January 2023

In June 2022, the Supreme Court overturned Roe v. Wade, ruling in Dobbs v. Jackson Women’s Health Organization that nothing in the United States Constitution guarantees a women’s right to abortion. Within six months of the decision, 15 states had banned abortion. More are anticipated to do so in the 2023 state legislative sessions that will commence this month.

For 50 years, abortion was a protected, albeit highly endangered, constitutional right. The supportive legal environment, plus advances in birth control, fertility treatments, and other reproductive technologies, allowed women and pregnant people autonomy and freedom in their personal decisions about bearing children. To be sure, legal and financial barriers prevented far too many people, particularly young, low-income, Black, Native American, and Latina women, from exercising their constitutional right. Nevertheless, an extensive body of research demonstrates that legal access to comprehensive reproductive healthcare improved maternal and child health outcomes and advanced gender equity in the United States.

The Dobbs decision has already dramatically changed the landscape. Abortion care in the U.S. is no longer simply difficult to access. It is illegal in 15 states. Abortion care providers and pregnant people seeking care are now subject to heavy fines, suspension, and in some cases, imprisonment. Criminalization has had a ripple effect; fear and suspicion have already resulted in the denial of necessary reproductive healthcare.

The freedom to control if and when to have children is globally recognized as a fundamental human right. At Gender Equity Policy Institute (GEPI), we are committed to defending and advancing human rights, particularly for those marginalized on the basis of sex or gender, and to conduct research that helps the U.S. advance gender equity for all people.

This study reports on the state of reproductive and sexual health in the United States during the final years of the Roe era. Gender Equity Policy Institute’s “The State of Reproductive Health in the United States,” analyzes data on key indicators such as teen births, maternal mortality, and newborn deaths, and compares trends between groups of states. Our objective in this inaugural report is to establish a baseline for future assessments of the effects of abortion bans on women’s health and well-being in the coming years.

For this study, to evaluate reproductive health and well-being in the U.S., we apply the framework adopted by the global community in the 2030 Agenda for Sustainable Development, specifically Sustainable Development Goal 3, which calls for all nations to “ensure healthy lives and promote well-being for all at all ages.” (See Appendix 2.)

The U.S., despite being one of the 193 nations that have signed onto the 2030 Agenda, is the only developed nation that has not measured or publicly reported on its progress on any of the 17 sustainable development goals. With only eight years remaining to reach the 2030 SDG targets, and the newly hostile environment for women’s rights created by the Dobbs decision, a report putting the spotlight on women’s reproductive and sexual health in the United States is in order.

To examine and compare annual levels and trends on key indicators of reproductive health, well-being, and equity, we first classified states into three groups – supportive, restrictive, and banned – based on their level of support for comprehensive reproductive healthcare, and then compared outcomes in the three groups over time. Outcome data was abstracted from high-quality, publicly available sources, including the Centers for Disease Control and Prevention (CDC), the U.S. Census American Community Survey (ACS), and others. The analysis looked at the 50 states and the District of Columbia and primarily focused on the years 2015 – 2021.

The data is clear. For women, girls, and gender diverse people who can become pregnant, there are two Americas

For those who live in one of the 22 states which support reproductive freedom, the trends are largely positive. The health and well-being of women and babies in these states outpaces that of those living in states which ban or restrict abortion care. This is true across nearly all indicators.

The situation is dramatically different, and more precarious, for the 59% of women and girls who live in the 29 states which ban or restrict abortion care and other reproductive healthcare. On nearly every measure, people in banned and restrictive states have worse outcomes than their counterparts in supportive states. Moreover, these states are less likely to enact policies, like paid parental leave, which have been shown to improve outcomes for new parents and babies.

The end of legal protection for abortion threatens to further increase maternal mortality, newborn and infant mortality, and teenage births in the U.S. These threats are not equal for all women. Women who live in states that ban or restrict abortion and other reproductive healthcare are likely to suffer the burden of these adverse consequences. Nationwide, Black and Native American women already face disproportionately higher maternal mortality rates and Latinas are more likely than other women to be uninsured. Therefore, for Black, Latina, and Native American women who live in states hostile to reproductive freedom, the health dangers will be compounded.

Los Angeles County faces an affordable housing crisis, one of the most acute in the state of California. Rising rents and home purchase prices, a countywide shortfall of new units to meet current and future demand, old housing stock, and a high proportion of low-wage working families in the metropolitan area have combined to leave too many of the County’s residents struggling to secure safe, quality housing. Compounding these trends, the Covid pandemic exacerbated socioeconomic disparities for groups with disproportionately high rates of low-income, especially women of color and single mothers.

SB-679, authored by Senator Sydney Kamlager, would create the Los Angeles County Affordable Housing Solutions Agency (LACAHSA), a countywide multistakeholder agency whose purpose is to increase the supply of affordable housing and provide rental assistance throughout Los Angeles County.

The Gender Equity Policy Institute analyzed housing expenditures and income of Los Angeles County residents to assess the disparate gender and race/ethnicity impacts of the region wide housing affordability crisis. Our findings show that people of color and women, especially Black and Latina women, are more likely to be spending an unsustainable portion of their income on housing.

Understanding current racial and gender housing inequities in Los Angeles County, we hope, will assist LACAHSA in addressing Los Angeles County’s regionwide housing crisis in a way that contributes to eliminating existing inequalities, advancing gender and racial equity in housing, and promoting a healthy and sustainable future for all people in Los Angeles County.

 

The federal Infrastructure Investment and Jobs Act (IIJA), signed by President Biden in November 2021, will bring at least $45 billion to California for investments in transportation, communications, water, clean air, and other infrastructure projects. And with the Inflation Reduction Act on the verge of passage, California stands to benefit from an infusion of federal funds for climate action and drought relief.

States have wide discretion in choosing the types and locations of projects to be funded and hence will play a key role in determining how the $1.2 trillion in federal infrastructure funds will be spent. The Biden administration’s implementation guidance urges states to invest the funds “equitably”, following its Justice40 Initiative, which calls for delivering 40 percent of the benefits of federal investments to disadvantaged communities.

Assembly Bill (AB-2419), authored by Assembly member Isaac Bryan, would write that goal into state law by mandating that 40% of the IIJA funds directly benefit communities defined as environmentally and socially disadvantaged. The Act calls for an additional 10% of the federal funds to directly benefit communities defined as low-income. The remaining half of IIJA funds could be used for infrastructure projects without restriction.

The Act also would guarantee high labor standards and foster the creation of quality jobs for underrepresented groups. The Strategic Growth Council would be charged with implementing the law. AB 2419 also establishes the Justice40 Committee, comprised of representatives from environmental justice organizations, labor, and disproportionately impacted communities, to monitor implementation and issue recommendations for equitable and sustainable infrastructure investment.

The Gender Equity Policy Institute analyzed demographic data on the communities targeted for infrastructure investment under AB 2419 to assess the likely distribution of funds by race/ethnicity, gender, and region.

Our findings show clear benefits to communities that have been disproportionately harmed by decades of discriminatory practices in infrastructure siting and building. Roughly three-quarters of those living in communities targeted for investment are Black, Latino, Asian American, or Native American. Women of color particularly stand to benefit from the targeted infrastructure investment.

AB-2419 received a rating of 94% on GEPI’s intersectional gender equity scale, indicating that, if enacted, it would powerfully advance gender and racial equity in California. By targeting infrastructure investments to historically under-served and marginalized communities, AB-2419 provides a blueprint for an equitable and transformative approach to infrastructure investment.