Estimating the economic impact of restricting reproductive healthcare access in Ohio

Abstract

Objective

This study analyzes the economic impacts of Ohio's Senate Bill 23, which would ban abortion care after fetal cardiac activity is detected.

Methods

Leveraging previous research and publicly available datasets, a unique set of calculations were developed to determine abortion outcomes, individual costs, and public costs in three scenarios in which abortion care is banned in Ohio. Scenario 1 assumes that all abortion care is sought out‐of‐state. Scenario 2 assumes that all pregnancies result in a birth. Scenario 3 assumes that pregnancies either result in receiving out‐of‐state abortion care or result in a birth.

Results

The total additional economic impact of restricted abortion access in Ohio likely ranges between $98.8 million and $118.4 million, but could be up to $551.4 million per year.

Conclusion

Regardless of the three scenarios analyzed, restrictions to accessing abortion care result in negative economic impacts for both individuals and the state. Several policy recommendations are proposed for consideration by policymakers and communities.

INTRODUCTION

Abortion is currently banned in 14 states, with several others imposing gestational limits of 6–18 weeks. ¹ Legal battles over abortion continue nationwide, necessitating a deeper understanding of the economic repercussions, particularly for individuals and state economies. Previous research exemplified by the Turnaway Study, revealed that denial of abortion care led to increased household poverty, debt, and lowered credit scores.2, 3 The study, spanning 10 years and involving nearly a thousand women nationwide, concluded in 2016. ⁴ Given the evolving legal landscape, it is crucial to grasp the financial impacts of abortion regulation.

Nationwide, over half of abortion recipients are in their twenties, predominantly low‐income, and mostly women of color, with 61% already having children. ⁵ Moreover, about 40% have at least some college education. In Ohio, where 74% of unintended pregnancies reported in 2021 were to women earning below 200% of the federal poverty level, legal uncertainties have intensified, notably with the Dobbs v. Jackson Women's Health Organization ruling overturning long‐standing precedents.6, 7 This ruling overturned the Court's previous ruling in Roe v. Wade, which had established women's legal right to have an abortion under the U.S. Constitution. ⁸

Ohio's Senate Bill 23, also known as the “Heartbeat Protection Act,” was initially enforced for 82 days after Roe v. Wade was overturned and restricts abortions after detectable fetal cardiac activity, which usually occurs around 6 weeks of pregnancy. However, in November 2023, Ohioans voted to constitutionally safeguard abortion rights, although legal battles persist, with abortion currently legal up to 22 weeks from last menstrual period (LMP).

Surrounding Ohio are states with varying abortion laws, highlighting the significance of maintaining access. This study examines the economic impacts of Ohio's S.B. 23, focusing on additional costs borne by individuals such as lost earnings, transportation, medical expenses, as well as additional costs to the state regarding public assistance. While emotional and broader economic impacts are not fully quantified due to data limitations, this analysis serves as a baseline for informed legislative decisions.

METHODOLOGY

Three scenarios were developed to illustrate the potential range of economic impacts associated with restricted abortion access in Ohio. All three scenarios assume that Senate Bill 23 is in effect in Ohio, which bans abortion after fetal cardiac activity is detected. The scenarios are as follows:

The pregnancies that would have been terminated if S.B. 23 was not in effect…:

… require travel to another state to access abortion care (scenario 1).

… result in a birth (scenario 2).

… either result in a birth or require travel to another state to access abortion care (scenario 3).

The analysis for each scenario includes assumptions regarding abortion outcomes if S.B. 23 was in effect as well as assumptions for the additional costs incurred by women seeking abortion care and the additional costs incurred by the public. The assumptions and data utilized for each component of the analysis are detailed below.

Abortion outcomes

The estimated number of abortions, disaggregated by race for each scenario, are presented in Table 1. For each scenario, we begin with the same number of total resident abortions performed in 2021 (i.e., 20,716). We then calculate the number of abortions that would still have taken place if S.B. 23 were in place (i.e., 6266 in all scenarios, explained below). The remaining 14,450 pregnancies are the basis for our economic analysis in scenarios 1–3.

TABLE 1.

2021 estimated abortion outcomes by race.

	Outcome	Black/African American	White	Other	Total
Scenario 1	Total abortion completed in Ohio	2793	2431	1042	6266
	Gestation of 6 weeks or less	2552	2221	952	5725
	Risk to the woman's life of a major bodily function	28	24	10	62
	Other physical health concerns	213	186	80	479
	Total abortions requiring out‐of‐state travel	6441	5605	2404	14,450
	Total resident abortions	9234	8036	3446	20,716
Scenario 2	Total abortion completed in Ohio	2793	2431	1042	6266
	Gestation of 6 weeks or less	2552	2221	952	5725
	Risk to the woman's life of a major bodily function	28	24	10	62
	Other physical health concerns	213	186	80	479
	Total births resulting from restricted abortion access	6441	5605	2404	14,450
	Parenting births	5861	5101	2188	13,150
	Adoption births	580	504	216	1300
	Total resident abortions	9234	8036	3446	20,716
Scenario 3	Total abortion completed in Ohio	2793	2431	1042	6266
	Gestation of 6 weeks or less	2552	2221	952	5725
	Risk to the woman's life of a major bodily function	28	24	10	62
	Other physical health concerns	213	186	80	479
	Total births resulting from restricted abortion access	767	2056	203	3026
	Parenting births	698	1871	185	2754
	Adoption births	69	185	18	272
	Total abortions requiring out‐of‐state travel	5674	3549	2201	11,424
	Total resident abortions	9234	8036	3446	20,716

The weeks of completed gestation are utilized as a proxy for the detection of fetal cardiac activity. According to the U.S. Centers for Disease Control and Prevention, approximately 27.6% of abortions in Ohio during 2020 were for pregnancies with a gestation of 6 weeks or less. ⁹ This percent was applied to the total abortions performed for Ohio residents in 2021 and distributed uniformly among racial categories. It is assumed that these abortions would be legally available in Ohio under S.B. 23.

In an analysis of the eight states that report the reason for an abortion, approximately 0.3% are due to the risk to the woman's life or a major bodily function; 2.3% are due to other physical concerns.10, 11, 12, 13, 14, 15, 16, 17 It is assumed that the distribution of these reasons is uniform by race. It is also assumed that abortions due to these reasons would be legally available in Ohio through the exceptions provided by S.B. 23.

An increase in travel distance up to 100 miles to the nearest abortion provider is estimated to increase births by 2.4% overall. ¹⁸ Specifically, the estimated increase in births is 3.3% for Black women and 2.1% for White women. ¹⁸ There were 129,604 births in Ohio for women between the ages of 15 and 44 years during 2021. ¹⁹ This is comprised of 23,252 births for Black/African American women, 97,914 births for White women, and 8438 births for women of other races. An increase in travel distance up to 100 miles to the nearest abortion provider would result in an additional 767 births for Black/African American women, 2056 births for White women, and 203 births for women of other races. The overall increase in births of 2.4% was utilized to calculate the increase in births for women of other races.

Travel costs

A scenario in which abortion is banned in Ohio, Indiana, Kentucky, and West Virginia but remains available in Michigan and Pennsylvania would result in a median increase of 96 miles and an average increase of 131 miles to the nearest abortion provider for individuals in Ohio. ²⁰ The federal mileage reimbursement rate was $0.56 during 2021. ²¹ Utilizing median and average distances, the round‐trip additional transportation costs would range from $107.52 to $146.72 per person, respectively.

In a 2011 survey of abortion patients at six facilities across the United States, 25.0% of respondents reported lost wages, 10.0% of respondents reported additional child care costs, and 6.0% of respondents reported incurring hotel and travel costs associated with obtaining abortion care. ²² The average value of lost wages reported was $238.52, the average value of additional child care costs was $68.66, and the average value of hotel and travel costs was $168.65, after converting to 2021 dollars using the Consumer Price Index for All Items.

Lifetime earnings loss

To calculate lifetime earnings loss, which varies significantly by race and income level, we begin with an understanding of unintended pregnancy rates by race and income level (Table 2). Although not all pregnancies ending in abortion are unintended, this study assumes that most are. This assumption allows us to use previous literature to arrive at more detailed estimations. The national rate of unintended pregnancy per 1000 women between the ages of 15 and 44 years was 137 for women with income less than 100% of the federal poverty level (FPL), 85 for women with income between 100% and 199% of FPL, and 26 for women with income greater than or equal to 200% of FPL during 2008. ²³ The national rate of unintended pregnancy was higher for Black women compared with White women for every income range during 2008. ²³

TABLE 2.

Rate of unintended pregnancy per 1000 women aged 15–44 years in the U.S., 2008 and percent of unintended pregnancies in Ohio, 2021, by race and income.

Income	Black, non‐Hispanic		White, non‐Hispanic		Overall
	Rate, 2008	Percent, 2021	Rate, 2008	Percent, 2021	Rate, 2008	Percent, 2021
Less than 100% of FPL	163	51.3%	110	38.2%	137	46.6%
Between 100% and 199% of FPL	99	26.7%	73	28.6%	85	27.7%
200% or more of FPL	51	22.0%	20	33.2%	26	25.7%

The national rates of unintended pregnancy by race and income from 2008 were applied to the respective population of women between the ages of 15 and 44 in Ohio during 2021. The overall rate of unintended pregnancy by income was utilized for women of other races. The distribution of unintended pregnancy by income was calculated for each race and then applied to the estimated number of abortions that would have resulted in a parenting birth under S.B. 23.

The age categories in the Ohio Department of Health's Induced Abortions in Ohio, 2021 report include aggregate abortion counts for ages less than 15 years; single age abortion counts for 15 years through 21 years; aggregate abortion counts beginning for 20–24 years and ending with 40–44 years; and aggregate abortion counts for 45 years of age and older. ⁶ It is assumed that the abortions that would have resulted in a parenting birth by income and race as a result of S.B. 23 being in effect followed the same age distribution as all resident abortions by race during 2021.

After determining the number of abortions that would have resulted in a parenting birth by race and income, lifetime earnings were estimated for women in Ohio between the ages of 18 and 30 years by utilizing 2017–2021, 5‐year IPUMS data from the U.S. Census Bureau's American Community Survey. ²⁴ The weighted average of wage and salary income was calculated for women at every age between 18 and 64 years and was broken out by race (Black/African American, White, and Other) and income (less than 100% of FPL, between 100% and 199% of FPL, and greater than or equal to 200% of FPL). Wage and salary income was then summed for the remaining years in the workforce, after accounting for the mortality rate of women in Ohio by age and race.

Because portions of the abortion statistics from the Ohio Department of Health are aggregated into 5‐year age ranges, two estimates were developed to calculate lifetime earnings. The low estimates assume that all abortions in each age range were for women of the highest age in the age range. The high estimates assume that all abortions in each age range were for women of the lowest age in the age range. For example, all abortions for women between the ages of 25 and 29 years were assumed to be 29 years of age for the low estimates and 25 years of age for the high estimates.

Previous research models estimate that an abortion ban would result in a decrease in average lifetime earnings by age 65 of $39,173, or 3.3%, for women between the ages of 18 and 30 years who would have had an abortion, after accounting for education. ²⁵ The percent decrease in lifetime earnings due to an abortion ban was then applied to the estimates of lifetime earnings calculated for women in Ohio between the ages of 18 and 30 years by income and race who would have had a parenting birth if S.B. 23 was in effect. There are further costs to the public in the form of lost tax revenue because of the lifetime earnings loss. However, lost tax revenue is not included in the analysis due to the data limitations on when the earnings loss would occur.

Child care costs

The utilization and costs of early care and education in the United States by age of the child and income were calculated using 2012 data from the National Survey of Early Care and Education Project Team (Table 3). ²⁶ Aggregate child care costs are estimated for the percent of children with any regular early care and education for whom the parents have out‐of‐pocket costs. The aggregate child care costs reflect costs for children between 0 and 60 months, or up to 5 years of age. Data for 200% or more of FPL reflect a weighted average of data for 200%–299% of FPL and data for 300% or more of FPL. Therefore, the median annual cost does not reflect a true median but instead reflects a weighted average. All cost estimates are regionally adjusted to Ohio and converted to 2021 dollars. The low estimates utilize the median annual costs (between $2858.36 and $6267.97 depending on income and age of child), whereas the high estimates utilize the average annual costs (between $3887.37 and $7651.59).

TABLE 3.

Utilization and costs of early care and education by age of the child and income in the United States, 2012 (2021$).

Income	Age range	Percent of children with any regular care	Percent of children with regular care for whom parents have zero out‐of‐pocket costs	Median annual cost	Average annual cost
Less than 100% of FPL	0–35 months	42.4%	69.9%	$3813.05	$4847.78
	36–71 months	51.5%	63.3%	$2858.36	$3887.37
Between 100% and 199% of FPL	0–35 months	41.2%	52.4%	$4527.64	$6762.88
	36–71 months	56.1%	45.7%	$3350.00	$4413.30
200% of more of FPL	0–35 months	57.9%	31.7%	$6267.97	$7651.59
	36–71 months	69.5%	21.4%	$5273.48	$6991.05

Source: Analysis of data from the National Survey of Early Care and Education Project Team. ²⁶

Medical costs

Medicaid health insurance was utilized as a proxy for publicly funded births. Table 4 displays the Medicaid status of women between the ages of 15 and 44 years who had a birth in the past year was calculated utilizing 2017–2021, 5‐year IPUMS data and was broken out by race and income. ²⁴ The percentage with Medicaid health insurance was then applied to the estimated abortions that would have resulted in a parenting birth by race and income to determine what portion of parenting births would have been publicly funded.

TABLE 4.

Percent of women aged 15–44 years who had a birth in the past year and had Medicaid health insurance by race and income in Ohio, 2021.

Income	Black/African American	White	Other
Less than 100% of federal poverty level	87.00%	79.20%	68.20%
Between 100% and 199% of federal poverty level	60.50%	46.40%	49.40%
200% or more of federal poverty level	24.00%	9.70%	12.70%

Previous researchers evaluated the public costs and savings of births resulting from unintended pregnancies that were paid for by Medicaid, the Children's Health Insurance Program (CHIP), or the Indian Health Service (IHS) during 2010. ²⁷ The average cost per publicly funded birth in Ohio totaled $18,144 during 2010. After converting to 2021 dollars using the Consumer Price Index for Medical Care, the average cost per publicly funded birth in Ohio totaled $24,537.24. This includes $14,773.73 for prenatal care, labor and delivery, postpartum care, and the first year of infant medical care, as well as $9763.51 for the following 4 years of medical care for the child.

The median out‐of‐pocket costs for abortion in Ohio were $588 for medication abortion, $625 for first trimester procedural abortion, and $820 for second trimester abortion during 2020. ²⁸ These costs are not included in this analysis as they represent costs incurred by women regardless of S.B. 23 being in effect.

Social assistance costs

The 2017–2021, 5‐year IPUMS data from the U.S. Census Bureau's American Community Survey were analyzed to determine the utilization rates of public assistance and the Supplemental Nutrition Assistance Program (SNAP) as well as the amount of public assistance received for women in Ohio between the ages of 15 and 44 years by race and fertility status. ²⁴ Public assistance, as defined in IPUMS data, refers to federal/state Supplemental Security Income (SSI) payments to elderly (age 65+), blind, or disabled persons with low incomes; Aid to Families with Dependent Children (AFDC); and General Assistance (GA).

The utilization rate of public assistance for women in Ohio between the ages of 15 and 44 years who had a birth in the past year was 10.3% for Black/African American women, 4.2% for White women, and 3.8% for women of other races during 2021. In comparison, the utilization rate of public assistance for women in Ohio between the ages of 15 and 44 years who did not have a birth in the past year was 4.4% for Black/African American women, 1.9% for White women, and 2.3% for women of other races during 2021. This means that having a birth in the past year increased the utilization rate of public assistance by 6.0% points for Black/African American women, 2.2% points for White women, and 1.5% points for women of other races. For women in Ohio between the ages of 15 and 44 years who had a birth in the past year, the amount of public assistance received averaged $3638.98 for Black/African American women, $3925.85 for White women, and $2291.54 for women of other races.

The utilization rate of SNAP for women in Ohio between the ages of 15 and 44 years who had a birth in the past year was 52.4% for Black/African American women, 20.1% for White women, and 25.8% for women of other races during 2021. In comparison, the utilization rate of SNAP for women in Ohio between the ages of 15 and 44 years who did not have a birth in the past year was 34.3% for Black/African American women, 12.4% for White women, and 17.9% for women of other races during 2021. This means that having a birth in the past year increased the utilization rate of SNAP by 18.1% points for Black/African American women, 7.7% points for White women, and 7.9% points for women of other races. According to the Ohio Department of Job and Family Services, the annual SNAP benefit amount per person averaged $2788 during 2021. ²⁹

RESULTS

In each scenario, we estimate the number of abortions requiring out‐of‐state travel, the number of pregnancies resulting in a birth, and abortions completed in Ohio that would still be legal under S.B. 23 (Table 1). These numbers are then applied to the costs of each outcome for both individuals and the public. Each scenario assumes that S.B. 23 is in effect, meaning that abortion is legally available in Ohio until fetal cardiac activity is detected. Of the 20,716 Ohio abortions reported to the Ohio Department of Health in 2021, 6266 abortions would still be performed legally under the provisions of S.B. 23. ⁶

Scenario 1 assumes that all pregnancies after fetal cardiac activity is detected require travel to either Michigan or Pennsylvania for abortion care. Of the 14,450 abortions performed for Ohio residents that would require out‐of‐state travel to obtain abortion care, 6441 are for Black/African American women, 5605 are for White women, and 2404 are for women of other races.

The top half of Table 5 details the low estimates of the economic impacts of Scenario 1, which are based on the median increase in miles traveled to the nearest abortion provider. The additional costs incurred by the 14,450 women seeking abortion care out‐of‐state totals nearly $2.7 million. This is comprised of nearly $1.6 million in transportation costs, $861,600 in lost wages, $99,200 in child care costs, and $146,200 in hotel and travel costs. The average additional cost to women is $184 per abortion requiring out‐of‐state travel under S.B. 23. In this scenario, there would be no additional costs incurred by the public since all abortions that occurred during 2021 would still result in an abortion. Of these total costs, approximately $1.2 million represents the additional costs for Black/African American women, more than $1.0 million additional costs for White women, and approximately $442,700 additional cost for women of other races.

TABLE 5.

Scenario 1 economic impacts by race (rounded). ^a

Estimate	Cost type	Impact category	Black/African American	White	Other	Total
Low	Individual costs	Transportation costs	$692,536	$602,650	$258,478	$1,553,664
		Lost wages	$384,073	$334,223	$143,349	$861,645
		Child care costs	$44,227	$38,486	$16,507	$99,220
		Hotel and travel costs	$65,176	$56,717	$24,326	$146,219
		Total individual costs	$1,186,012	$1,032,076	$442,660	$2,660,748
	Public costs	Total public costs	N/A	N/A	N/A	N/A
	Total costs and average cost	Total costs	$1,186,012	$1,032,076	$442,660	$2,660,748
		Average cost per abortion requiring out‐of‐state travel	$184	$184	$184	$184
High	Individual costs	Transportation costs	$945,024	$822,366	$352,715	$2,120,104
		Lost wages	$384,073	$334,223	$143,349	$861,645
		Child care Costs	$44,227	$38,486	$16,507	$99,220
		Hotel and travel costs	$65,176	$56,717	$24,326	$146,219
		Total individual costs	$1,438,500	$1,251,792	$536,897	$3,227,189
	Public costs	Total public costs	N/A	N/A	N/A	N/A
	Total costs and average cost	Total costs	1,438,500	$1,251,792	$536,897	$3,227,188
		Average cost per abortion requiring out‐of‐state travel	$223	$223	$223	$223

^a For lost wages, child care, and hotel and travel costs associated with traveling out‐of‐state, amounts account for the percent of individuals who would incur that type of cost, based on previous literature. This is true for all scenarios.

The bottom half of Table 5 details the high estimates of the economic impacts of Scenario 1, which are based on the average increase in miles traveled to the nearest abortion provider (instead of the median). The additional costs incurred by the 14,450 women seeking abortion care out‐of‐state totals nearly $3.2 million. This is comprised of nearly $2.1 million in transportation costs. Other costs remain the same as the low estimate. The average additional cost to women is $223 per abortion requiring out‐of‐state travel under S.B. 23. Of these total costs, approximately $1.4 million represents the additional costs for Black/African American women, more than $1.3 million additional costs for White women, and approximately $536,900 additional cost for women of other races.

Scenario 2 assumes that any pregnancy after fetal cardiac activity is detected results in a birth. This means that 14,450 abortions performed for Ohio resident pregnancies would result in a birth. Approximately 91% of women denied an abortion who gave birth chose parenting instead of adoption. ³⁰ Therefore, 13,150 of the 14,450 abortions performed for Ohio residents would result in a parenting birth, assuming women denied an abortion in Ohio would make similar decisions. Of these parenting births, 5861 are for Black/African American women, 5101 are for White women, and 2188 are for women of other races.

The top half of Table 6 details the low estimates of the economic impacts of Scenario 2, which are based on 13,150 abortions performed for Ohio residents in 2021 that would have resulted in a parenting birth if S.B. 23 were in effect. The additional costs incurred by women and the public totals $461.8 million. This is comprised of an additional $275.8 million incurred by women and $186 million in additional costs incurred by the public. The average cost per parenting birth totals $35,120, which is comprised of $20,975 in individual costs and $14,145 in public costs.

TABLE 6.

Scenario 2 economic impacts by race (rounded).

Estimate	Cost type	Impact category	Black/African American	White	Other	Total
Low	Individual costs	Lifetime earnings loss	$82,485,833	$83,813,213	$30,472,584	$196,771,630
		Child care costs	$32,030,161	$34,153,631	$12,864,145	$79,047,937
		Total individual costs	$114,515,994	$117,966,844	$43,336,729	$275,819,567
	Public costs	Maternity medical costs and 1 year of infant medical costs	$57,203,726	$35,227,481	$15,752,685	$108,183,892
		Child medical costs from ages 1–4 years	$37,804,202	$23,280,770	$10,410,470	$71,495,442
		Public assistance costs	$1,269,720	$450,565	$75,928	$1,796,213
		SNAP costs	$2,960,710	$1,089,988	$484,259	$4,534,957
		Total public costs	$99,238,358	$60,048,804	$26,723,342	$186,010,504
	Total costs and average cost	Total costs	$213,754,352	$178,015,648	$70,060,071	$461,830,071
		Average cost per parenting birth	$36,471	$34,898	$32,020	$35,120
		Average individual costs per parenting birth	$19,539	$23,126	$19,807	$20,975
		Average public costs per parenting birth	$16,932	$11,772	$12,214	$14,145
High	Individual costs	Lifetime earnings loss	$111,152,657	$109,767,678	$41,165,633	$262,085,968
		Child care costs	$41,999,968	$44,502,289	$16,833,045	$103,335,302
		Total individual costs	$153,152,625	$154,269,967	$57,998,678	$365,421,270
	Public costs	Maternity medical costs and 1 year of infant medical costs	$57,203,726	$35,227,481	$15,752,685	108,183,892
		Child medical costs from ages 1–4 years	$37,804,202	$23,280,770	$10,410,470	$71,495,442
		Public assistance costs	$1,269,720	$450,565	$75,928	$1,796,213
		SNAP costs	$2,960,710	$1,089,988	$484,259	$4,534,957
		Total public costs	$99,238,358	$60,048,804	$26,723,342	$186,010,504
	Total costs and average cost	Total costs	$252,390,983	$214,318,771	$84,722,020	$551,431,774
		Average cost per parenting birth	$43,063	$42,015	$38,721	$41,934
		Average individual costs per parenting birth	$26,131	$30,243	$26,508	$27,789
		Average public costs per parenting birth	$16,932	$11,772	$12,214	$14,145

The bottom half of Table 6 details the high estimates of the economic impacts of Scenario 2. The additional costs incurred by women and the public totals $551.4 million. This is comprised of an additional $365.4 million incurred by women and $186 million in additional costs incurred by the public. The average cost per parenting birth totals $41,934, which is comprised of $27,789 in individual costs and $14,145 in public costs.

Scenario 3 assumes that any pregnancy after fetal cardiac activity is detected either results in a birth or requires travel to Michigan or Pennsylvania for abortion care. Using previous findings explaining how an increase in travel distance up to 100 miles to the nearest abortion provider would increase births, we find that an additional 3026 births would occur in Ohio. ¹⁸ Of these, 2754 would be parenting births (767 for Black/African American women; 2056 births for White women; 203 births for women of other races). Abortions requiring out‐of‐state travel total 11,424 and the remaining 6266 abortions would still take place under S.B. 23.

The low estimates of the economic impacts of obtaining an out‐state‐abortion in Scenario 3 are detailed in the top half of Table 7, which are based on the median increase in miles traveled to the nearest abortion provider. The total cost for the 11,424 abortions requiring travel to either Michigan or Pennsylvania is $2.1 million. This includes $1.2 million in transportation costs, $681,200 in lost wages, $78,400 in child care costs, and $115,600 in hotel and travel costs. The average additional cost to women is $184 per abortion requiring out‐of‐state travel under S.B. 23. There are no additional costs incurred by the public for these abortions.

TABLE 7.

Scenario 3 economic impacts of traveling for abortion care by race (rounded).

Estimate	Cost type	Impact category	Black/African American	White	Other	Total
Low	Individual costs	Transportation costs	$610,068	$381,588	$236,652	$1,228,308
		Lost wages	$338,338	$211,625	$131,244	$681,207
		Child care costs	$38,960	$24,369	$15,113	$78,442
		Hotel and travel costs	$57,415	$35,912	$22,272	$115,599
		Total individual costs	$1,044,781	$653,494	$405,281	$2,103,556
	Public costs	Total public costs	N/A	N/A	N/A	N/A
	Total costs and average cost	Total costs	$1,044,781	$653,494	$405,281	$2,103,556
		Average cost per abortion requiring out‐of‐state travel	$184	$184	$184	$184
High	Individual costs	Transportation costs	$832,489	$520,709	$322,931	$1,676,129
		Lost wages	$338,338	$211,625	$131,244	$681,207
		Child care costs	$38,960	$24,369	$15,113	$78,442
		Hotel and travel costs	$57,415	$35,912	$22,272	115,599
		Total individual costs	$1,267,202	$792,615	491,560	$2,551,377
	Public costs	Total public costs	N/A	N/A	N/A	N/A
	Total costs and average cost	Total costs	$1,267,202	$792,615	$491,560	$2,551,377
		Average cost per abortion requiring out‐of‐state travel	$223	$223	$223	$223

The high estimates of the economic impacts of obtaining an out‐of‐state abortion in Scenario 3 are detailed in the bottom half of Table 7, which are based on the average increase in miles traveled to the nearest abortion provider. The total cost for the 11,424 abortions requiring travel to either Michigan or Pennsylvania is nearly $2.6 million. This includes nearly $1.7 million in transportation costs, $681,200 in lost wages, $78,400 in child care costs, and $115,600 in hotel and travel costs. The average additional cost to women is $223 per abortion requiring out‐of‐state travel under S.B. 23. There are no additional costs incurred by the public for these abortions.

For the 2754 abortions performed for Ohio residents during 2021 that would have resulted in a parenting birth if S.B. 23 were in effect, the low estimate of the additional costs incurred by women and the public totals $96.7 million, as detailed in the top half of Table 8. This is comprised of an additional $60.6 million incurred by women and $36.1 million in additional costs incurred by the public. The average cost per parenting birth totals $21,994 in individual costs and $13,109 in public costs.

TABLE 8.

Scenario 3 economic impacts of traveling for abortion care by race (rounded).

Estimate	Cost type	Impact category	Black/African American	White	Other	Total
Low	Individual costs	Lifetime earnings loss	$9,823,428	$30,741,918	$2,576,521	$43,141,867
		Child care costs	$3,814,546	$12,527,238	$1,087,690	$17,429,474
		Total individual costs	$13,637,974	$43,269,156	$3,664,211	$60,571,341
	Public costs	Maternity medical costs and 1 year of infant medical costs	$6,812,524	$12,921,117	$1,331,923	$21,065,564
		Child medical costs from ages 1–4 years	$4,502,190	$8,539,173	$880,227	$13,921,590
		Public assistance costs	$151,214	$165,263	$6420	$322,897
		SNAP costs	$352,598	$399,798	$40,945	$793,341
		Total public costs	$11,818,526	$22,025,351	$2,259,515	$36,103,392
	Total costs and average cost	Total costs	$25,456,500	$65,294,507	$5,923,726	$96,674,733
		Average cost per parenting birth	$36,471	$34,898	$32,020	$35,103
		Average individual costs per parenting birth	$19,539	$23,126	$19,807	$21,994
		Average public costs per parenting birth	$16,932	$11,772	$12,214	$13,109
High	Individual costs	Lifetime earnings loss	$13,237,426	$40,261,777	$3,480,641	$56,979,844
		Child care costs	$5,001,873	$16,323,031	$1,423,269	$22,748,173
		Total individual costs	$18,239,299	$56,584,808	$4,903,910	$79,728,017
	Public costs	Maternity medical costs and 1 year of infant medical costs	$6,812,524	$12,921,117	$1,331,923	$21,065,564
		Child medical costs from ages 1–4 years	$4,502,190	$8,539,173	$880,227	$13,921,590
		Public assistance costs	$151,214	$165,263	$6420	$322,897
		SNAP costs	$352,598	$399,798	$40,945	$793,341
		Total public costs	$11,818,526	$22,025,351	$2,259,515	$36,103,392
	Total costs and average cost	Total costs	$30,057,825	$78,610,159	$7,163,425	$115,831,409
		average cost per parenting birth	$43,063	$42,015	$38,721	$42,059
		Average individual costs per parenting birth	$26,131	$30,243	$26,508	$28,950
		Average public costs per parenting birth	$16,932	$11,772	$12,214	$13,109

For the 2754 abortions performed for Ohio residents during 2021 that would have resulted in a parenting birth if S.B. 23 were in effect, the high estimate of the additional costs incurred by women and the public totals $115.8 million, as detailed in the bottom half of Table 8. This is comprised of an additional $79.7 million incurred by women and $36.1 million in additional costs incurred by the public. The average cost per parenting birth totals $28,950 in individual costs and $13,109 in public costs.

DISCUSSION

Reproductive rights in Ohio, especially those related to abortion, are simultaneously undergoing attempts to restrict and protect those rights in the post‐Roe landscape. This analysis aims to evaluate the economic impacts of restricted abortion access in Ohio under S.B. 23. Three scenarios were developed to illustrate the potential range of economic impacts based on 2021 resident abortion data in Ohio.

The potential additional economic impact of restricted abortion access in Ohio ranges from $2.7 million (Scenario 1 low estimate) to $551.4 million (Scenario 2 high estimate). However, it is unlikely that all pregnant people seeking abortion care would travel out‐of‐state to receive care (Scenario 1), just as it is unlikely that all pregnancies in Ohio would result in a parenting birth (Scenario 2). It is more likely that some pregnant people would seek abortion care out‐of‐state and some pregnancies would result in a parenting birth if S.B. 23 were in effect in Ohio (Scenario 3). Thus, the more probable total additional economic impact of restricted abortion access in Ohio ranges between $98.8 million and $118.4 million per year. According to our Scenario 3 estimates, the additional costs incurred by women seeking abortion care range from $62.7 million to $82.3 million, whereas the additional costs incurred by the public are $36.1 million.

In any situation—whether women seek abortion care out of state, or if their pregnancy results in a birth—restricting access to reproductive healthcare comes at a significant cost for all women. Women will experience additional lost wages and lost lifetime earnings due to restrictions to abortion care. The average additional individual cost per abortion requiring out‐of‐state travel is between $184 and $223, while the average additional individual cost per parenting birth is between $22,000 and $28,000.

In Ohio, women account for nearly two‐thirds of minimum wage workers. ³¹ In 2021, the state's minimum wage was $8.80 per hour, translating to $352 per week for a full‐time, 40‐hour workweek, before taxes. The additional out‐of‐state travel costs to receive abortion care ($184–223) are between 52% and 63% of a weekly salary (which does not include the medical cost of abortion care or other regular living expenses). The annual earnings while working full time at a minimum wage salary amount to $18,304 (not including taxes), or 105% FPL. The average additional cost per parenting birth ($22,000–28,000), which is equal to between 120% and 153% of an annual minimum wage salary. Remember that 91% of individuals who are denied an abortion choose to parent rather than place for adoption. ³⁰ For many of these individuals, the additional cost of parenting amounts to well over a year's salary, presenting significant financial hardship.

It is important to remember that over 70% of the abortions performed for Ohio residents during 2021 were for women with incomes less than 200% of the poverty level. For a two‐person household in 2021 (e.g., one parent and one child), that would be an annual income of less than $34,840. This is not a self‐sufficient wage. Previous research demonstrates that self‐sufficiency is not reached until individuals earn about 250% of the federal poverty level (which would be about $43,550 for a two‐person household). ³²

Furthermore, restrictions to abortion care affect women differently based on race. In 2021, more of the total resident abortions were completed for Black/African American individuals. While the data in this report cannot provide an explanation for this, based on previous research, there are at least two possible related explanations. First, one of the primary reasons pregnant people seek abortion care is due to their perceived financial situation. ³³ Black women earn, on average, $0.63 for every dollar earned by a White man, while White women earn $0.79. ³⁴ This racialized wage gap presents a disproportional financial burden on Black women, which may shape their family planning goals. Second, Black women may face greater challenges accessing and using desired contraception due in part, to structural racism and stigma based on socioeconomic status. ³⁵ While cost is a barrier for some women in accessing and using contraceptives, the barriers experienced reach beyond individual‐level factors. ³⁶ Social and structural factors, such as a shortage of neighborhood health service providers, lower rates of insurance coverage, limited access to educational and economic opportunities, and practitioner bias, contribute to the barriers that Black women encounter in accessing and using their preferred forms of contraception. ³⁶

While restrictions to reproductive healthcare burden individual women, they also burden state economies. In the most probable Scenario 3, banning abortions under S.B. 23 would cost the state of Ohio an additional approximately $36.1 million per year of births. Explained another way, removing barriers to abortion care would allow the state to save up to $36.1 million dollars to potentially allocate toward other programs assisting Ohioans.

The most significant public costs are attributed to maternity medical costs and the first year of infant medical costs, paid through the state Medicaid program (over $21M in scenario 3, and over $108M in scenario 2). Pregnant individuals are eligible for Medicaid benefits if their income falls below 200% FPL and on average, Medicaid funds between 53% and 55% of births in Ohio. ³⁷ Among women seeking abortion access in Ohio, more than 70% of women fall below 200% FPL. These considerations are important for at least two reasons. First, it is crucial for the state to consider the effects of restricting abortion access in terms of the cost of public health care provision for eligible individuals. These additional yearly costs are significant and should be accounted for in fiscal budgets. Second, in addition to securing funds to support the Medicaid program, additional support will be needed to care for the well‐being of mothers and children. For example, Ohio implemented the Maternal and Infant Support Program in 2021, which aims to reduce and eliminate racial disparities in maternal and infant outcomes and reducing infant mortality. ³⁷

Limitations

While many anticipated costs to both individuals and the public are considered in this analysis, there are limitations to these estimates. First, the estimates provided are reliant on a series of assumptions that are based on other research studies. Because data utilized from these studies and other public sources do not always disaggregate by race, gender, or income level, some estimates rely on cumulative averages, while others more accurately represent costs for specific groups of people. Additionally, some data sources are available at the state level, while others are available at a national level. For example, in calculating the number of abortions for pregnancies with gestation periods of 6 weeks or less, we chose to use Ohio‐specific data that represented all abortions, rather than national‐level data that was disaggregated by race. Nationally, the percentage of abortions occurring at 6 weeks or less varies by less than 4% points among racial groups (43.4% for Black women, 47.1% for White women, and 46.8% for women of other races). ⁵ Having state‐level data disaggregated by race would improve the precision of this and similar analyses in future research.

Furthermore, while recognizing the deeply personal reasons behind individuals' family planning decisions, the costs of restricting access to desired abortion care are not fully accounted for. The costs associated with raising children extend far beyond age 4. Emotional and mental costs associated with abortion decision making are not quantified. Additionally, the individual and state costs of nonparenting births for are not accounted for in this study, given that some nonparenting births involve state agencies and others involve private adoption centers. Additional research is needed to understand these birth outcomes.

It is also important to note that restrictions on abortion access can impact economic self‐sufficiency even when abortion care remains legal in a state. While Ohio's S.B. 23 would have banned abortions after fetal cardiac activity is detected, other laws also restrict access to care (e.g., mandatory waiting times, required in person medical visits). The economic analysis provided in this article does not include the out‐of‐pocket cost of abortion care, which can range between $588 and $820 depending on the type of medical procedure and gestation period. ²⁸ However, any restrictions on abortion access can create delays in accessing wanted care and these delays can mean that abortion seekers must seek care providers that are further away in order to obtain the appropriate care. For example, introducing mandatory waiting periods caused a 53%–69% increase in the share of second trimester abortions. ³⁸ The additional out‐of‐pocket expenses for obtaining later care could have been avoided had the mandatory waiting periods not been in place. Future research examining the economic impact of restrictions on abortion access should take into account these types of laws as well.

When calculating public benefit costs, we did not quantify the cost of lost talent from the workforce (e.g., healthcare industry). Recent studies show that when healthcare professionals cannot learn about abortion care in states that ban it, they also are unable to learn other valuable skills related to women's reproductive health. ³⁹ Furthermore, they prefer practicing medicine in states that do not ban abortion. ⁴⁰ When healthcare professionals choose to study and practice medicine in other states, Ohio loses out on highly qualified healthcare providers. This decrease in the quality of healthcare is a loss to all Ohioans, not just those seeking abortion care. Indeed, studies have found that quality maternal health care has positive impacts on maternal mortality overall and reducing racial disparities in healthcare outcomes. ⁴¹

Policy considerations and future research

This report addresses the potential economic impacts of a single law concerning a specific aspect of reproductive health (i.e., abortion). Since the November 2023 passage of Ohio Issue 1, named the Right to Reproductive Freedom with Protections for Health and Safety ballot measure, Ohio laws with respect to reproductive freedom will be determined by the courts and legislature under this new constitutional amendment.

However, reproductive health encompasses a broader range of issues beyond access to abortion. Years of research have demonstrated that factors limiting economic mobility are multifaceted and interconnected. A variety of policies that positively affect both reproductive equity and economic mobility are recommended for policymakers and communities alike.

Policymakers should concentrate on two main areas of access: removing barriers to reproductive healthcare access and broadening access to contraception. Some laws, like Ohio's § 2317.56 directly impact individuals by requiring mandatory in‐person counseling and waiting periods. ⁴² Other laws ban certain abortion methods, allow withholding of medical information, or impose fetal tissue policies. ⁴³ Others involve placing medically unnecessary restrictions on providers in the form of building codes, licensing and certification standards and hospital transfer agreements and affiliations. ⁴³ Policymakers should consider repealing or revising these laws to minimize barriers to individuals seeking reproductive healthcare access.

Policymakers should also consider expanding access to contraception, especially long‐acting reversible contraception (LARCs). LARCs (e.g., intrauterine devices/IUDs and birth control implants) are considered highly safe and among the most effective forms of pregnancy prevention. One study by the Colorado Family Planning Initiative showed that Colorado's program to improve LARC access resulted in a reduction of the teen pregnancy rate by 6.4%. ⁴⁴ At the federal level, policymakers should consider making contraception of choice available to low‐income individuals by eliminating cost‐sharing measures through Title X. ⁴⁵ States can expand access to contraception through implementing state Medicaid waivers to broaden eligibility for family planning program services. ⁴⁶

Communities and community members can advocate for comprehensive sex education to be available for young people. Evidence‐based, developmentally appropriate, and unbiased educational materials can be provided in schools, by medical providers, from community organizations, or at home as a critical component of development. ⁴⁷ Advocates can also promote awareness and reduce stigma around reproductive health through open communication to develop a shared understanding of the broader implications of reproductive health and those with reproductive health needs.

While some of the above recommendations extend beyond addressing the effects of restrictions to abortion care specifically, it is important to consider the ways that access to reproductive health care, including educational information, can impact individual economic self‐sufficiency. There are opportunities for action at the public policy level, within private workplaces, and among communities that can allow for greater economic mobility.

Finally, while this economic estimate applies specifically to Ohio, it may serve as a model for understanding the potential economic impact of similar legislation that would restrict access to reproductive health care in other states. Other state analyses should take into account current and future access to health care, while still factoring into account individual and public costs like transportation, child care, medical care, wages and lifetime earnings loss, and public benefit costs. Incorporating additional costs, such as cost of medical procedures and additional public family support services may provide additional context and allow for an even more accurate estimate of costs in future studies.

Speice T. Estimating the economic impact of restricting reproductive healthcare access in Ohio. Perspect Sex Reprod Health. 2024;56(3):303‐314. doi: 10.1111/psrh.12286