Pregnant Women are Often Uninsured and Go Without Needed Care in Abortion-Ban States, Study Shows

Pregnant women are more often uninsured and have worse access to routine medical care in states that ban (or restrict) abortion care, according to a new study opens in new tab/window appearing in the American Journal of Preventive Medicine opens in new tab/window, published by Elsevier, from researchers at Harvard Medical School, the City University of New York’s Hunter College, and other institutions. The researchers also link the deficiencies in pregnancy coverage and care to abortion-ban/restriction states’ skimpy Medicaid programs.

The study analyzed data on 20,919 pregnant women who participated in the 2014-2022 Behavioral Risk Factor Surveillance System (BRFSS), a health survey led by the CDC and state health departments. It assessed how many pregnant women were uninsured, were unable to afford a doctor’s visit in the past year, or lacked a personal healthcare provider, and compared states that have imposed abortion restrictions after Roe v. Wade was overturned in 2022 to other states.

The researchers found that 258,362 pregnant women in the US lacked health coverage in 2022, 62% of whom lived in abortion-ban states. The three states where the largest share of pregnant women lacked coverage were Texas (21.0%), Arkansas (18.8%), and Florida (18.6%) – all of which are abortion-ban/restriction states. Nationwide, pregnant women in abortion ban/restriction states (compared to other states) were significantly more likely to be uninsured (15.0% vs. 9.9), unable to afford physician care (19.5% vs. 13.1%), and to lack a personal healthcare provider (29.2% vs. 21.5%).

The study also identified pregnant women with chronic illnesses that require careful medical treatment to reduce maternal and infant health risks. Women who had diabetes before becoming pregnant more often lacked a personal doctor in abortion-restriction states, and those who developed diabetes during their pregnancies were more likely to be uninsured or to have gone without doctor care.

The researchers assessed whether differences in the generosity of states’ Medicaid programs explained why abortion ban/restriction states had worse access to pregnancy care. They found that worse access was almost entirely explained by three Medicaid policies:

1. Failure to implement the ACA’s Medicaid Expansion;

2. Banning Medicaid coverage for pregnant immigrants who were documented for less than 5 years; and

3. Setting a relatively stringent income threshold for Medicaid eligibility for pregnant women.

These findings suggest that worse access to care in abortion-ban states is mostly driven by those states’ stingy Medicaid policies, and that the deep Medicaid cuts included in the Republican budget bill could worsen care for many pregnant women.

Senior author of the study Steffie Woolhandler, MD, MPH, Hunter College, City University of New York, Harvard Medical School, Boston, Department of Medicine, Cambridge Health Alliance, Cambridge, and Public Citizen Health Research Group, Washington, DC, notes, “America’s high maternal and infant mortality rates are a national disgrace, and states that have banned abortions have the worst record. Politicians in those states claim to care about children and families, but their policies that deny care to pregnant women speak louder than their words.”

Lead author Adam Gaffney, MD, MPH, Harvard Medical School, Boston, and Department of Medicine, Cambridge Health Alliance, Cambridge, concludes, “Many state governments are coercing women into continuing unwanted pregnancies, yet also maintain barriers that keep them from getting needed pregnancy care. These care gaps will get worse if Congress goes ahead with slashing Medicaid. Instead of undermining the healthcare safety net, Congress should expand coverage and assure that all women can get the care they need before, during, and after pregnancy, and have access to abortion care.”

Notes for editors

The article is “Healthcare Access among Pregnant Women in States with and without Abortion Restrictions,” by Adam Gaffney, MD, MPH, David U. Himmelstein, MD, Samuel L. Dickman, MD, Lenore Azaroff, MD, ScD, Danny McCormick, MD, MPH, and Steffie Woolhandler, MD, MPH (https://doi.org/10.1016/j.amepre.2025.107671). It appears online in the American Journal of Preventive Medicine, published by Elsevier.

The article is openly available for 30 days at https://www.ajpmonline.org/article/S0749-3797(25)00163-1/fulltext opens in new tab/window.

Full text of this article is also available to credentialed journalists upon request; contact Astrid Engelen at +31 6 14395474 or [email protected] opens in new tab/window. Journalists wishing to interview the authors should contact Adam Gaffney, MD, MPH, at +1 917 539 0434 or [email protected] opens in new tab/window, or Steffie Woolhandler, MD MPH, at +1 617 312 2766 or [email protected] opens in new tab/window.

About the American Journal of Preventive Medicine

The American Journal of Preventive Medicine opens in new tab/window is the official journal of the American College of Preventive Medicine opens in new tab/window and the Association for Prevention Teaching and Research opens in new tab/window. It publishes articles in the areas of prevention research, teaching, practice and policy. Original research is published on interventions aimed at the prevention of chronic and acute disease and the promotion of individual and community health. The journal features papers that address the primary and secondary prevention of important clinical, behavioral and public health issues such as injury and violence, infectious disease, women's health, smoking, sedentary behaviors and physical activity, nutrition, diabetes, obesity, and alcohol and drug abuse. Papers also address educational initiatives aimed at improving the ability of health professionals to provide effective clinical prevention and public health services. The journal also publishes official policy statements from the two co-sponsoring organizations, health services research pertinent to prevention and public health, review articles, media reviews, and editorials. www.ajpmonline.org opens in new tab/window

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