Abortion Health Care Reproductive Rights

RFLC Research Spotlight: Evaluating Priorities

January 27, 2021

States with more restrictive abortion policies tend to have fewer supportive policies in place for women and families.

As legislative sessions have begun across the country, we are already seeing dozens of anti-abortion bills being introduced.

In this special RFLC research spotlight, we talk to Dr. Terri-Ann Thompson, PhD, Senior Associate at Ibis Reproductive Health and Nimra Chowdhry, JD, State Legislative Counsel at the Center for Reproductive Rights about their collaborative research and new interactive website: Evaluating Priorities: Evaluating Abortion Restrictions and Supportive Policy Across the United States.

The Evaluating Priorities project analyzes a set of 18 abortion restrictions and 25 supportive policies (including policies that support pregnant people, improve access to healthcare, promote families financial health, and more) in all 50 states and Washington D.C. The new interactive evaluatingpriorities.org clearly illustrates the hypocrisy of anti-abortion policymakers who claim to pass policy in the interest of women, pregnant people, and children. States with the most abortion restrictions tend to have the fewest number of supportive policies in place.

This easily accessible new resource provides both the data and the background public health evidence to push back on restrictive policies and advocate for supportive policies. As always, the SiX Reproductive Rights team is here to assist you in using the data effectively in your work as policymakers.

Q&A with Dr. Terri-Ann Thompson, PhD, (Ibis Reproductive Health) and Nimra Chowdhry, JD (Center for Reproductive Rights)

This interview has been edited for brevity and clarity.

What was the motivation to conduct the Evaluating Priorities analysis?

Since abortion was legalized in the United States in 1973, states have created hundreds of laws limiting whether, when, and under what circumstances a pregnant person may obtain an abortion. In the last decade, abortion restrictions have passed at an alarming rate; with over 450 bills passed since 2011 that restrict access to abortion care.

Some anti-abortion policymakers state that these restrictions are necessary to protect the health and well-being of women, their pregnancies, and their children. So we, Ibis Reproductive Health and the Center for Reproductive Rights, collaborated to determine if the concern that anti-abortion policymakers say they have for women, their pregnancies, and their children translates into the passage of state policies known to improve the health and well-being of pregnant people (throughout their life course) and children.

Why did it feel important to document policy disparities that the movement, legislators, and public have anecdotally recognized for some time now?

It felt important for two reasons. First, we know that abortion restrictions have real impacts on pregnant people and their families. For instance, prior research has shown that restrictions to public coverage interfere with people’s personal medical decision-making by putting care that should be covered by their health insurance out of financial reach. Second, we know that people of color, low-income people, immigrants, young people, and others are disproportionately affected by these restrictions. These same communities face numerous challenges, including economic insecurity, discrimination, and exposure to environmental toxicants, that policymakers have failed to address.

This research aims to call out the hypocrisy of anti-abortion state legislators who enact abortion restrictions under the guise of improving health while ignoring supportive health measures like expanded Medicaid, establishing maternal mortality review boards, and giving reasonable accommodations for pregnant workers.

What are your top takeaways from the analysis?

We selected 18 abortion restrictions that target when, where, and how abortion can be provided and covered. Similarly, we selected 25 policies that support pregnant people; promote children’s health, education, and safety; and support family financial health. Each state was analyzed to see how many of these restrictions and policies they had on the books.

The findings are clear—states with a high number of abortion restrictions tend to have fewer supportive policies in place. And likewise, states where legislators have prioritized passing and funding supportive policies have fewer abortion restrictions.

This, and other data from the Evaluating Priorities research, is available at www.evaluatingpriorities.com for advocates and policymakers to help shift policy priorities in favor of health and well-being.

Are there any standout examples from the findings that you would like to highlight?

In states where restrictive abortion policies make it harder for people to make choices about their pregnancies and to access abortion care, we also see that there are fewer policies in place that could support individuals and their children before and after pregnancy. We know, for example, that policies that increase Medicaid eligibility limits for pregnant women have been shown to increase health care coverage of pregnant women and reduce infant mortality and low birth weight. Yet none of the three states with the highest number of abortion restrictions have increased Medicaid eligibility limits for pregnant women or expanded family and medical leave beyond federal requirements. If those policies are not in place- then we don’t see the resulting benefits for pregnant people and children’s health outcomes.

How can the Evaluating Priorities data be useful in policymaking conversations, in your opinion?

For policymakers seeking to ground their initiatives on evidence, the data from Evaluating Priorities gives them ready examples of how abortion restrictions negatively impact people’s lives and conversely examples of policies that actually support the wellbeing of women, children, and their families. Evaluating Priorities provides the tools to start a conversation about shared health and policy priorities, and work toward a proactive, evidence-based agenda that promotes health.Further, policymakers are able to point to states that have more robust supportive policies, and utilize them as models for legislation.

What is included in the Evaluating Priorities interactive website that policymakers can use?

Policymakers may use the interactive map to identify how many abortion restrictions and supportive policies are present in their state as well as to see how their state compares with others in their region and nationally. Policymakers can also view and download a factsheet for their state, which includes details on the state’s restrictions and supportive policies and a summary of how the state ranks in these areas. Importantly, for each indicator included in our analyses, we highlight evidence on its impact as well as the data source for that evidence, which can be used to explain the negative impacts of abortion restrictions and advocate for proactive evidence-based policies that have been shown to improve health outcomes. As an example, one of the abortion restrictions included in the analysis is ambulatory surgical center standards imposed on facilities providing abortion. This restriction can result in clinic closures, limiting access to care, but it could also increase the cost of care, which can further impede access. Finally, the site also includes a page that offers main takeaways from the analysis, frequently asked questions, and additional resources.

**Finally, Dr. Thompson, as a quantitative and qualitative researcher, how have seen the policy disparities in Evaluating Priorities impacting people on an individual level?**

Amidst a pandemic, the deep inequities in our health care system are more visible than ever. Instead of supporting families during a pandemic and economic downturn, policymakers have continued to pass abortion restrictions and further deepen inequities. When the pandemic hit, some state officials moved to restrict and limit access to abortion care—an essential healthcare service—during their executive responses to mitigate the spread of COVID-19. The same states that imposed these restrictions also tend to have the highest numbers of abortion restrictions and the fewest supportive policies in our analysis. Restrictions under the pandemic caused a range of confusion across states as providers moved to cancel appointments and patients were forced to drive across state lines to receive care or potentially not receive any care at all. The reality is that when it comes to sexual and reproductive health care, we know that people of color, including Black and indigenous communities, are most impacted by restrictive state laws when they decide to end a pregnancy. These inequities are created at the state level, and efforts to overcome them must begin by holding state lawmakers accountable. Abortion restrictions, and policymakers who choose to prioritize them over supportive health policies, place pregnant people’s immediate and long-term well-being at stake. Investing in reproductive health—by implementing policies that support it, and abolishing policies that restrict anyone’s power to exercise their human right to live a pleasurable, safe, and healthy sexual and reproductive life—needs to be a priority.

Contact Information:
Terri-Ann Thompson, PhD, Ibis Reproductive Health, tthompson@ibisreproductivehealth.org

Nimra Chowdhry, JD, Center for Reproductive Rights, nchowdhry@reprorights.org

Resources to bookmark:

Evaluating Priorities Interactive Map and State Policy Cards Official Website
Indicator Appendix and Public Health Impact Data
Examples of Evaluating Priorities in the Press: RFLC Member LA Rep. Mandie Landry Op-Ed
Additional Ibis Reproductive Health Research Fact Sheets: U.S. Policy Briefs, Hyde Amendment FAQ on Impact
Additional Center for Reproductive Rights State Policy Resources: What if Roe Fell, COVID-19, 2020 Legislative Wrap Up
RFLC Scientific Research Reference Packet

For additional resources, messaging guidance, or to be connected with a research expert on reproductive health topics, please reach out to fran@stateinnovation.org.