States that restrict abortion see more foster care entries

Key takeaways:

• State restriction of abortion is associated with an 11% increase in foster care entry.
• The study was prompted by last year’s overturning of Roe v. Wade.

States that restrict abortion saw an 11% increase in foster care entries, according to findings published in JAMA Pediatrics.

Since last year, when the U.S. Supreme Court upheld a Mississippi law limiting abortion access in the Dobbs v. Jackson Women’s Health Organization decision and overturned the nearly 5-decade precedent set by Roe v. Wade, numerous studies have explored the effect of Dobbs, such as extended travel times to receive an abortion, an increase in mental distress for women and the a worsening of physician shortages.

“My co-author and I began talking about this issue last year after the Dobbs decision,” Savannah Adkins, PhD, professor of economics at Bentley University in Waltham, Massachusetts, told Healio. “We'd been discussing other research having to do with antiabortion legislation and decided to investigate areas we thought may be impacted. The foster care system was the first thing we chose to look at, since an argument of antiabortion proponents is that those children could go into foster care or be adopted.”

Using data from the Adoption and Foster Care Analysis and Reporting System database, which collects data from all 50 states and Washington, D.C., on children in foster care, Adkins and colleagues examined a sample of children conceived between Jan. 1, 1990, and Dec. 31, 2011, who were placed into foster care at any point between Jan. 1, 2000, and Dec. 31, 2020, and examined which states had Targeted Regulation of Abortion Providers (TRAP) laws in place at that time.

“We ... estimated the likelihood of entering foster care if there was a TRAP law in place at the time of conception compared with no TRAP law being in place at the time of conception,” Adkins said.

The study included 4,179,701 children: 30.4% were Black, 54.8% were white and 5.4% were of other races.

About 23% of the children in foster care were conceived in states with a TRAP law in effect. Having a TRAP law was associated with an 11% increase in foster care entry.

Common reasons for entries included neglect (57.3%), parental drug abuse (24.9%), caretaker inability to cope (18.3%), physical abuse (15.2%), child behavioral problem (11%) and inadequate housing (10.7%).

The findings highlight the disparate impacts from the Dobbs decision on minority communities, and will only “serve to exacerbate existing inequalities and place a larger strain on an already strained system,” Adkins said.

“Unfortunately, the results were not particularly surprising, since individuals seeking abortion are more likely to be single, below the poverty line and from minoritized communities,” Adkins said. “Therefore, it makes sense that lack of access to abortion would impose financial hardship and pose a greater impact on these individuals.”

Adkins said future studies could examine other downstream impacts of lack of abortion access.

“Particularly, prior literature has found that individuals in foster care face more difficulties with health, mental health, and education, among other things, so it would be interesting to see the strain placed on these systems subsequently,” Adkins said.

In an accompanying editorial, Tracey A. Wilkinson, MD, MPH, and Caitlin Bernard, MD, MSCI, from the Indiana University School of Medicine, said the study has “contributed an important examination of how abortion access affected foster care entries even before the loss of federal legal protections for abortion access.”

“As further evidence of the downstream effects of this fundamental shift in human rights in our country continues to be documented, continuing to examine and speak out about the impact on families and communities is imperative,” they wrote. “What is desperately needed now is a simultaneous focus on action to truly support families and ensure that everyone is given the opportunity to raise their children in safe and sustainable communities.”

References:

Adkins S, et al. JAMA Pediatr. 2023;doi:10.1001/jamapediatrics.2023.4738.

Wilkins TA, et al. JAMA Pediatr. 2023;doi:10.1001/jamapediatrics.2023.4735.