In June 2022, the U.S. Supreme Court overruled Roe v. Wade, effectively ending 50 years of federal protections to abortion care. As of October 2023, twenty-six states have since enacted laws to ban or restrict abortion access, with 14 states completely banning the procedure. Today, an estimated 25 million American women of childbearing age, or about one third of women ages 15 to 45, live in areas where abortion care is severely restricted. Historically, many states were able to restrict access to abortion even before 2022 through Targeted Regulation of Abortion Providers (TRAP) laws; these laws decrease abortion volumes by legally limiting the number of abortion-providing facilities.
With more than 4 million children placed into foster care during the study period, researchers at Beth Israel Deaconess Medical Center (BIDMC) and Bentley University used state-level data to evaluate the link between restricted abortion access and subsequent entries into the foster care system. The findings, published in JAMA Pediatrics, reveal fewer children conceived in years when abortions were more accessible were subsequently placed into foster care. Conversely, first trimester pregnancy in a state with a TRAP law in place was associated with an overall 11 percent increase in children entering the foster care system.
“Limited access to abortion has significant personal impacts for the mothers and children affected, but also broader national economic and policy-level implications,” said senior author Ashley L. O’Donoghue, PhD, an economist in the Center for Healthcare Delivery Science at BIDMC. “With the repeal of Roe v. Wade, and many states already facing overburdened foster care systems, it is important to study the impact that restricted abortion access has on the foster care system to help inform future policy changes.”
To compare the number of children conceived between 1990-2011 and placed in foster care between 2000-2020 in states with and without TRAP laws, O’Donoghue and colleagues looked at the comprehensive Jones and Pineda-Torres data on state-level TRAP laws enacted since the 1970s and federal data from the Adoption and Foster Care Analysis and Reporting System. The team found an overall increase in foster care entries in states with restrictive abortion laws, compared to states without them, including a 15 percent increase for Black and racial and ethnic minority children in states with TRAP laws.
“Our findings highlight the complex interplay between race, socio-economic status and abortion, noting that those who are less able to provide for their children may be the most vulnerable when denied an abortion,” said O’Donoghue, who is also an instructor in medicine at Harvard Medical School. “Additionally, the race-specific findings are particularly salient. Policies that restrict abortion may contribute to the overrepresentation of racial and ethnic minority children in the foster care system, perpetuating inequities and further straining vulnerable populations.”
When the team compared states with TRAP laws to states without a decade before the laws’ enactment, they saw few differences in foster care entries. However, when they compared states with and without TRAP laws a decade after the laws were enacted, they saw the increases in children entering the foster care system persisted.
“The ripple effects are persistent for years after the TRAP law’s passage, resulting in lasting effects on foster care systems,” O’Donoghue said. “Our findings suggest that overturning Roe vs. Wade could have significant consequences for the foster care system and beyond in years to come.”
Co-authors included Noa Talmor, BS, Molly H. White, MS-ACMS, Caryn Dutton, MD, MS, and Ashley L. O’Donoghue, PhD of BIDMC and corresponding author Savannah Adkins, PhD, of Bentley University.
This work was not supported by any outside funding.
O’Donoghue serves as a volunteer case reviewer for the Massachusetts Department of Children & Families’ Foster Care Review Unit. Talmor works full-time at IQVIA, a health data company, within the Market Access Strategy Consulting division.
About Beth Israel Deaconess Medical Center
Beth Israel Deaconess Medical Center is a leading academic medical center, where extraordinary care is supported by high-quality education and research. BIDMC is a teaching affiliate of Harvard Medical School, and consistently ranks as a national leader among independent hospitals in National Institutes of Health funding. BIDMC is the official hospital of the Boston Red Sox.
Beth Israel Deaconess Medical Center is a part of Beth Israel Lahey Health, a health care system that brings together academic medical centers and teaching hospitals, community and specialty hospitals, more than 4,800 physicians and 38,000 employees in a shared mission to expand access to great care and advance the science and practice of medicine through groundbreaking research and education.