Implications of Abortion Restrictions for Adolescents

Abstract

This cross-sectional study examines the proportion of the adolescent population potentially facing barriers to abortion access owing to 3 types of state restrictions in the US.

In 2022, the Dobbs v Jackson Women’s Health Organization Supreme Court decision removed federal constitutional protections for abortion.¹ As states have adopted new abortion restrictions, 50% of reproductive-age women now live in states that ban or severely restrict abortion access.² However, adolescents’ experiences have not been examined in detail. As the Dobbs decision exacerbates existing health and social inequalities, those implications will extend to adolescents who face disproportionate barriers to accessing abortion care, including transportation, finances, and potential parental involvement requirements.³ The aim of this study was to understand the scope of post-Dobbs abortion policy changes across states for this population overall and by racial and ethnic subgroups because abortion restrictions are expected to disproportionately impact historically marginalized groups.⁴

Methods

For this cross-sectional study, data on abortion policies as of December 20, 2024, were obtained from KFF.⁵ We identified states with full abortion bans, restrictive gestational limits (6-22 weeks), and those allowing abortion beyond 22 weeks. We also identified states that, as of September 1, 2023, required parental involvement (consent or notification) for adolescents to access abortion according to Guttmacher policy tracking.⁶ To assess implications by race and ethnicity, we obtained single-race population estimates (2020 US Census) from the Centers for Disease Control and Prevention Wide-ranging Online Data for Epidemiologic Research database. The Rutgers University Institutional Review Board determined the study was exempt from review since it was not human participant research. We followed the STROBE reporting guideline.

First, we calculated state-specific counts of females aged 13 to 17 years overall and by race and ethnicity. Second, we calculated the number and percentage of female adolescents overall and by each race and ethnicity for those living in states with abortion bans or restrictive gestational limits. Third, we incorporated information about age-specific parental involvement requirements to calculate the number and percentage of adolescents living in states with bans, 6-week to 22-week gestational limits, or parental involvement requirements. Analyses were performed in R, 4.4.1 (R Project for Statistical Computing).

Results

As of December 20, 2024, 12 states banned abortion entirely, and 10 states had restrictive gestational limits. Additionally, as of September 1, 2023, parental involvement in an adolescent’s decision to have an abortion is required in the 10 states with restrictive gestational limits and in 14 of 29 states (including the District of Columbia) without bans or without restrictive gestational limits (Figure).

Figure. Abortion Restrictions in the US.

Data on abortion bans and gestational limits were current as of December 30, 2024. Data on parental involvement requirements (consent or notification) for adolescents in states without full bans were current as of September 1, 2023.

The study included 10 666 913 females aged 13 to 17 years in the US (Table). Of these, 24% (2 519 258) live in states with abortion bans and an additional 24% (2 512 969) live in states with restrictive gestational limits. Exposure to parental involvement laws expands the number and percentage of adolescents facing abortion restrictions, as 42% of adolescents (4 527 346) live in states without abortion bans that have parental involvement requirements. Overall, 66% of females aged 13 to 17 years (7 080 485) live in a state with an abortion ban, a 6-week to 22-week gestational limit, or parental involvement requirements, including 66% of American Indian or Alaska Native, 43% of Asian, 55% of Hispanic, 36% of Native Hawaiian and Other Pacific Islander, 78% of non-Hispanic Black, 72% of non-Hispanic White, and 62% of multiracial adolescents.

Table. Adolescent Females Aged 13 to 17 Years Living in States With Restrictive Abortion Policies and Parental Involvement Requirements Stratified by Race and Ethnicity.

Race and ethnicity	Total population, No.a	Adolescents, No. (%)
		Residing in 12 states with bans	Residing in 10 states with gestational limitsb	Residing in 24 states with parental involvement requirements and no ban c,d	Residing in 36 states with bans, gestational limits, and/or parental involvement requirementsb,c,d
Overall	10 666 913	2 519 258 (24)	2 512 969 (24)	4 527 346 (42)	7 080 485 (66)
American Indian or Alaska Native	88 162	24 524 (28)	11 819 (13)	33 430 (38)	58 061 (66)
Asian	560 842	77 796 (14)	76 094 (14)	164 536 (29)	242 893 (43)
Hispanic	2 800 108	699 156 (25)	474 136 (17)	845 688 (30)	1 548 574 (55)
Native Hawaiian and Other Pacific Islander	22 162	2882 (13)	3261 (15)	5119 (23)	8016 (36)
Non-Hispanic Black	1 483 282	397 872 (27)	475 659 (32)	746 132 (50)	1 153 891 (78)
Non-Hispanic White	5 250 041	1 227 279 (23)	1 369 027 (26)	2 535 416 (48)	3 781 019 (72)
Multiracial	462 316	89 749 (19)	102 973 (22)	197 025 (43)	288 031 (62)

^a In all 50 states and the District of Columbia; states with bans included Alabama, Arkansas, Idaho, Indiana, Kentucky, Louisiana, Mississippi, Oklahoma, South Dakota, Tennessee, Texas, and West Virginia. States with gestational limits between 6 and 22 weeks included Florida, Georgia, Iowa, Kansas, Nebraska, North Carolina, Ohio, South Carolina, Utah, and Wisconsin. States with only parental involvement laws included Arizona, Colorado, Delaware, Maryland, Massachusetts, Michigan, Missouri, Montana, New Hampshire, North Dakota, Pennsylvania, Rhode Island, Virginia, and Wyoming.

^b Gestational limit between 6 and 22 weeks from the last menstrual period.

^c Parental consent or notification.

^d Limited to adolescents aged 13 to 15 years in Delaware, Massachusetts, and Montana because their parental involvement requirements only include those younger than age 16 years; in South Carolina, limited to adolescents aged 13 to 16 years.

Discussion

More than 7 million adolescents live in states with abortion bans, restrictive gestational limits, or parental involvement requirements. Means of accessing abortion by circumventing geographic restrictions that are available to adults (eg, traveling to another state or using telehealth) are less accessible to adolescents due to cost and logistical barriers, leaving them disproportionately affected by geographically based restrictions.³ American Indian or Alaska Native, non-Hispanic Black, and non-Hispanic White adolescents had higher numbers of adolescents potentially affected by abortion access restrictions owing to geographic variation in residence. Study limitations include that the population estimates refer to 2020 and the rapidly changing legal landscape.

Supplement.

Data Sharing Statement