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A Troubling Post-Roe Landscape for the Health of Moms and Their Babies

On indicator after indicator, health care lags in the states that ban abortion or are likely to in the wake of the Supreme Court’s ruling. Will the abortion-ban states be able to catch up?

A row of newborn babies in cribs in a health-care facility.
Texas was one of the first states to pass a “trigger law,” outlawing abortions in most circumstances 30 days after the Supreme Court ruled Roe v. Wade unconstitutional. When the court’s draft opinion overturning Roe leaked back in May, Republican legislators said they were gearing up for the next step: strengthening health care and other services for women and children. “It only makes sense,” Rep. Steve Toth told reporters. “The dog’s caught the car now.”

Rep. Giovanni Capriglione agreed. “We have to now work really hard to help these new moms and these new babies.” For Toth, “it means prenatal care, helping them stay in school. It means making sure that we help women once the baby is born, it means adoption services.”

For Texas mothers facing a post-Roe world, however, there is a huge mountain to climb in finding that help now. In recent years the state has ranked 40th in the country in mothers’ health as measured by its maternal mortality rate, 49th in the share of children with health insurance and 22nd in its rate of adoptions. To say that Texas needed to work really hard to help its moms and babies was a huge understatement.

Texas certainly isn’t alone. The Guttmacher Institute, which researches reproductive health, counted 26 states that either banned abortions when the Supreme Court issued its ruling in June or were likely to do so soon thereafter — 13 states that already had trigger laws in place and another 13 expected to follow with bans of their own.

Compared with the states likely to continue allowing abortions, the 26 abortion-ban states only insure two-thirds as many children 18 years old or younger. Maternal mortality is two-thirds higher. Infant mortality is 30 percent higher. Their average ranking in one of the most comprehensive health-care performance comparisons, conducted by The Commonwealth Fund, is only half as high.

The differences spill over into other health issues as well. The states pursuing abortion bans, for example, have had a COVID-19 death rate 30 percent higher than the states permitting abortion. Their COVID-19 vaccination rate has lagged that of states expected to continue to allow abortions by 15 percentage points. Twenty-five percent more individuals in states with abortion bans have poor dental and oral health. One-fourth more children suffer from food insecurity. And of the dozen states that have not expanded the Medicaid program under the Affordable Care Act, 10 have abortion bans.

As always in American federalism, there are variations even among the states that are banning abortion and those that are expected to continue to allow it. Infant mortality in Iowa, which bans abortion after 22 weeks, is 4.27 per thousand live births, far below the average of all of the states banning abortion or expected to. In comparison, infant mortality in North Carolina, which permits abortions, is 6.76 per thousand live births, far above the average for states permitting abortion. In West Virginia, a state banning abortion, maternal mortality is 12.9 per 100,000 in population, half the average of all of the states with abortion bans. New Jersey, which permits abortion, has a maternal mortality rate of 38.1 per 100,000, more than twice as high as the average of the states that allow abortion.

But when all of the states with abortion bans or expecting to enact them are compared to those where the procedure is expected to remain legal, a clear picture emerges:
Abortion bans and health care
Sources: abortion bans (Guttmacher Institute); COVID-19 deaths and vaccinations (New York Times); infant mortality (CDC); uninsured children (Commonwealth Fund): children’s food insecurity (Annie E. Casey Foundation); maternal mortality (World Population Review); dental care (American Dental Association); state health system performance (Commonwealth Fund)
The promise of the trigger states to help the new moms and babies thus lags far behind their performance. Catching up will require a massive investment in health care among states that for the most part have already proven themselves either unwilling or unable to increase that category of spending significantly.

The federal government has grant programs available for many of these challenges. The Department of Health and Human Services, for example, has a $350 million program “to support safe pregnancies and healthy babies,” as HHS puts it, and there’s an ongoing block grant program for maternal and child health. There’s a big collection of other initiatives, from CDC research to newborn screening and research funded by the National Institutes of Health. Federal efforts run into the billions of dollars.

Nevertheless, there are what the March of Dimes calls “maternity care deserts” throughout the country: places where women don’t have adequate access to maternity care. The result, the organization concludes, is higher rates of serious health problems and deaths for both mothers and babies. And the United States doesn’t fare well in international comparisons: It has double the maternal death rate of other high-income countries — 10 times higher than that of New Zealand and Norway, in fact.

The nation’s big problems in providing health care to moms and babies is an enormously important backstory of the Supreme Court’s decision in Dobbs v. Jackson, and there’s no escaping the fundamental point: For the most part, the states creating abortion bans lag well behind those allowing abortion when it comes to health care in general, and for mothers and children in particular. While some lawmakers in abortion-ban states may be sincere in their promises to do more for moms and their babies, they have a long way to go to catch up.

Governing's opinion columns reflect the views of their authors and not necessarily those of Governing's editors or management.
Donald F. Kettl is professor emeritus and former dean of the University of Maryland School of Public Policy. He is the co-author with William D. Eggers of Bridgebuilders: How Government Can Transcend Boundaries to Solve Big Problems.
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