A wide gap has long persisted between those who do and do not have the financial resources to make decisions about whether and when to become a parent, and the US Supreme Court’s overturning of Roe v. Wade has made it even harder for those with the fewest resources to access abortion care. A new analysis in Human Rights Magazine (published by the American Bar Association), co-authored by Liza Fuentes of the Guttmacher Institute and Elizabeth B. Harned of Planned Parenthood of Metropolitan Washington, DC, examines the role of wealth inequity in shaping abortion access in the United States.

The article highlights long-standing disparities in access to health insurance and health outcomes contributing to this inequity.

• People living with low incomes are twice as likely as those with higher incomes to lack health insurance.
• Women with incomes below the federal poverty line have an unintended pregnancy rate more than five times higher—and an abortion rate six times higher—than those of women with higher incomes.

“Access to abortion should not be determined by who you are or how much money you have,” says Guttmacher Institute Senior Research Scientist Liza Fuentes. “As with all abortion restrictions and bans, the impact of overturning Roe falls hardest on those who already struggle to access health care and face interlocking systems of oppression.”

Federal and state abortion-related policies further target people living with low incomes.

• The Hyde Amendment prohibits spending federal Medicaid funds on abortion coverage. State Medicaid funds can be used for abortion, but only seven states have affirmatively provided for this coverage (and another nine states have been court ordered to do so).
• These policies disproportionately affect Black, Latinx and Indigenous communities because of their systematic exclusion from economic opportunity.

The financial costs of abortion are not limited to the procedure itself but can also include travel, child care and taking time off work.

• As of January 1, 2023, 12 states are enforcing total abortion bans with very limited exceptions that make it difficult, if not outright impossible, to access care without traveling elsewhere. Abortion care is currently unavailable in two additional states.

• Patients in states that have not completely banned abortion often have to navigate burdensome and medically unnecessary restrictions that can lead to additional costs.
• In the United States, only 33% of the lowest paid workers have access to paid sick days.
• Abortion access is further complicated by the lack of available services. In 2017, nearly 90% of all US counties had no abortion provider, and the overturning of Roe has further decreased the number of providers.

The constantly changing legal landscape of abortion in the United States has created fear and confusion regarding the potential legal risks of health care decisions.

• Pregnant people have long faced criminal charges for pregnancy outcomes, including for self-managing an abortion.
• People who do not have the financial resources to access care from a clinical provider may be more likely to choose to self-manage their abortion, putting themselves at legal risk.
• Black and Indigenous people and immigrants are already disproportionately involved in the criminal legal system because of systemic racism.

The authors recommend ways that readers of Human Rights Magazine can help protect abortion access for people across the country:

• Join a bar association committee to take actions that protect and expand reproductive rights.
• Get involved with local legal and reproductive health organizations to educate others and advocate for abortion access at the local and state levels.
• Donate to abortion funds that provide resources to assist people who otherwise could not afford to access abortion care.

“People with legal, political and financial privilege must step up to restore, protect and expand abortion rights and access,” says Fuentes. “Such efforts must address the needs of the communities most harmed by abortion restrictions and bans.”

“Abortion Out of Reach: The Exacerbation of Wealth Disparities After Dobbs v. Jackson Women’s Health Organization,” by Elizabeth B. Harned, Vice President of Public Affairs at Planned Parenthood of Metropolitan Washington, DC, and Liza Fuentes, Senior Research Scientist at the Guttmacher Institute, is published in Human Rights Magazine.

Supported by The Commonwealth Fund, a national, private foundation based in New York City that supports independent research on health care issues and makes grants to improve health care practice and policy. The views presented here are those of the author and not necessarily those of The Commonwealth Fund, its directors, officers, or staff.

Additional information on abortion policies and access in the United States is available at Roe v. Wade Overturned: Our Latest Resources.