The Road to Parenthood: How Abortion Bans and Travel Barriers Impact Births

The study by NBER and the Society of Family Planning finds that abortion bans significantly increase birth rates, particularly in areas where travel distances to legal facilities expand and appointment availability is limited. Despite telehealth and financial aid expansions, geographic and socioeconomic barriers continue to restrict abortion access, disproportionately affecting marginalized communities.

A study by the National Bureau of Economic Research (NBER), supported by the Society of Family Planning, examines how abortion bans in the United States have affected birth rates, focusing on travel distances and appointment availability. Authored by Caitlin K. Myers, Daniel L. Dench, and Mayra Pineda-Torres, the research employs a difference-in-differences approach to analyze county-level birth data and access to abortion services. The study finds that total abortion bans significantly increase birth rates, but the magnitude of their impact depends on how far individuals must travel to obtain an abortion. Even in counties where abortion facilities remained within reach, birth rates increased by 1.0%, indicating a "chilling effect" due to legal uncertainty and logistical barriers. In counties where the nearest abortion facility was previously 50 miles away but increased to 300 miles post-Dobbs, birth rates rose by 2.8%. Further, in areas where appointments at nearby facilities were constrained, births increased by an additional 0.4 percentage points. These findings reveal that distance and appointment availability play a major role in shaping reproductive outcomes following restrictive abortion policies.

Disproportionate Impact on Vulnerable Communities

The study highlights that abortion bans disproportionately affect marginalized groups, particularly Black and Hispanic women, unmarried women, and those with lower educational attainment. Birth rates increased by 3.8% among Hispanic women, 3.2% among Black women, and 2.0% among White women. Similarly, unmarried women experienced a 3.5% rise in births compared to 1.8% for married women. Educational attainment also played a crucial role, with births increasing by 3.1% among women with only a high school diploma or less, compared to just 1.3% among college graduates. These disparities reflect not only higher unintended pregnancy rates among these groups but also greater challenges in overcoming barriers to abortion access. Low-income individuals are more likely to struggle with the financial and logistical burdens of traveling long distances, taking time off work, arranging childcare, and securing transportation. The findings reinforce that abortion bans are not applied equally across populations and tend to exacerbate existing social and economic inequalities.

The Role of Telehealth and Financial Support

Following Dobbs, efforts to expand abortion access through telehealth services and financial aid saw a dramatic increase, but these measures have not fully offset the barriers posed by increased travel distances. Abortion funds witnessed an 88% rise in donations, distributing $37 million to over 102,000 people, covering approximately 10% of all abortions. Telehealth abortion services also grew, with the number of virtual clinics increasing from 11 to 20, and telehealth abortion rates nearly doubling from 13,590 in Q2 of 2022 to 22,430 in Q2 of 2023. While these advancements have expanded access in states where telehealth abortion is permitted, they have not eliminated geographic disparities. In states with abortion bans, telehealth options remain restricted or entirely inaccessible, leaving many individuals with no choice but to travel long distances. Initially, telehealth services like Aid Access relied on European doctors and Indian pharmacies, meaning abortion pills could take 2 to 4 weeks to arrive. However, with the emergence of "shield laws" in states like California, Massachusetts, and New York, U.S.-based providers are now shipping abortion pills more quickly to those in ban states. Despite these efforts, the research finds that distance continues to be a major factor in determining whether individuals can access abortion care.

Persistent Effects of Bans Over Time

One of the study's key findings is that the effects of abortion bans on birth rates have remained stable over time. Using state-level birth data from 2023 and provisional data from 2024, researchers found no evidence of a decline in birth rates associated with bans, even as abortion funds and telehealth services expanded. This suggests that legal and logistical barriers remain significant obstacles for those seeking abortion care. Even in states where abortion remains legal, increased demand from out-of-state patients has placed significant strain on clinics, resulting in longer wait times and reduced appointment availability. In counties where destination facilities were overwhelmed by increased patient volumes, birth rates rose further. The study also indicates that in the second full year following Dobbs, abortion bans continued to shape reproductive choices, demonstrating the long-term impact of these policies.

State-Level Differences and Policy Implications

The study reveals considerable variation in the effects of abortion bans across different states. States enforcing near-total bans, such as Texas, Louisiana, and Alabama, experienced the highest increases in birth rates, particularly in rural areas where residents had to travel hundreds of miles for abortion services. In contrast, Missouri, which had already implemented severe abortion restrictions before Dobbs, saw smaller increases in births because many residents were already traveling out of state for care. The most significant increases in births were observed in counties where both travel distances and appointment constraints were most severe. In parts of Texas, Oklahoma, and Louisiana, where the nearest abortion provider was over 200 miles away and appointment availability was highly limited, birth rates rose by nearly 5%. Conversely, counties that maintained shorter travel distances or had more open appointment availability saw smaller changes in birth rates.

These findings highlight the deeply uneven impact of abortion bans and emphasize the critical role of geography in shaping reproductive health outcomes. While telehealth expansion and financial assistance programs have provided some relief, they have not fully mitigated the effects of increased travel burdens. The study underscores the importance of considering both legal and logistical factors when evaluating the impact of abortion restrictions. Policymakers aiming to address reproductive healthcare disparities must consider strategies that go beyond legal protections, including improving transportation infrastructure, funding abortion funds, and expanding telehealth services. The persistence of these disparities demonstrates that abortion bans function not only as legal restrictions but also as mechanisms that reinforce broader economic and racial inequalities in access to reproductive care.

Ultimately, the research provides crucial evidence that abortion bans do not just eliminate access in a binary sense but create significant structural barriers that disproportionately affect already disadvantaged groups. While abortion remains legal in some states, these policies have created a fragmented landscape where access is highly dependent on one's socioeconomic status and geographic location. The continued rise in birth rates in ban states suggests that, even as alternative services expand, the burden of accessing abortion care remains substantial for many.