The Impact of Restrictive State Abortion Laws: State of the Research Evidence in 2025

The historic Dobbs v Jackson Women’s Health Organization Supreme Court decision of July 2022 abruptly ended almost 50 years of constitutionally protected access to abortion care, with legal oversight now residing within each state. As of October 2025, 12 states have near-total bans and another 6 states restrict abortion to between 6 and 12 weeks of gestation. As such, the current legal landscape is that 18 states comprising nearly one-third of the US population have implemented restrictive abortion policy. 

Extant research at the time of the Dobbs v Jackson decision suggested that restrictive abortion laws would likely have a significant negative impact on reproductive and obstetrical care access and practice, maternal and infant health outcomes, and the social and economic well-being of women and families (summarized in a literature review published in Milbank Quarterly in 2023). So, in late 2025 and nearly 3.5 years past the landmark court decision, what has in fact transpired?  

Although the wrecking ball of this Supreme Court decision is still swinging and the dust is far from settled, many conclusions can be drawn from the emerging research to date. First, the fact that 18 states ban or severely restrict abortion does not appear to have significantly reduced the number of procedures nationwide. According to estimates from the Guttmacher Institute, the number of abortions nationwide was estimated to be 930,000 in 2021, declining in 2022, and subsequently rising to over 1 million in both 2023 and 2024. In 2024, 63% of procedures were medication abortions and 25% were accessed via telehealth.

The total number of abortions across the country has clearly increased; and in 2024 an estimated 155,000 women in states with bans accessed abortions in neighboring legal states. It is also apparent, however, that the number of abortions in states with restrictive laws has dramatically decreased with some states reporting zero procedures. In addition, a recent study focusing on the 14 states with the most restrictive abortion policies found a ~2% increase in birth rates above trend predictions, particularly among racial and ethnic minorities, Medicaid beneficiaries, unmarried individuals, and those without a college degree. Thus, while the number of abortions nationwide has increased post-Dobbs, the evidence also suggests that restricting abortion has led to an increase in birth rates in restrictive states especially among subgroups with higher rates of negative birth outcomes.

Second, it is quite clear that restrictive policies are changing many aspects of obstetrical care access and quality. Within a year of the Dobbs decision, OB/GYN practitioners across the country began reporting new constraints and serious concerns. Of those practicing in states with abortion bans, 40% reported new constraints on their ability to provide care for miscarriages and other pregnancy-related medical emergencies, and 55% reported that their ability to follow standards of medical practice has been compromised. The post-Dobbs legal landscape, along with the Trump administration rescinding of guidance for the performance of emergency abortions, has also created myriad new challenges for OB/GYN practice, education, and training. There has been an exodus of both clinicians and medical residents in restrictive states, further exacerbating long-standing disparities in reproductive health care access.

In addition, careful population-based research is beginning to reveal some negative effects of restrictive abortion care policy on maternal and infant health outcomes. Time-series analyses comparing states with bans to more permissive states show that restrictive abortion laws are associated with a slight, non-significant increase in the overall rate of congenital anomalies but a significant increase in infants with cyanotic congenital heart disease. In addition, a recent (2025) literature review reported that while maternal mortality decreased by 21% in permissive states post-Dobbs, it rose 56% overall and 95% among White women in Texas during the first year of its post 6-week ban. Texas also experienced a 50% increase in maternal sepsis during this time. Another study found that 2023 maternal mortality rates in states with abortion bans increased and were twice as high as those in permissive states. Black mothers living in states with bans were 3.3 times more likely to die during pregnancy, childbirth or postpartum, controlling for prior trends.

Furthermore, research regarding infant mortality trends nationwide concluded that infant death rates in states after the adoption of an abortion ban were 5.6% higher than expected, especially among non-Hispanic Black women. A time-series analysis focusing on Texas found that in the year after the implementation of its 6-week abortion ban in 2021, infant mortality rates rose by 17% over expected, rising 21% for non-Hispanic Black babies.

Overall, the results of several studies combined suggest that states with abortion bans have experienced 22,000 additional births, 59 excess pregnancy-associated maternal deaths, and 478 excess infant deaths since Roe v Wade was overturned. These findings reinforce well-documented concerns that restrictive abortion policy would indeed have negative effects on birth outcomes and would also exacerbate existing social disparities in negative birth outcomes. 

Although prior research (including from the Turnaway Study) suggests that an increase in births due to restrictive abortion policy will have negative effects on family economic stability and child poverty, research on this topic post-Dobbs is currently scant. Of note, however, is an analysis of foster care data from 2000-2020 that found an 11% increase in foster placements after Targeted Regulation of Abortion Providers, or TRAP laws, were enacted, controlling for many factors. This rate was even higher for children from racial and ethnic minority groups. This study suggests that restrictive state abortion policies in the form of TRAP laws are associated with an increase in foster care placements.

It is clear that state abortion policy has been and will continue to be quite dynamic, with intense tensions between state legislatures and state constitutions. Over the past 3 years, state ballot initiatives brought by both legislatures and citizens have codified abortion protections in the constitutions of 11 states, although this method of abortion policymaking likely has peaked. State abortion policy action is also dynamic regarding several other key issues related to abortion care, including abortion telehealth restrictions, medication abortion regulations, and TRAP laws.

In sum, despite the dynamic and multidimensional nature of the legal landscape for abortion, the negative effects of restrictive state abortion policies are beginning to emerge. Although much more research needs to be conducted, the signals from the limited yet high-quality research to date reveal that restrictive abortion policy is having negative effects on medical practice and on maternal and infant health, while having only a small impact on abortion prevention. 

Furthermore, recent Trump administration cuts to the Centers for Disease Control and Prevention have gutted staff and essential data/surveillance systems in the Division of Reproductive Health, including programs focused on maternal health, contraceptive best practices, and assisted reproductive technology, raising many concerns about public health infrastructure for this and other core areas of population health. In addition, the forthcoming drastic cuts to Medicaid and the upheaval already leashed upon Planned Parenthood and other key components of the reproductive health care safety net are predicted to decrease access to contraception. The obvious result will be a further increase in the already high rates of unintended pregnancy in the United States, with additional cascading negative effects on public health and social welfare in the context of restrictive abortion policy. 

The near-term future is sure to bring continued tensions and ongoing policy change regarding abortion and reproductive health care at both the state and federal levels. What is crystal clear, however, is that we need solid population-based data to support sophisticated policy analysis, epidemiologic studies, and health services research on the effects of restrictive abortion policy on a wide range of outcomes. Regardless of political and ideological differences, everyone who cares about the health and well-being of children and families should agree that additional objective research based on high-quality data is essential to fully understand the reproductive health care experiences of women and public health realities in the post-Dobbs policy landscape. 

About the Author