When the Supreme Court ruled on Dobbs v. Jackson Women’s Health Organization in June 2022, the decision upended fifty years of precedent by overturning Roe v. Wade – and created a legal quagmire that continues to play out on a state level across the country. In the wake of the decision, the accessibility of abortion is caught up in a complex web of state laws, legal challenges, and the threat of further restrictions – complicated by perennial challenges to accessibility like cost. More than any time in the last five decades, access to reproductive health care is dependent on where you live and how your state’s laws protect – or restrict – abortion access.

In the weeks following the decision, the Institute for Women’s Policy Research launched a new tool to provide a snapshot into the disparities in reproductive rights and healthcare across the United States, and to help policymakers understand the impacts of Dobbs and abortion restrictions on women’s economic well-being. The Reproductive Rights Index, produced as part of IWPR’ Status of Women in the States Initiative, provides a data-driven look at how much reproductive health care access differs based on where you live, and puts a numerical value on some of the consequences of restrictive policies.

Of the five states that ranked the lowest in the Index, three (Arkansas, Missouri, and South Dakota) are – as of writing — enforcing total bans on abortion. The law now in effect in the lowest-ranked state, Missouri, is one of the most draconian restrictions in the country: a complete ban, with no exceptions for rape or incest. A total ban in the second lowest-ranked state – Idaho – is scheduled to take effect in the coming days but is at the center of a Justice Department lawsuit because of its potential to deny emergency treatment to patients facing dire health risks (in the meantime, a separate bill now in effect means that abortion is already heavily restricted in the state).

Not only do these laws infringe on women’s rights, they also cost state economies billions of dollars. In the five states that rank lowest in the Index, the annual economic loss from abortion bans and other restrictions on reproductive health services is approximately $8.5 billion. In the state of Texas, home to one of the most restrictive abortion bans in the country, the economic loss to women and the state economy is $14.5 billion annually. And while these bans and restrictions impact everyone, they have a disproportion impact on women of color and lower-wage workers – people who also experience systemic racism and other structural barriers to obtaining reproductive health services.

IWPR’s Index underscores the full implications of these bans for individual people, as well as the entire economy and civic system. The data is clear: access to the full range of reproductive health services – including abortion – is linked to other indicators of well-being and progress for women. States that rank near the bottom of the index on reproductive rights also come in at the bottom on these other indicators – including employment and earnings, political participation, and educational attainment and opportunity. These states are also less likely to have strong family policies, such as paid family or medical leave.

To put a finer point on it – not only do women in Missouri face higher barriers to reproductive health care than women in New Jersey, the highest ranked state in the index, they also, on average, make less money. They’re less likely to have a college degree. And these things aren’t coincidental – they’re the result of policy changes that fail to prioritize women, the realities of their lives, and their health needs.

In late July, IPWR hosted a webinar launching the report in which IWPR President and CEO Dr. C. Nicole Mason was joined by a panel of experts highlighting the impacts of abortion bans and other restrictions on reproductive health services and ways that different communities are responding to this crisis moment in reproductive health. With insights into the business community and philanthropic activities, as well as highlighting some of the policy work and organizing that’s striving to ensure access to care and fill the gaps in the wake of the Dobbs decision, the webinar provides a snapshot of the ways this decision is playing out across the country.

The evidence all adds up to one thing: policy change is necessary, on both the state and the federal levels, to ensure access to reproductive health care. IWPR’s policy recommendations include:

• Codifying and protecting the right to abortion. States should enact laws to ensure that women to have access to a full range of reproductive health services, including abortion.
• Improving access to abortion. States should improve access to abortion by removing restrictions and barriers to access – things like restrictions on insurance coverage for abortion services, mandatory waiting periods, parental consent/notice, and lack of proximity to an abortion provider.
• Requiring insurance coverage of comprehensive reproductive health care services. States should require insurance coverage of the full spectrum of reproductive health care, including abortion, contraception, and infertility services.
• Requiring inclusive, comprehensive, and evidence-based sex education. States should support and invest in this education in schools.