With Roe v. Wade expected to be overturned in the coming weeks, abortion is likely to become even more restricted or altogether banned in West Virginia. Indeed, the fall of Roe will create a stark patchwork of abortion legality and access in states across the country. This will exacerbate scenarios wherein people with means will continue to have access to abortion because they have the ability to afford the time and money costs of long travel to a state where abortion is legal, including taking time off from work, finding child care, navigating waiting periods, and covering the cost of the abortion itself. It will primarily be for poorer people with fewer resources that abortion will become (even more) inaccessible.
In addition to implementing several abortion restrictions in recent years, West Virginia lawmakers have also limited access to and largely failed to invest in family economic and health supports, placing those who become pregnant in often perilous health and economic conundrums where abortion is inaccessible at the same time as family, health, and economic supports that make parenting possible are inadequate. Because of this stark reality, abortion access will become — and already is — an economic issue.
Nationally, half of all people who seek abortions live below the poverty level and 75 percent are low income, with incomes below 200 percent of the federal poverty level. In addition to having extremely low incomes, they overwhelmingly lack access to family and work supports like paid (or even unpaid) maternity leave, paid sick days, consistent work scheduling, or affordable child care.
Further, 59 percent of those seeking abortions already have at least one child and 55 percent report a recent disruptive life event such as the death of a family member, job loss, the termination of a relationship with a partner, or overdue rent or mortgage payments. This data reinforces why poorer people are more likely to seek abortions and how they will be disproportionately impacted by further abortion restrictions or bans. Those who already have children, who have recently lost a job, or who are already behind on their bills already make up the majority of those seeking abortions and will be less likely to navigate the patchwork post-Roe landscape where accessing abortion becomes far more costly and onerous.
Landmark research called the Turnaway Study gives us a good idea of what will, and is already, happening to those who are denied abortions. The economic consequences last for years. The study found that women who were denied abortions and went on to give birth experienced increases in household poverty lasting at least four years compared with those who received abortions; years after abortion denials, women were more likely to not have enough income to cover basic living expenses like food, housing, and transportation; and being denied an abortion increased the likelihood of bankruptcies and evictions. Those denied abortions are also more likely to stay in contact with a violent partner.
West Virginia already has nine abortion restrictions in place, including a 20-week ban, a 24-hour waiting period, parental notification requirements, bans on using state Medicaid dollars to fund abortions, and bans on telemedicine administration of abortion medication. Together, these restrictions make abortion incredibly difficult to access. For example, the collective impacts of the telemedicine ban, waiting period, and requirement that Medicaid enrollees pay out-of-pocket for an abortion lengthen the process of securing an in-person appointment, which then positions the individual seeking the abortion closer to the 20-week cutoff date, or even beyond it.
The number of abortions performed in West Virginia was nearly halved between 2010 to 2020. While increased access to birth control through the passage of the Affordable Care Act and the Medicaid expansion likely played a role, the number of abortions continued to decline significantly as abortion restrictions were passed.
The state’s health and economic statistics paint a picture of the lack of support available to women, children, and families. West Virginia has the fourth-highest poverty rate in the country, with 18.7 percent of women and 23.1 percent of children living below the poverty line. Poverty is higher among communities of color, where the overall poverty rate is 29 percent for Black West Virginians and 18.9 percent for Latino or Hispanic West Virginians. Understanding the intersections between poverty, race, and abortion access, we know that West Virginia has a high number of residents for whom existing abortion restrictions have already created barriers that further restrictions or outright bans will only exacerbate.
West Virginia, and the nation as a whole, also have unacceptably high infant and maternal mortality rates. These rates are often used as an indicator of the overall health of a population, and while maternal and infant mortality have been declining in other developed countries across the world, they have been increasing in recent decades in the United States. West Virginia’s overall maternal mortality rate is even higher than the national average. In 2017, West Virginia’s maternal mortality rate was 21.4 per 100,000 compared with 17.4 per 100,000 nationally. Similarly, the infant mortality rate in West Virginia, 7.02 per 1,000, is higher than the national average that same year of 5.89 per 1,000. Race and ethnicity data is conspicuously missing from the available annual reporting in West Virginia, so we do not know how disproportionately impacted Black women and other minorities are by infant and maternal mortality. Nationally, Black women have three times greater maternal mortality rates than white women, and infants born to Black women are more than twice as likely to die in the first year compared with infants born to white women. West Virginia is also an outlier in other negative health statistics including rates of heart disease, diabetes, and other chronic health conditions.
Over the same period that abortion restrictions were enacted at the state level, surprisingly little has been done to increase economic and health security for families and children.
West Virginia does not have a paid family and medical leave policy for maternity leave or a state-level Child Tax Credit or Earned Income Tax Credit, both of which increase economic security for families and have long-term benefits for educational attainment, health outcomes, and future earnings for children.
The state also has the fourth-largest rate (nearly two-thirds) of families living in child care deserts, where child care is inaccessible for many families. And in areas where child care is accessible, it is often unaffordable, with child care in a center costing more than in-state college tuition for both infants and toddlers. At the state level, legislators have done little in recent years to address the need for more affordable, accessible child care options for families. And while many families qualify for subsidies to help cover the cost of child care, the program is underfunded, only reaching one in four eligible families. State legislators could prioritize spending more on child care, as state spending is less in 2022 than it was in 2009 per Department of Health and Human Resources (DHHR) testimony earlier this year. A roadmap for improvements to the state’s child care system published by the West Virginia Early Childhood Planning Taskforce in 2014 has gone largely unimplemented.
What’s more, state lawmakers have enacted outright roadblocks to family health and economic security in recent years. In 2017, the DHHR enacted a pilot program to drug screen and test applicants for Temporary Assistance for Needy Families (TANF) benefits. TANF is the only cash assistance program available to families and its eligibility is incredibly narrow, limited to families far below 40 percent of the poverty line with lifetime limits on how long families can remain eligible. Nationally, drug screening and testing has proved costly and ineffective, and that was no different in West Virginia, where less than one half of one percent of TANF recipients tested positive for any substance. Despite the pilot program’s overwhelming failure, the legislature passed a policy in 2021 extending the drug screening and testing program statewide.
It remains to be seen how state lawmakers will proceed if given the ability to ban abortion altogether. What’s already clear is that current restrictions paired with a lack of family and economic supports are already harming low-income people. State lawmakers should resist the political urge to further attack abortion and instead focus on improving health and economic supports for families, collecting more comprehensive data on maternal and infant mortality, and removing barriers to programs that improve outcomes for children and families.
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