State abortion bans more frequently affect Black, White, American Indian women

Credit: Pexels / Tima Miroshnichenko

White, Black, and American Indian / Alaskan Native women of reproductive age may be more adversely affected by statewide abortion bans than other racial and ethnic groups, according to new data.¹

A national study of racial and ethnic demographics affected by US state policies limiting or banning abortion after ≤6 weeks’ gestation showed that groups including Black women of reproductive age were up to 59% more likely to live in a state that banned abortions versus a state without such laws. Amid an era of shifting policies following the Supreme Court removal of constitutional protection of abortion in Dobbs v Jackson Women’s Health Organization,² the findings highlight the disparate means by which women may be affected by abortion laws.

A team of investigators led by Demetri Goutos, MBA, of the department of health law, policy and management at Boston University School of Public Health, sought to assess the race and ethnicity of reproductive-age females in states that implemented restrictive abortion policies following the 2022 Supreme Court ruling, compared to states that did not adopt abortion policies.¹

“Reduced access to reproductive health care is associated with racial and ethnic disparities in pregnancy-related morbidity and mortality in the US,” investigators wrote. “Since (Dobbs v Jackson), several states have restricted abortion access entirely or limited abortions to 6 weeks’ gestation or less, coinciding with the average timing of pregnancy discovery and precluding most individuals from legally accessing abortion.”

Goutos and colleagues used state-by-state abortion policy data from the State Abortion Policy Tracker, stratifying states based on their adoption of an effective abortion ban (any ban of abortion at any gestational age or post-6 weeks’ gestation); a limited abortion access law (banned abortion between 6 and 23 – 24 weeks’ gestation); and available abortion access (no law).

The rates of females of reproductive age of each race and ethnicity were defined for each state with effective abortion bans and compared to states with limited or fully available access to abortion. Investigators estimated prevalence ratios (PRs) as well as percentage-point differences between the groups to define disparities.

Through November 2023, 15 states had entirely banned abortion; 2 states banned abortion post-6 weeks’ gestation; 10 states had limited access to abortions; and 24 states maintained full abortion access. Investigators observed approximately 43.8 million women of reproductive age in states with effective abortion bans, versus 106.3 million in the comparison group.

Among the states with effective abortion bans, 55.5% of reproductive-age women were White, 18.8% were Black and 18.8% were Hispanic. In the states without bans, the rates were 54.2%, 11.9%, and 22.1%, respectively. The team observed higher proportions of reproductive-age women living in a state with an effective abortion ban for 3 race and ethnicity groups:

• American Indian or Alaskan Native (0.88% vs 0.75%; percentage point [pp], 0.13; PR, 1.17)
• Black (18.85% vs 11.88%; pp, 6.97; PR, 1.59)
• White (55.50% vs 54.20%; pp, 1.31; PR, 1.02)

Another 4 race and ethnicity groups had a greater proportion of women living in states with full abortion access, including Asian; Hispanic; Native Hawaiian or Other; and multiracial.

Though the study may have been limited by the reliance on survey-based US census data to estimate populations, the team concluded their findings showed that a higher proportion of American Indian/Alaskan Native, Black and White females of reproductive age were living in states with effective abortion bans than in states without such laws. They advocated for the pursuit of policies that ensure these subpopulations receive adequate reproductive health care access, to reduce already present health disparities.

“Although these restrictive laws were not based on race, they were concentrated in states with higher proportions of American Indian or Alaska Native and Black individuals, resulting in a differential effect of restrictive abortion laws in these groups,” investigators wrote. “American Indian or Alaska Native and Black populations are disproportionately affected by disparities in pregnancy-related deaths, reproductive health, and poverty.”

References

1. ^{Goutos D, Cesare N, Vu C, et al. Race and Ethnicity of Reproductive-Age Females Affected by US State Abortion Bans. JAMA. Published online May 01, 2024. doi:10.1001/jama.2024.6023}
2. ^{Petronelli M. US Supreme Court overturns Roe v Wade, eliminating abortion rights. Contemporary OB/GYN. Published June 24, 2022. https://www.contemporaryobgyn.net/view/us-supreme-court-overturns-roe-v-wade-eliminating-abortion-rights}