This analysis examines the post-Dobbs decision policy landscape and its impacts on the US maternal health crisis and proposes policy solutions for addressing restrictive abortion policies.

Methods

The impacts of restrictive abortion policy on marginalized and vulnerable populations were analyzed using the CDC Analytical Framework and the Racial Equity and Policy (REAP) Framework. The analysis also explored policy options for ensuring equal access to abortion care at both state and federal levels.

Results

Health disparities are exacerbated in reproductive-age women following the Dobbs decision with bans or restrictions impacting over 23 million women of reproductive age. These inequities are in addition to underlying health disparities driven by structural racism including the physical environment, income, and insurance status. Policy recommendations at the federal level like reversing the Dobbs decision or supporting the EACH Act have low political feasibility during the current administration. The most impactful and feasible policy options are state-led initiatives reforming state Medicaid programs to segregate state and federal monies and mandating private, public, and marketplace insurance plans to cover abortion services under the plan’s maternity care benefits.

Conclusion

Accessibility and affordability of abortion care are critical determinants of perinatal health outcomes. Thus, restricting access and/or affordability contributes to an increase in the number of women coerced to continue a pregnancy, inherently increasing risks for perinatal health complications and mortality. While federal level action would be most efficacious and equitable, state-level policy action is most feasible to increase access to abortion in the current administration.