Abortion bans and restrictions limit women's participation in the workforce, according to a new analysis that quantifies the negative impacts on state economies.

South Dakota saw an average loss in GDP of nearly 1% per year between 2021 and 2023, due to a drop in labor force participation by people who became pregnant and didn't have access to abortion care, according to data from the Institute for Women's Policy Research. That adds up to nearly $641 million in economic losses to the state.

Jamila Taylor, president and CEO of the Institute for Women's Policy Research, said the 16 states with abortion bans or extreme restrictions, including South Dakota, are costing the national economy $68 billion annually.

"Not only do these restrictions and bans have a clear impact on the health and well being of people with the ability to get pregnant, they also have an impact on their productivity and their economic position in life," Taylor said.

Taylor added abortion access not only helps family finances, but also allows women ages 15 to 44 to engage more broadly in society -- in local communities or politics, for example.

Despite restrictions, abortion numbers are rising. The first full calendar year after the Dobbs decision overturned Roe v. Wade saw an 11% increase in abortions since 2020 - or over one million abortions in the formal health care system in 2023, according to The Guttmacher Institute.

If voters pass South Dakota's constitutional Amendment G in November, it will enshrine protections to abortion.

Hannah Haksgaard, University of South Dakota law professor, said even if it passes, people seeking an in-state abortion would likely see a lag time before services become available.

"There would still likely be state legislation that would try to restrict abortion in certain ways, and then the question would become whether those restrictions violated the new constitutional amendment," she said.

Haksgaard added that could make providers move slowly on offering abortion services in the state, until the legal issues are settled.


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A recent survey of OB/GYNs in the state shows that doctors are concerned and confused by Texas' abortion ban. 76% of doctors surveyed say they feel like they can't practice medicine according to best practices and evidence-based medicine, and 60% of those who responded fear legal repercussions.

Dr. Damla Karsan, an ON/GYN with Comprehensive Women's Healthcare in Houston, said the guidelines are not clear.

"The question is how sick does a woman have to be, how close to death does she have to be to be confident that the state will deem that the intervention was warranted? There's just really no clarity around this," she said. "It's a very murky area."

Texas adopted the "heartbeat bill" in 2021 that bans abortions as early as six weeks into a pregnancy. The legislation makes exceptions for a life-threatening physical condition, or a serious risk of substantial impairment of a major bodily function.

Those in the medical field say they're concerned the abortion law will create a shortage of OB/GYNs in the state. Many of those surveyed say they're considering retiring early or leaving Texas because of the legislation and 57% of resident physicians say the abortion law is relevant to their decision about staying in the state after residency. The law will negatively impact low income and rural patients, Karsan said.

"We already have one of the highest maternal mortality rates, and we have some staggering numbers of counties in the state of Texas that don't even have an OB/GYN, and so that's going to get worse. And as usually happens it's those individuals that have the least access to care, are going to be hurt the most," she continued.

Karsan has been involved in two legal challenges to the abortion ban, including the case of Kate Cox.
The Houston mother of two received national attention after traveling to another state to obtain an abortion after it was determined her third child would not survive, prompting one message from Karsan for Texas lawmakers.

"Abortion is healthcare and healthcare decisions are complicated, and those decisions really should be left to individuals who have years and years of training to be able to navigate this space. And, this is not political; this is medical," she argued.


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In the race for New Hampshire governor, the candidates' positions on reproductive rights could be a deciding factor.

Pollsters have said it is a dead heat between Democrat and former Manchester Mayor Joyce Craig and Republican former U.S. Sen. Kelly Ayotte, and both claim to champion women's health.

Kayla Montgomery, vice president of public affairs for the Planned Parenthood New Hampshire Action Fund, said Ayotte voted for a national abortion ban while in the Senate and supported the Supreme Court overturning Roe v. Wade.

"We can't put our trust in someone who has been against abortion rights and against reproductive freedom her entire career," Montgomery contended.

Ayotte said if elected, she would not change the state's current law, which allows for abortions up to 24 weeks of pregnancy, or back new restrictions.

Craig said she would work to codify abortion rights into the state constitution. New Hampshire is the only New England state without an explicit legal right to abortion care.

Ayotte said her opponents are "politicizing abortion to win votes" but her previous board position with the right-leaning nonprofit Winning For Women is raising questions about her pivot to a more moderate approach. The group has spent millions backing anti-choice candidates for office and Ayotte herself backed bills to remove insurance coverage for birth control.

Sen. Debra Altschiller, D-Stratham, said Ayotte has grown out of step with New Hampshire voters.

"She instead decided to get on board with an extreme right-wing agenda on limiting reproductive health care for the people of her own state," Altschiller asserted. "We remember."

Altschiller added reproductive freedoms are under attack at the State Capitol, despite a majority of voters backing abortion rights, and thinks Craig would serve as a firewall in the governor's office to ensure protections. She noted Craig has also committed to nominating pro-choice justices to the state Supreme Court, where there is a retirement coming up in 2026.


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By Kylie Marsh for the Charlotte Post, with support from the Pulitzer Center on Crisis Reporting.
Broadcast version by Shanteya Hudson for North Carolina News Service reporting for the Charlotte Post-Public News Service Collaboration.

Tomeka Isaac was 35 weeks pregnant in 2018 when she suddenly fainted.

At the emergency room, Isaac and her husband were told that their son, Jace, died in utero. Without time to process, Isaac was also informed that she had HELLP syndrome (Hemolysis, Elevated Liver enzymes and Low Platelet) with no further explanation and transferred to an emergency room to be induced.

Bereaved, Isaac investigated her medical records to determine how the baby died and whether it was preventable.

At 40, Isaac was at a heightened predisposition for preeclampsia, or high blood pressure during pregnancy. A 2021 report by the American Journal of Public Health found that Black women were five times more likely to die from heart and blood pressure-related conditions than white women, according to data between 2016-17. The report also found pregnant and postpartum Black women were two times more likely than white women to die of severe bleeding or vessel blockages.

“I checked all the boxes that they say is a cause of maternal death or stillbirth,” Isaac said. “I went to all my appointments, I had access to all other resources that I thought I needed, I had Blue Cross Blue Shield, I was going to a provider that I had been going to for years.” Isaac explained that she isn’t the typical victim of Black perinatal mortality. “When you check all those boxes, we still have a disparity.”

Never during Isaac’s pregnancy was a urine sample collected, and she has no idea why. If it were, doctors would have been able to detect preeclampsia much earlier.

Isaac’s experience is only one example of medical mistreatment or neglect women of color face at exponential rates in North Carolina.

Alexis Garrett knew she was considered a “high-risk” pregnancy because she was overweight and over 35 years old when her son Maui was born in 2020. She was referred to a “high-risk clinic,” Novant Maternal Fetal Medicine.

Garrett is acutely aware of the stigma placed against women like her in healthcare settings. She’d witnessed friends, cousins and acquaintances lose their lives or their babies due to birthing complications in hospitals.

“I try to limit my interactions with the healthcare system,” Garrett said. “I’ve always been kind of leery about it. As I grew older, you know, you hear the whispers and, oh somebody died here and somebody died there,” Garrett said. “[Providers] think we’re faking our pain, or have a higher pain tolerance,” she said. “For this reason alone, we are so unprotected and so unheard.”

One of Garrett’s friends, who also gave birth on the same day Maui was born, ended up losing her baby. Garrett delivered Maui vaginally at 26 weeks.

At a rate of 14%, Black infants are twice as likely to be born weighing less than 5.5 pounds than white infants (7%); the highest rate of any ethnicity. Similarly, the rate of premature births for Black infants, 14.6%, is the highest for premature birth rates, which can also contribute to low birthweight.

The U.S. Department of Health and Human Services Office of Minority Health reports that Black women have the highest rates of obesity compared to other groups in the United States, and that about 4 out of 5 Black women are overweight or obese. Last year, the Brookings Institute published research analyzing the distribution of grocery stores in several large U.S. cities. Grocery stores are less likely in Black-majority neighborhoods, regardless of the average household income of those communities. Feeding America reports that 1 in 5 Black people in America were food insecure in 2021, Black families’ poverty rate of 17.1% was higher than compared to the nationwide rate of 11.5%.

With a comprehensive view of the prevalence of these health conditions in the Black community, one can get a clearer picture of the source of the poor treatment, and poorer health outcomes, for Black mothers and their babies.

When having her daughter Hiro in 2021, Garrett was dealing with even more stress due to the murder of her partner, Horace McCorey. There are many stressors of daily life that have serious physiological health impacts on Black birthing people.

Author and doula Sabia Wade wrote about the effects of “weathering,” or the impact of stressors, in the 2023 book “Birthing Liberation: How Reproductive Justice Can Set Us Free.” For example, Wade reports the heightened frequency of Black people’s involvement with the criminal justice system, including deadly interactions, and high rates of unemployment especially following the COVID-19 pandemic in 2020.
A 2023 report from the United States Department of Justice states that an estimated 1 in 19 Black adult U.S. residents was under correctional supervision in 2021.

The U.S. Bureau of Labor Statistics reported that unemployment amongst Black adults was 11.4%, despite the average rate (among all demographics) of 8.1% in 2020.

“We don’t know if these people have hoods on when they treat us,” Garrett said, alluding to traditional headwear of Ku Klux Klan members.

Garrett’s second pregnancy presented just as much difficulty. At a routine checkup for her daughter Hiro, Garrett was again pressured for a Cesarean section.

“At this point, I was getting an attitude,” she said. “There [weren’t] any measures being taken to try to get this baby from being born early.”

Garrett had been informed she had a “low cervix,” also sometimes called an insufficient cervix, which can also lead to premature birth. Her friend was given a cervical stitch, also known as a cerclage.

“I’m literally telling them ‘You will not make me have this baby. I will not be bullied into having this baby.’”

Eventually, Hiro’s heart rate dropped to dangerous levels, and Garrett started passing clots. The baby was delivered by emergency C-section at 23 weeks.

After delivering, Hiro was whisked away to the NICU. Garrett also noticed that little Hiro had a large scar on her back, and one around her arm. Garrett was told that the scar around her daughter’s arm was possibly from the umbilical cord being wrapped around it, and the scar on her back was from a bacterial infection from her placenta. Garrett is distrustful and feels completely dismissed.

“Every question I ask, I’m getting deflective answers,” she said. “The scar looks like a third-degree burn. Somebody screwed up.”

To make things worse, when Garrett complained about the scar, a doctor suggested plastic surgery.

Thirty-six hours after her c-section, the hospital’s wound team informed Garrett her skin was necrotizing: a fast-spreading bacterial infection that causes tissue death. However, the no one explain what necrotizing meant as she spent 38 days in the hospital recovering before leaving “half-dead” with a walker.

“I have to live with these scars,” Garrett said.

Earlier this year, the North Carolina Maternal Mortality Review Committee reported that bias and discrimination contribute to traumatic and near-death experiences. It can manifest in terms of race or ethnicity, weight, geography, substance use, history of incarceration and other factors.

For example, Black neighborhoods are targeted by the tobacco industry more than other ethnic groups, according to the American Lung Association. In 2017, Reuters reported that poor Black neighborhoods tend to have a higher proportion of smoke shops per capita than other neighborhoods. Smoking can increase the rate of premature births and low birthweight. Similarly, higher density of liquor stores has been found in Black neighborhoods.

The American Heart Association reports that approximately 60% of Black women aged 20 and older have a cardiovascular disease, and 60% have high blood pressure. Factors leading to these conditions include family history, being overweight, diabetes, smoking and high cholesterol.

In 2022, the incarceration rate for Black women was 64 per 100,000, 1.6 times the rate for white women, according to The Sentencing Project, a non-profit that advocates to minimize incarceration in the U.S. North Carolina has a “habitual felon” statute in which any person convicted three times can be given harsher sentencing.

Heightened stress and anxiety, poor mental health, chronic conditions, financial burden, and strained relationships among incarcerated people and impoverished communities can adversely affect birth outcomes.

A study by the University of Pennsylvania found states that implemented three-strike laws like North Carolina saw immediate worsening of birth outcomes among Black infants, especially those from poor backgrounds. Those effects didn’t impact white infants.


Kylie Marsh wrote this article for the Charlotte Post.


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