In a comprehensive analysis published in the American Journal of Preventive Medicine on June 5, 2025, an alarming disparity in healthcare access among pregnant women in the United States has been rigorously documented. The study, conducted by a team of researchers from Harvard Medical School, Hunter College at the City University of New York, and multiple other institutions, reveals that pregnant women residing in states that have banned or severely restricted abortion access confront significantly inferior access to routine medical care. This discrepancy, the researchers emphasize, is closely tied to the Medicaid policies prevalent in these states, shedding light on systemic factors underlying the ongoing maternal health crisis in the country.
The investigation utilized data spanning nearly a decade, sourced from the 2014-2022 Behavioral Risk Factor Surveillance System (BRFSS), a large-scale health survey spearheaded by the Centers for Disease Control and Prevention (CDC) alongside state health departments. The robust dataset included responses from over 20,000 pregnant women nationwide, enabling a detailed comparative analysis of health coverage status, affordability of physician visits, and continuity of care through a personal healthcare provider. Critically, the analysis differentiated between states imposing abortion restrictions post the landmark 2022 Supreme Court decision overturning Roe v. Wade and those without such constraints.
Findings from the analysis expose a stark disparity in insurance coverage. In 2022 alone, approximately 258,000 pregnant women in the United States lacked any form of health insurance. More troublingly, nearly two-thirds (62%) of these uninsured women were concentrated in abortion-ban or abortion-restriction states. Texas emerged with the highest proportion at 21%, followed by Arkansas with 18.8%, and Florida with 18.6%. These figures underscore how state-level abortion policies intersect with other systemic barriers to amplify healthcare vulnerabilities among pregnant populations.
Beyond insurance coverage, the study illuminated significant differences in access to essential pregnancy care. Pregnant women living in states with restrictive abortion laws were markedly more likely to report being unable to afford a doctor’s visit within the past year and reported lacking a personal physician. Quantitatively, 15% of pregnant women in abortion-restriction states were uninsured, compared to just under 10% in states without such restrictions. Similarly, nearly 20% of pregnant women in restrictive states struggled to afford physician care, surpassing the 13% rate in other states. Additionally, nearly 30% of these women lacked an ongoing relationship with a personal healthcare provider, whereas the figure was around 21.5% in states without abortion limitations.
Delving deeper into subpopulations, the study meticulously examined pregnant women managing pre-existing chronic illnesses, such as diabetes, which require vigilant medical attention to minimize risks to both maternal and infant health. Alarmingly, women with pre-gestational diabetes in abortion-restriction states were more frequently without a personal doctor. Furthermore, those who developed gestational diabetes during pregnancy faced heightened odds of being uninsured or foregoing physician visits altogether. These findings highlight the compounded risks faced by vulnerable pregnant women in an already precarious healthcare environment.
Addressing potential confounders, the researchers scrutinized Medicaid programs’ role in mediating access to healthcare services. Medicaid, a pivotal source of coverage for low-income pregnant women, varies significantly across states based on eligibility criteria and benefit generosity. The analysis revealed that worse access to prenatal care in abortion-ban states was predominantly attributable to three Medicaid policy dimensions: the refusal to expand Medicaid under the Affordable Care Act; exclusion of coverage for pregnant immigrants documented for less than five years; and maintaining stringent income eligibility thresholds for pregnant women.
These restrictive Medicaid policies collectively erect formidable financial and administrative barriers, deterring pregnant women from securing regular prenatal care. The research exposes a troubling reality wherein political decisions about reproductive rights are intricately linked with broader health policy frameworks, magnifying disparities in maternal healthcare access. Given that Medicaid is a lifeline for many low-income and minority women, the study warns that any future cuts or limitations—such as those proposed in recent Republican budget initiatives—would exacerbate these already significant care deficits.
The study’s senior author, Dr. Steffie Woolhandler of Hunter College and Harvard Medical School, underscored the dire consequences of current policies, stating: “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.” This statement places the findings within a wider socio-political context, illustrating how legislative environments profoundly impact health outcomes.
Lead author Dr. Adam Gaffney emphasized the contradiction in contemporary state policies by noting: “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.” His remarks address the interconnectedness between reproductive rights and comprehensive maternal healthcare access.
The multifaceted nature of this crisis demands urgent policy attention. The findings suggest that improving pregnant women’s health coverage and access to care requires not only safeguarding abortion access but also substantial reforms in Medicaid implementation and expansion. Without such integrated approaches, pregnant women—especially those affected by chronic diseases and socioeconomic disadvantages—will continue to face heightened risks during one of the most critical periods of their lives.
Furthermore, the study’s granular data analysis highlights crucial public health implications, particularly for states that have resisted Medicaid expansion or imposed restrictive eligibility criteria. These policies indirectly endanger maternal and infant health, contributing to the persistent inequalities observed in maternal mortality rates. The researchers advocate for Medicaid reforms that prioritize inclusivity, affordability, and continuous care to reverse these trends and close the systemic gaps in healthcare access.
This investigation is a striking example of how political and social determinants directly impinge upon healthcare equity. By harnessing comprehensive, statistically rigorous data from a trusted source like the BRFSS, the researchers provide compelling evidence that challenges policy makers to reconcile reproductive rights with the broader healthcare needs of pregnant women. The data-driven methodology ensures robust conclusions and reaffirms the role of scientific inquiry in informing health policy discourse.
In conclusion, the study calls for a paradigm shift—one where states prioritize comprehensive healthcare access for all pregnant women regardless of their reproductive choices. It presents a clear call to action that enmeshes reproductive rights, Medicaid policy, and maternal health into a cohesive framework aimed at rectifying stark disparities and safeguarding the health of mothers and infants across the United States.
Subject of Research: People
Article Title: Healthcare Access among Pregnant Women in States with and without Abortion Restrictions
News Publication Date: June 5, 2025
Web References:
https://doi.org/10.1016/j.amepre.2025.107671
https://www.ajpmonline.org/
References:
Gaffney A., Woolhandler S., et al. Healthcare Access among Pregnant Women in States with and without Abortion Restrictions. American Journal of Preventive Medicine. 2025 Jun 5.
Keywords:
Pregnant women, healthcare access, abortion restrictions, Medicaid, insurance coverage, maternal health, chronic illness, diabetes, United States, policy disparities, maternal mortality, ACA Medicaid expansion
