By inhibiting drug development, economic growth, and military recruitment, as well as driving doctors away from the places they’re needed most, bans almost certainly harm you — yes, you.
Last year in Texas, federal Judge Matthew Kacsmaryk ruled that, based on his read of some very bad science, the Food and Drug Administration (FDA) needed to withdraw its approval of the safe and widely used abortion drug mifepristone. He claimed that the FDA hadn’t adequately considered its safety (it had) and that the lack of restrictions on the drug (there were plenty) had led to many deaths and severe adverse events (demonstrably false).
That case didn’t go away: On March 26, the US Supreme Court will hear arguments on whether one judge’s take supersedes that of an agency full of scientific experts. Although mifepristone remains available by mail and in some retail pharmacies — and will at least until the court issues its ruling in June — there’s already a lot of concern about how the decision could reverberate throughout the rest of American society. Not only are there concerns about access to the drug among people who need it for other reasons, but many also fear the case could threaten the FDA’s ability to do its job, which would in turn jeopardize the entire drug innovation ecosystem — a major contributor to the American economy.
The notion of a “butterfly effect” is sometimes used to describe situations where tiny, incremental events (like the flapping of a butterfly’s wings) have enormous and sometimes unpredictable downstream consequences (like a tornado). It’s a useful framework for thinking about the fallout of abortion policies: Although changes to these policies might not always be incremental, their consequences can be dramatic and often surprising — and can touch people, issues, and industries that go well beyond individual pregnancy terminations.
The last time the Supreme Court heard an argument on abortion was in 2022. That June, the court’s opinion in Dobbs v. Jackson Women’s Health Organization overturned the constitutional right to abortion, and experts say we’re only just beginning to see the repercussions of that decision.
“What happened in Dobbs has just opened the door for so many other things beyond reproductive care,” said Sabrina Talukder, who directs the Women’s Initiative at the Center for American Progress.
Restricting abortion means removing women’s control over not only their bodies, but also their futures — and giving that control to someone else. In a nation where sex education and contraception access are already spotty and about half of all pregnancies are unplanned, that act is a population-level assault on women’s autonomy. The result is a psychic wound even to those who aren’t seeking abortions.
On a more individual level, it also means many women are forced to carry unwanted pregnancies to term — an estimated 30,000 of them annually in the US, according to a recent estimate. Without being able to control their fertility, women are forced into a different set of educational and professional choices than they might otherwise make.
But that’s not where the impact ends. The tactics anti-abortion activists use to achieve their goals themselves constitute an assault on the American institutions and conventions that form the bedrock of many of our most trusted systems.
Some predictions of the consequences of restricting abortion are hypothetical. That doesn’t mean they’re not reasonable; it’s just that contemporary Americans have never lived in a world where our courts were so willing to subvert our institutions in service of anti-abortion ideology. Imagining the impacts of that subversion isn’t fantasy, it’s forethought.
To see real-world effects, we only need to compare states. Although the right to abortion was constitutionally guaranteed for a half-century after Roe, many state governments nevertheless systematically made abortions hard to get by enacting so-called targeted regulation of abortion provider laws, otherwise known as TRAP laws. These laws force abortion clinics to comply with all kinds of burdensome requirements to stay open, limiting abortion access in states that enacted them, and creating a sort of real-world laboratory allowing experts to compare outcomes in states with and without straightforward abortion access.
Here are nine repercussions that could follow — and in some cases, have already happened due to — the efforts of US anti-abortion activists.
1) They complicate miscarriage treatment and access to other health care
Although attacks on mifepristone center on its use in abortions, the drug is also used in treating miscarriages once they’re already in progress. Theoretically, it should be legal and accessible for miscarriage treatment even in states where abortion is now banned.
However, because the drug has been so politicized, women prescribed the drug to reduce bleeding and the need for surgical intervention after a miscarriage often can’t get it. This means that although the American College of Obstetricians and Gynecologists recommended mifepristone as part of miscarriage treatment in its 2018 guidelines, only 2.5 percent of women having miscarriages were getting mifepristone from their health care providers in 2020. Given how much its profile has risen since then, it’s unlikely access has improved much today.
Other effects on health care access result from OB-GYNs’ willingness to practice in states that restrict abortions. After all, it’s not only pregnant people who need OB-GYN care. These doctors also provide other types of care to women: They diagnose and treat sexually transmitted infections, cancers of the female reproductive tract, menopause, and a range of other conditions. Americans need OB-GYNs to help check out-of-control transmission of syphilis from mothers to babies.
2) They undermine FDA authority
One of the biggest fears experts have about the potential fallout of the Kacsmaryk case is about what the decision could mean for the FDA’s authority. In this case, a lower court judge used junk science — since retracted by the journals that published it — to make conclusions that he then substituted for the scientific and medical expertise of the FDA, said Amanda Banks, a physician and biotechnology entrepreneur, speaking at a press conference on March 14. If his decision holds, it will set a precedent “that anyone with an ideological or other disagreement, coupled with a scientifically untrained judge, can undo the scientific and medical expertise of the agency,” she said.
To be clear, among federal agencies, the FDA is no upstart pipsqueak. It’s not perfect, but the agency’s depth of expertise and its rigor in evaluating the risks and benefits of drugs and products set a global gold standard.
Allowing such a respected federal agency’s authority to be challenged — and cutting access to a drug it has approved — on the basis of an activist judge in a lower court would have consequences well beyond mifepristone, Banks said. The biggest immediate risks would likely be to products considered politically fraught, like contraception and IVF. Down the line, there would also be risks to products that are developed using certain living cells, among them many vaccines and therapies used to treat cancer and immune system diseases.
If successful, Kacsmaryk’s appeal could lead to sudden changes in other drugs’ availability due to lawsuits brought by people who object to those drugs on their own ideological grounds — or even by companies that might be seeking to remove a competing product for commercial gain. “There is a slippery slope here,” said Banks.
3) They chill pharmaceutical innovation
Developing one new drug typically costs a pharmaceutical company a minimum of a billion dollars. However, companies are willing to make that investment if there’s a good chance of proving the drug works, then selling it to a lot of people. The FDA is a key partner in making that happen.
If the Supreme Court lets Kacsmaryk’s decision stand, though, it would mean that other FDA decisions could easily be undermined by lower courts. That would inhibit investment and new research and development in the pharmaceutical industry, warned Banks. More than 700 biopharmaceutical executives have signed an open letter in support of the FDA’s authority; that “was entirely about the effect that this could have on the industry as a whole,” she said.
“The regulatory process that we rely upon as an industry is rigorous,” Banks said, and without a guarantee that the outcome of that rigorous process will stand once the FDA comes to it, galvanizing internal support for investing in risky therapies, diagnostics, and tests will be challenging for pharmaceutical companies, as will raising capital from venture capital or other private investors.
“In an uncertain world, the investment also becomes quite uncertain — and so it threatens the innovation potential of our industry,” she said.
4) They raise infant and maternal mortality
As part of providing pregnancy care, OB-GYNs sometimes have to terminate pregnancies due to complications that affect the viability of the fetus, the health of the mother, or both. In states that ban abortion, OB-GYNs cannot perform terminations without the risk of breaking the law. As a result, many of these specialists are leaving states with the most severe abortion restrictions. Additionally, medical trainees are avoiding these states because they know that in a state that does not permit abortion, they won’t get training in a key part of pregnancy care.
The lack of OB-GYNs is a major problem in the US, especially in rural areas. Where there aren’t enough OB-GYNs, there isn’t enough maternity care, which raises the risk of both infant and maternal mortality.
In a nutshell, banning abortion creates untenable working conditions for the exact health care providers whose job it is to preserve the lives of mothers and babies.
5) They reduce educational achievement and earnings, especially for Black women
When women have unplanned pregnancies in their teens and early 20s, it often derails their educational or career plans. Abortion access allows them more control over the timing of their fertility, which also gives them more agency to see their aspirations through. Indeed, since abortion was legalized in the early 1970s, rising access has increased women’s likelihood of starting college by 41 percent and raised their chances of graduating by 72 percent.
The link between abortion access and educational attainment is particularly pronounced for Black women, as are many of the worst consequences of obstructing abortion access. In this population alone, abortion access increases the likelihood of starting college by up to 200 percent and significantly increases the number of years spent in school.
Lower educational achievement means lower earnings. Pre-Dobbs, researchers estimated that for women living in abortion-restricting states, the gender pay gap widens an additional 5 to 6.5 percent for every TRAP law put in place.
When she imagines the fallout of abortion bans, “I think about people being able to feed their families, I think about patients that literally don’t have housing,” said Tracey Wilkinson, a pediatrician who specializes in reproductive health issues at Indiana University’s medical school. “The ripple effects are just so profound for families and communities.”
6) They decrease workforce participation and economic growth
Although creating children often involves both women and men, it should be news to zero people that historically, women have borne a much greater share of the parenting burden. The more women are forced to carry more pregnancies to term, the more women spend their time caring for children rather than working.
While mothering children is an option many women choose joyfully, a significant proportion opt to either delay or forgo that option when given the choice. Instead, many of these women choose to pursue other ambitions, often as part of the labor force.
Abortion restrictions remove that choice for many women, with real, large-scale economic consequences. In 2021, the Institute for Women’s Policy Research (IWPR) estimated abortion restrictions were costing state economies $105 billion annually by keeping women of childbearing age out of the labor force, lowering their earnings, and increasing job turnover and time away from work. Conversely, they found that eliminating abortion restrictions would increase the growth of the US labor force by an additional 500,000 women, leading to an increase in private sector earnings growth of more than 9 percent.
Nina Besser Doorley, who oversees policy and strategy for the IWPR, said her organization has just begun analyzing data from 2023 that will show how much impact Dobbs has already had on women’s workforce participation and earning potential. “We have every indication that the impacts of this decision have been absolutely massive on an individual level, as well as on a systemic level,” she said, “so I would be hugely surprised if any research that we got at this point showed anything else.”
7) They threaten military readiness
Limiting access to mifepristone as a means of having a safe and private abortion would create big barriers to recruiting women to the US Armed Forces, as three former Army, Navy, and Air Force secretaries recently wrote in a Washington Post editorial. Without mifepristone, women who are deployed would have to miss multiple days of work or travel long distances to get an abortion — a difficult thing to explain to an (often male) commanding officer, said Louis Caldera, former secretary of the Army and director of the White House Military Office, at the March 14 press conference. “The need for women to leave their units to go try to take care of their reproductive health care needs hurts their units,” and it could also hurt their promotion opportunities, he said.
As male interest in joining up has waned, the armed forces are facing a severe recruitment crisis. Women already make up 20 percent of the military, and as they are increasingly in recruiters’ sight lines, that number will likely rise.
But not if the cost is being unable to end an unwanted pregnancy, said Caldera. “When we put those kinds of barriers, it makes it harder to recruit, it makes it harder to retain, it makes it harder to keep and promote the very people we’ve invested in — who we need in the senior ranks.”
8) They increase the number of kids living in poverty and entering foster care
In the Turnaway Study, which gathered data between 2008 and 2010, 40 percent of women said they were seeking an abortion due to financial considerations related to the cost of raising a child. When financially strained women are forced to carry pregnancies to term instead of getting abortions when they know they cannot afford to have a child, the result is that babies are born into under-resourced homes. That raises the risk that those children, or other children in the home, will live in poverty or ultimately enter the foster care system.
A recent study examined the likely consequences of the Dobbs decision by looking at what happened in foster care systems pre-Dobbs in states with TRAP laws.
When the researchers compared states with and without TRAP laws, they found foster care placements increased 11 percent in states with these restrictions in the years after the laws were enacted.
That’s not only a tragedy for families and children, but also an expensive burden for taxpayers. Child welfare services, including foster care, currently cost the federal government billions of dollars; the more children who need those services, the more taxpayer money gets spent providing them.
9) They damage mental health
In a survey conducted before the Supreme Court overturned the constitutional right to abortion, women living in states with more abortion restrictions had higher rates of mental distress. In another study, states enforcing abortion restrictions between 1974 and 2016 had higher suicide rates in women of childbearing age in particular.
Post-Dobbs, these trends are unfortunately holding up: A recent study suggested that in states with trigger bans, anxiety and depression have risen while symptoms of these conditions have simultaneously decreased in states without these bans.
This is happening at a time when Americans are living in an age of broadly unmet mental health care needs: 122 million Americans live in areas with provider shortages, and only one-third of people diagnosed with a behavioral health condition get the care they need.
Even if you’re not seeking an abortion and you don’t think you ever will, it’s worth taking a moment to see what it looks like when a nation systematically undervalues women’s bodily autonomy. The examples here aren’t a complete list, experts told me — and anti-abortion advocates have no intention of stopping at abortion restrictions; advocates are already using many of the same tactics to undermine contraceptive access as they used to chip away at abortion access.
“It isn’t about abortion, it’s about control — abortion was just the first thing. And now that the floodgates are open,” said Wilkinson, “I’m surprised by how quickly the other side is moving.”
