequences to the childbearing person’s health and well-being. Tragically, more than 80 percent of pregnancy-related deaths are preventable. Yet, because of systemic racism and discrimination, inadequate access to high-quality and culturally affirming maternal health care, including doulas, midwives, and labor and delivery classes, and other social drivers of health, Black women and birthing people continue to bear the brunt of this crisis. In a recent poll released by In Our Own Voice, a majority of Black women (54 percent) said they have felt the effects of racial and gender bias in the health care system and one in five (19 percent) said they felt a healthcare provider did not take their pain seriously during pregnancy or childbirth because of their race and/or gender.

Abortion bans have undoubtedly exacerbated the inaccessibility of high-quality maternal health care. For example, hospitals have closed their maternity wings entirely because of the legal landscape, compounding the already dire state of maternity care deserts. Many providers are being forced to leave states with abortion bans, adding to the pre-existing shortage of health care providers. Many new residents are choosing not to train in ban states – but those that do are likely to miss out on learning essential skills in caring for pregnant people, which will inevitably lead to worse maternal and reproductive health outcomes. Moreover, providers have repeatedly been forced to compromise the care they offer to pregnant people, including those experiencing significant pregnancy complications or medical emergencies, as a result of abortion bans. One study estimates that, if there was a federal abortion ban, there could be a staggering 39 percent increase in maternal deaths for Black women.

Our new research finds that of the 26 states that have banned or are likely to ban abortion after Dobbs, 17 also have above-average maternal mortality rates.Limited information about maternal mortality is available by state, especially for different groups of women. This analysis uses CDC data via the Kaiser Family Foundation to examine maternal mortality rates per 100,000 live births. We characterize a state as having above average maternal mortality if its rate is above the national average of 23.5. There are 20 states above average (Alabama, Arizona, Arkansas, Florida, Georgia, Indiana, Kentucky, Louisiana, Mississippi, Missouri, Nebraska, New Jersey, New Mexico, North Carolina, Ohio, Oklahoma, South Carolina, Tennessee, Texas, Virginia) of which 17 are also states that have banned or are likely to ban abortion after Dobbs. However, it is important to note that maternal mortality rates were not available for Alaska, Delaware, D.C., Hawaii, Idaho, Maine, Montana, New Hampshire, North Dakota, Rhode Island, South Dakota, Vermont, West Virginia and Wyoming. Overall, of the 26 states that have banned or are likely to ban abortion after Dobbs, three have below average rates and six do not have sufficient data.

  • Nearly 55 percent of all Black women of reproductive age in the United States live in states that have both banned or are likely to ban abortion and have above-average maternal mortality.
  • Roughly six in 10 Black women who are veterans and six in 10 Black women who are economically insecure live in states at this intersection.
  • The majority of Black mothers and the majority of disabled Black women live in these states.

Black women’s inequitable access to insurance coverage also compounds the harmful impacts of a lack of access to abortion and maternity care. Although insurance coverage for maternal health care has greatly improved since the passage of the Affordable Care Act and the recent state expansions of Medicaid postpartum coverage, millions of people have lost coverage due to Medicaid “unwinding”Medicaid unwinding refers to the disenrollment of people from Medicaid as a result of the end of COVID-era continuous enrollment policies. and coverage for abortion coverage is still extremely limited. Nearly one third of Black women are enrolled in Medicaid, which restricts insurance coverage for abortion care except in very limited circumstances. Medicaid enrollees living in abortion ban states may be prevented from using their coverage for care even in those narrow circumstances, as state bans are often more restrictive. Our research finds that nearly 1.8 million Black women covered by Medicaid live in states that have banned or are likely to ban abortion after Dobbs. Even more troubling is our finding that nearly 1 million uninsured Black women live in states that have both above-average maternal mortality rates and that have banned or are likely to ban abortion. This lack of insurance coverage means that these women are significantly less likely to be able to access high quality reproductive, preventative, primary and overall health care, which inevitably leads to worse health outcomes and greater health inequities.

Additionally, abortion bans also increase the threat of criminalization facing Black communities, which in turn has negative consequences for maternal health outcomes. Black people are already over-surveilled and over-policed, and this is especially true for Black immigrants. Alarmingly, Black women are also disproportionately subject to criminal proceedings arising from their pregnancies. In Our Own Voice’s recent poll shows that more than one-third of Black women of reproductive age in states with abortion restrictions said the Dobbs decision has made them think about the risk of being arrested related to pregnancy, miscarriage or abortion care, compared to less than a quarter of Black women in states with more accessible abortion care. The consequences of arrests, prosecutions, detentions and convictions are far-reaching, especially for women of color. Moreover, there is an entrenched mistrust between Black and brown patients and the health care system stemming from the history of reproductive health care experiments and forced sterilization, and from ongoing discrimination and mistreatment. Criminalizing pregnant people exacerbates this mistrust and intensifies health inequities.

Abortion bans harm Black women’s economic security

Given the increased economic resources required to access abortions in many communities post-Dobbs, the 2.7 million economically insecure Black women in these 26 states are particularly likely to be harmed. Because getting abortion care now often necessitates traveling over long distances and for multiple days, costs include transportation, lodging, meals, child care, missed wages and more – in addition to the cost of the abortion itself. For many Black women, these costs would force them into economic precarity, or are so insurmountable as to push abortion care out of reach.

Compounding the impacts of these costs is the lack of supportive policies for Black women living in these 26 states. No states that have banned or are likely to ban abortion provide paid family and medical leave, creating an additional burden for Black women in these states who may need to take leave to access care. Having access to paid leave is especially important for Black women, who have high rates of labor force participation and frequently need to forgo leave or take leave without pay. Taking time off from work is especially difficult for Black women in particular jobs, such as service occupations. Our research shows that more than 1.4 million Black women in the 26 states surveyed work in service occupations.Service occupations are those defined by IPUMS. These same jobs are less likely to provide access to supports that are necessary both to access abortion care and to achieve economic security, including paid sick days and flexible scheduling. While the Pregnant Workers' Fairness Act regulations clarify that employers must provide time off for pregnancy related medical appointments, including for abortion or recovery, this time is unpaid, creating an insurmountable burden for many women.

State-level impacts of abortion bans

The actions of certain states are especially harmful for Black women and their families. We find that Black women in three states – Florida, Texas, and Georgia – account for 44 percent of Black women in ban states and one-quarter of all Black women of reproductive age in the nation. Moreover, all of these states have above-average maternal mortality rates and none of them provide paid family and medical leave.

  • Texas is home to more than 1 million Black women of reproductive age – 9 percent of all Black women of reproductive age in the country and 15 percent of Black women who live in these 26 states. Of these Black women, 407,500 are mothers, 348,700 are economically insecure, 24,300 are veterans and 93,100 are disabled. They are all harmed by Texas’s draconian abortion ban, which prevents abortions at all stages of pregnancy except for life-threatening medical emergencies. Birthing people in Texas are also highly vulnerable to poor health outcomes, and the state has failed to enact key policies that support pregnant and birthing people.
  • Florida is home to 960,500 Black women of reproductive age – 8 percent of all Black women of reproductive age in the country and 14 percent of Black women who live in these 26 states. Of these Black women, 358,900 are mothers, 354,700 are economically insecure, 15,700 are veterans and 68,800 are disabled. All of these women are harmed by Florida’s abortion law, which bans virtually all abortions after 6 weeks of pregnancy. In large part due to poor health care access overall in the state, birthing people in Florida are more likely to have negative health outcomes.
  • Georgia is home to 948,800 Black women of reproductive age – 8 percent of all Black women of reproductive age in the country and 14 percent of Black women who live in these 26 states. Of these Black women, 373,700 are mothers, 330,200 are economically insecure, 20,800 are veterans and 75,600 are disabled. Georgia’s women are harmed by very restrictive abortion laws, including a 6 week ban. Georgia has one of the highest maternal mortality rates in the country, and the state has failed to adopt policies necessary for improving maternal and infant health outcomes.

In this moment of multiple, overlapping health and socioeconomic crises, Black women affirm their human rights and call on policymakers to implement policies that strengthen access to and coverage of abortion, to dignified and safe pregnancy and birth, to equitable health care, and to the social, economic, political, and cultural supports needed for Black people and families to thrive. The Black Reproductive Justice Policy Agenda is a guidepost for the comprehensive policy needed in this country.

Methodological note: 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. People born in the U.S. territories are born in the United States. People reporting health insurance coverage may have multiple kinds of coverage. 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 multiple marginalized communities. The transgender and nonbinary communities are not mutually exclusive.

The authors would like to thank Ebony Baylor, Regina Davis Moss, Venicia Gray, Sharita Gruberg, Mettabel Law, Kiera Peoples and Meera Rajput for their contributions.

National Partnership logo
In Our Own Voice logo