Foster Care Admission Surged When Abortion Access Fell, Study Shows

Children born in states with laws targeting abortion, providers were more likely to be admitted into the foster care system, according to a new cohort study analyzing data from more than 4 million children.

In states with Targeted Regulation of Abortion Providers (TRAP) laws, there was an 11% increase in foster care placement compared to states without these laws (incidence rate ratio [IRR] 1.11, 95% CI 1.01-1.23), with a particular impact on Black children (IRR 1.15, 95% CI 1.05-1.28) and kids of other racial and ethnic minority groups (IRR 1.15, 95% CI 1.02-1.30), reported Savannah Adkins, PhD, of Bentley University in Waltham, Massachusetts, and co-authors in JAMA Pediatrics.

The reason for foster care entry was particularly attributable to housing inadequacy (IRR 1.21, 95% CI 1.11-1.32), they said.

“Restrictive abortion policies may contribute to the overrepresentation of racial and ethnic minority children in the foster care system, perpetuating inequities and further straining vulnerable populations,” authors wrote.

“That’s a really big finding because [minoritized] children are disproportionately represented in the foster care system as it is,” Adkins told MedPage Today.

In an accompanying editorial, Tracey Wilkinson, MD, MPH, and Caitlin Bernard, MD, MSCI, both of the Indiana University School of Medicine in Indianapolis, pointed out that post-Dobbs, 25 million women live in states with little to no abortion access and that Adkins’ findings reinforce that the burden of foster care is highest among minoritized kids.

“It is a sad day when we are faced with statistical evidence that our national policy includes forcing women to carry pregnancies and deliver children, only to take them away due to an inability to afford housing,” they wrote.

Wilkinson and Bernard also noted that the observed IRRs might not have clinical relevance despite being statistically significant, but, “[n]onetheless, for an already overburdened foster care system, even a 10% increase in children may make a huge difference.”

Following the Dobbs decision which led to the repeal of Roe v. Wade last year, Adkins and co-authors considered the downstream implications on foster care by analyzing TRAP laws, which historically have been used to make it harder for abortion providers to deliver care under the guise of patient safety. TRAP laws include four categories: building regulations, admitting privileges, transfer agreements, and distance laws.

Researchers used a dataset that included every TRAP law enacted since the 1970s, foster care data from the Adoption and Foster Care Analysis and Reporting System (AFCARS) database from the National Data Archive on Child Abuse and Neglect, as well as data from the U.S. Census Bureau and the CDC. The primary outcome was the number of children conceived who then entered the foster care system. Each child was only counted once even if they were removed multiple times.

The study included 4,179,701 children conceived between the start of 1990 through the end of 2011 who were placed into foster care between the start of 2000 and the end of 2020. The mean age was 7.4 and 51.4% were boys; 54.8% of the children were white, 30.4% were Black, and 5.4% were other races. Hispanic children were 19.2% of the cohort. Most kids had a documented disability or condition.

Of these children, 23% were conceived in a TRAP law state. Top reasons for entry into the system were neglect (57.3%), parental drug abuse (24.9%), caretaker inability to cope (18.3%), physical abuse (15.2%), child behavioral problem (11.0%), and inadequate housing (10.7%).

Authors note several limitations, including that the enforcement of TRAP laws may vary by state, and that women living near state borders could have more access to abortion, both of which could affect the extent of implications. Additionally, the authors did not consider self-managed abortion or contraception access.

Future studies should look at the cost related to increased foster care entries, the authors suggested. “The potential increase in caseloads due to the abortion restrictions and bans being implemented in the current policy landscape may exacerbate an already overburdened foster care system in many states,” they wrote in their conclusion.