Association Between Restricted Abortion Access and Child Entries Into the Foster Care System

Abstract

ImportanceThe 2022 US Supreme Court decision Dobbs v Jackson Women’s Health Organization overturned federal protections to abortion care, allowing many states to severely restrict or ban access to abortion. Given the implications of the Dobbs ruling, there is a need to understand the full consequences of restricted abortion access. Before 2022, many states restricted access to safe and legal abortions through Targeted Regulation of Abortion Providers (TRAP) laws, which provide a historical mode for estimating the consequences of abortion restrictions.ObjectiveTo use TRAP law enactment as a natural experiment to quantify the association between restricted abortion access and foster care entries.Design, Setting, and ParticipantsIn this cohort study, data on the enactment of TRAP laws and case-level data on foster care entries were used to estimate the association between restricted abortion access and foster care entries in each of the 50 US states and the District of Columbia. The sample included children conceived between January 1, 1990, and December 31, 2011, who were placed into foster care at any point between January 1, 2000, and December 31, 2020. Data analysis was performed from January 2023 to July 2023.ExposuresRestricted abortion access due to state-level TRAP laws during pregnancy.Main Outcomes and MeasuresThe main outcome was the number of children entering foster care in each state, measured by year of child conception. The analysis was performed using a generalized difference-in-differences design, comparing entries into foster care in states with TRAP laws to states without TRAP laws, before and after their implementation.ResultsThis study included 4 179 701 children who were placed into foster care during the study period, with 11 016 561 entries. More than half of the children were male (51.4%), and the mean (SD) age was 7.4 (5.2) years. There was an 11% increase in foster care placement after abortion access was restricted in states with TRAP laws, relative to states without TRAP laws (incidence rate ratio [IRR], 1.11 [95% CI, 1.01-1.23]). These laws had significant consequences for Black children (IRR, 1.15 [95% CI, 1.05-1.28]) and racial and ethnic minority children (IRR, 1.15 [95% CI, 1.02-1.30]). The increase in entries due to TRAP laws was particularly attributable to housing inadequacy (IRR, 1.21 [95% CI, 1.11-1.32]).Conclusions and RelevanceRestricted abortion access can have numerous consequences, and these findings reveal a heightened strain on the US foster care system, particularly affecting marginalized racial and ethnic communities and financially vulnerable families. These placements have been shown to have lifelong consequences for children and substantial costs for both states and the federal government. To further examine the widespread implications of the overturning of Roe v Wade, future studies should forecast the expected increase in foster care entries and estimate the expenditure needed to support these children.

Abortion Restrictions and the Child Welfare System

“…To the Editor Adkins et al used a natural experiment using Targeted Regulation of Abortion Providers (TRAP) legislation to evaluate the association between abortion restrictions and foster care. States that enacted TRAP legislation had 11% more foster children than ones that did not.…”

“…The study by Adkins et al also ignored alternate abortion coping techniques, such as cross-state travel, medicinal abortion, contraception, and others. These measures may affect birth and abortion rates and foster care needs.…”

“…In conclusion, the study from Adkins et al raises an issue that deserves more study: the effects of abortion restriction policies on child well-being. To further assess the social and economic impact of abortion restrictions, future studies should include more confounding factors, coping strategies, and long-term effects.…”

Abortion Restrictions and the Child Welfare System—Reply

“…In Reply We appreciate Li and Liu for their interest in our research . In their letter, Li and Liu highlight the importance of incorporating many drivers that lead a family to need the foster care system, such as socioeconomic status, social assistance, and racial prejudice.…”

US abortion restrictions led to an 11% increase in children placed in foster care, study finds

“…Restrictions on abortion access in the US in the past 20 years led to an 11% increase in children placed in foster care, a study in JAMA Paediatrics has found 1…”