Four years ago, the US Supreme Court’s ruling in the landmark Dobbs v. Jackson Women’s Health Organization decision overturned Roe v. Wade, eliminating nearly 50 years of a constitutional right to abortion and changing the future of reproductive freedom in the United States. The Dobbs decision activated trigger laws in 21 states that banned or significantly restricted abortion access throughout the nation.
In the years since, the Dobbs ruling has had harrowing consequences on health care access, maternal mortality rates, and women’s economic mobility, as well as the economy at large.
As highlighted by IWPR’s State Policy Action Lab (State PAL), 19 states have abortion bans, including 13 with near-total bans. Moreover, some states have enacted bans at other points of gestation and implemented fetal personhood laws, travel restrictions, waiting periods for abortion care, and even private insurance coverage bans. In addition to infringing on reproductive rights, these state abortion restrictions have had significant economic consequences for women.
According to our latest analysis, accounting for all state-level abortion restrictions, combined with the absence of federal protections, the annual economic cost adds up to more than $140 billion nationwide due to earnings losses among women ages 15 to 44. IWPR analysis also shows that without these barriers, nearly 325,000 more women would join the labor force each year. The current economic downturn, along with heightened barriers to women’s labor participation, has only increased financial instability for American families. State restrictions on reproductive care have further worsened economic insecurity for millions of people.
Access to reproductive care is essential for working women. In addition to the numerous documented physical and mental consequences, when pregnant people are denied access to wanted abortions, they are often forced to leave the labor market. And, in states with abortion restrictions, women workers tend to earn less and experience a pronounced decline in employment growth. This is particularly concerning for Black women, whose earnings have been shown to significantly increase when access to abortion is protected.
Another serious consequence of reproductive and abortion restrictions is higher maternal mortality and morbidity rates. Maternal deaths in abortion-restricted states are 62 percent higher than in states with access. Abortion restrictions will only worsen the existing maternal mortality crisis for Black women.
In addition to the ideologically driven federal agenda to eliminate access to abortion, restrictive states are using the courts to attack access to medication abortion, despite decades of proven safety. In October 2025, Louisiana v. FDA sought to restrict access to mifepristone unless dispensed in person by a physician, which would ban mail distribution and stop pharmacies from filling prescriptions—even in states without abortion restrictions. Last month, the US Supreme Court issued a ruling that extended a temporary stay protecting telehealth and mail-order access to mifepristone while the case moves through the lower courts. This most recent attack on access to medication abortion—which accounts for over 60 percent of abortions in the US annually—is just one of the latest among the persistent and ongoing threats.
While states like Louisiana are pushing to make it more difficult to access essential care, other states across the country are fighting back by passing legislation to ensure reproductive freedom. As highlighted by State PAL, 20 states and Washington, DC, have acted to enshrine abortion rights in either the state’s constitution and/or state statute. The Virginia legislature advanced a bill this year that will bring the question of codifying reproductive rights to the ballot. In addition, Massachusetts and New York passed interstate shield laws this year to protect patients and providers from out-of-state criminal charges related to abortion care. Thirteen states have passed legislation requiring private insurance companies to cover abortion care, and 20 states have ensured that patients covered under that state’s Medicaid program will be able to be reimbursed for abortion care.
Efforts must continue at every level of policymaking to protect against the further erosion of bodily autonomy and reproductive freedom. State policymakers must continue to support and advance access to abortion care through efforts such as codification of rights, data privacy, interstate shields, and health care coverage. Federal lawmakers must similarly seek to protect and promote access to critical reproductive health care by reducing financial barriers to abortion care—such as opposing restrictions on coverage like the Hyde Amendment—and supporting efforts to legislate a nationwide right to abortion.
Learn more about what states are doing to protect abortion access and policy recommendations at IWPR’s State PAL. And see IWPR’s federal policy solutions in the Promoting Access to Abortion brief.
Our giving levels reflect real data from IWPR’s research—because evidence shapes not just our work, but how we invite you to support it.
