One year after the Supreme Court’s ruling in Dobbs v. Jackson Women’s Health Organization overturned the Constitutional right to abortion enshrined in Roe v. Wade, women in the United States face numerous complex challenges in accessing reproductive healthcare, particularly in states that banned abortion after the decision.
This study reports on the state of reproductive and sexual health in California during the final years of the Roe era. Building on Gender Equity Policy Institute’s The State of Reproductive Health in the United States (January 2023), we analyze data on key reproductive health indicators—maternal mortality, teen births, and newborn deaths—and compare outcomes and trends between states grouped by reproductive healthcare access. Our objective in this state focused report is to establish a baseline on women’s reproductive and sexual health in California relative to the nation and other states.
California has excellent outcomes on measures across the entire continuum of women’s reproductive health and well-being, on which abortion care is one—albeit important—aspect. Among states publicly reporting data, California has the lowest maternal mortality rate in the U.S., less than half that even of the states that are supportive of reproductive freedom. By comparison, the maternal mortality rate in states that banned abortion in 2022 after Dobbs is nearly 5 times as high. On every indicator, women, pregnant people, and their babies have healthier outcomes in California and the other supportive states than they do in banned states.
California has been a leader in advancing women’s sexual and reproductive health for decades. After Dobbs, policymakers responded swiftly and decisively to put in place some of the nation’s strongest measures to protect reproductive freedom and prepare for the impact on California of abortion bans in other states. Voters overwhelmingly passed an amendment to the state Constitution to enshrine the right to abortion and contraception. More than 40 organizations, including sexual and reproductive health care providers, advocacy organizations, and legal and policy experts established the California Future of Abortion Council to coordinate reproductive freedom and justice efforts. Since its formation, the council has issued policy recommendations “to strengthen legal protections for consumers and abortion providers, expand the reproductive health care workforce, and ensure access to affordable care for low-income residents and communities of color.” Many of these recommendations were enacted into law in 2022 and others are pending in 2023.
The trends in California on health outcomes are largely positive. Nevertheless, California can do better. Compared to other supportive states, California ranks best only on maternal mortality; on other indicators, California ranks between 5th best and a middling 13th. Racial and ethnic disparities, common throughout the U.S. in all three groups of states (supportive, restrictive, and banned), are narrowing in California. But they remain unacceptably high.