Madeleine Livingston: How to Have Productive Conversations on the Business Impact of Reproductive Rights Restrictions
May 28, 2025
Madeleine Livingston
Having Productive Conversations on the Business Impact of Reproductive Rights Restrictions
A guide for business leaders outside HR to drive business impact focused conversations on reproductive rights by partnering with C-suite HR executives to integrate the issue into corporate strategy.
Big thank you to Tabya Sultan, Flory Wilson, Julia Kennedy, and Lizzie Murdoch for their brilliant contributions to this article!
In 2025 to date, corporate executives have dealt with the fallout of devastating wildfires, a presidential transition, sweeping DEI executive orders, the potential impact of tariffs, global military conflicts – and of course, all of the employee level challenges that accompany these events.
As economic uncertainty continues, the third anniversary of the Dobbs decision approaches, and we’re now beginning to see emerging trends in economic behavior, health outcomes, and employee benefit expectations. State level restrictions on reproductive rights – namely, access to abortion – have led to the following impacts:
- Migration out of States with Reproductive Rights Restrictions: 1 in 5 adults planning to have children in the next decade has moved or knows someone who has moved to another state due to reproductive rights restrictions. Recent economic research has indicated that state-level abortion bans have particularly impacted single-person households, which tend to be younger and more mobile. Notably, if these bans remain in place for five years, the resulting economic losses would be comparable to those typically associated with a 10% increase in local crime rates or approximately one-tenth of the impact experienced by communities exposed to toxic chemical releases.
- Delays in Preventive Care: According to Nurx patient surveying, 27% of women have delayed preventive care [e.g. annual primary care visit, women’s well visit] in response to the political environment surrounding sexual and reproductive health. This behavior may stem from distrust in the medical system in states with strict reproductive rights laws. Moreover, in addition to patient fear resulting in delayed preventive care, we also see a reduction in senior OBGYN residency applications in states with restrictions, leading to further access issues for years to come. These data are important to highlight as they illustrate that restrictive environments result in immediate and costly population health impacts like delayed cancer and infectious disease screenings.
- Strong Preference for Companies Offering Reproductive Health Benefits: 57% of individuals likely to have children in the next 10 years say they are more likely to apply for or accept a job with reproductive health care benefits. After the Dobbs decision, many employers pledged support for reproductive health access, but few implemented benefits that meaningfully addressed access gaps and the need for privacy.
The verdict? Reproductive rights restrictions are reshaping the health of the workforce and the competitive positioning of firms. For national employers, restrictive states are now home to dwindling local labor pools and impaired productivity, resulting in economic decline comparable to crime and environmental disasters.
So how do we have productive conversations about sexual and reproductive health access in the workplace? And, better still, how do we bring these conversations out of HR siloes and into broader firm competitive positioning discussions?
In my roles leading strategic partnerships at Nurx, one of the largest virtual women’s health providers, and serving as Board Chair of the Reproductive and Maternal Health Compass—a nonprofit initiative that provides employers with evidence-based benchmarks and a strategic framework to evaluate and improve their reproductive and maternal health benefits—I’ve learned how to articulate the economic impact of reproductive rights restrictions through both healthcare and business lenses.
The below guide helps senior executives illustrate how reproductive rights restrictions impact workforce and business performance, and encourages collaboration with C-suite HR leaders to embed the issue into corporate strategy. There are also suggestions for the broader ecosystem on where additional resources could be created to bring the story to life with more economic gusto.
Tip 1: Start and frame the conversation with facts about your organization: Map out where your employees live and how many of your employees live in states with reproductive rights restrictions. You can reference the Center for Reproductive Rights database here for the latest information. I recommend grouping states where abortion access is classified as Hostile and Illegal into one general ‘restricted’ category. You can deepen the analysis by looking at the percentage of employees living in maternity deserts (March of Dimes), Medically Underserved Areas and Health Provider Shortage Areas, contraceptive deserts (Power to Decide), or abortion care and general resource deserts (National Women’s Law Center.)
Tip 2: Bring the geographic data to life with storytelling and/or employee benefit satisfaction surveying
- Testimonials: You can solicit anonymous feedback from your employees on the personal toll of reproductive rights restrictions in their state via ERGs. Or, given the sensitivity of these experiences, you can opt to elevate external storytellers such as the couple featured in The Guardian’s profile of ‘American Refugees.’ Personal stories, especially involving those working in a similar industry to the employer may make executive decision-makers more attuned to where expanded action would have a clear impact on employee well-being.
- Employee Sentiment: Evaluate your employee benefit satisfaction surveys and identify if what is being offered is aligned to what is needed based on the evolving reproductive healthcare environment. Often, there are gaps in plan network coverage and within plan benefit designs that specifically impact access to reproductive health services.
Tip 3: Connect the dots for your executive team on the relationship between access restrictions and some of the potential economic impacts:
Zoom Out: Ground the team in key macroeconomic impact metrics.
- ⬇️Reproductive rights restrictions are having negative state-wide workforce and economic stability impacts.The Institute for Women’s Policy Research (IWPR) estimated that reproductive health restrictions reduce the U.S. economy by an average of $173 billion annually. These losses stem from long-term impacts on women’s earnings, job continuity, overall participation in the labor market, and GDP impact.
- ⬆️Eliminating these reproductive health restrictions could result in nearly 597,000 additional women entering the labor force annually. Adding 597,000 women to the workforce is equivalent to hiring for the entire U.S. Postal Service or one of the largest U.S. employers in a single year.
- ⬆️ Similarly, according to IWPR research, eliminating reproductive health restrictions could increase national GDP by nearly 0.7%. This potential GDP gain is economically comparable to the estimated impact of each of the following interventions on their own: GLP-1 medications, expanded behavioral health access, and cancer care immunotherapy.
- Reproductive Rights Restrictions (Roe Reversal) – IWPR Report
- GLP-1s (e.g., Ozempic, Wegovy) – Morgan Stanley, McKinsey
- Behavioral Health Access Expansion – Deloitte, WHO
- Universal Paid Leave (U.S. Proposal) – IWPR, OECD
- Cancer Immunotherapy – IQVIA, NIH, ASCO
Zoom In: Ground the team in potential impact to company performance
- ⬆️ Potential increase in healthcare costs for the business in states with restrictive reproductive rights environments: While data haven’t been released yet evidencing higher healthcare costs for women (and private payors/plan sponsors), we’ve seen an exodus of OBGYN talent in these states which may result in employees in these states struggling to get high quality preventive, gynecological, and maternity care. Higher costs would be driven by delayed preventive care and increased maternal and neonatal costs.
- ⬇️ Potential decrease in productivity: It is likely that employees in states with restrictive reproductive rights environments have reduced productivity due to: (1) the mental toll that navigating an uncertain care environment creates, and (2) needing to travel further for affirming and medically necessary care.
- ⬆️ Potential increase in attrition:
- Employees are leaving states that have reproductive rights restrictions. While Texas is known as a business-friendly state—with no income tax, a large workforce, and strong incentives for growth—its abortion ban is making it harder for companies to hire and keep talent. Over 50 Texas businesses signed an amicus brief supporting a lawsuit challenging the state’s abortion ban, citing difficulties in recruitment and retention.
- Employees are also leaving employers who do not provide comprehensive reproductive healthcare. As mentioned above, 57% of individuals likely to have children in the next 10 years say they are more likely to apply for or accept a job with reproductive health care benefits. Similarly, across employees between the ages of 18 to 34, 50%+ feel their companies are not doing enough to meet their reproductive health needs.
- 💬 Industry specific challenges:
- Frontline workers – or employees in the healthcare, public safety, retail, food services, education, public transport, manufacturing, and utilities sectors – are uniquely at risk with reproductive rights restrictions. Frontline workers often have lower wages and limited health benefits, and are more likely to be women of color, single parents, and/or immigrants [Center for Economic and Policy Research.] These economically vulnerable populations are known to face access challenges when it comes to reproductive healthcare.
- Sectors largely employing a young workforce [<44] will find that reproductive health benefits are particularly important to talent attraction and retention
Where We Need Data for Better Storytelling: We require neutral, third-party tools to accurately assess the costs that specific companies face. ‘Potential’ costs are rarely as compelling to executive decision-makers as definite costs. If you are working on any of the below, please reach out:
🛠️A direct cost analysis focused on the direct impact of reproductive rights restrictions on private insurance claims and costs
🛠️A calculator for company specific costs related to attrition and productivity that takes into account evidence-based estimates for expected attrition and productivity loss by industry.
It would be great to see organizations like the Institute for Women’s Policy Research and the Integrated Benefits Institute tackle this use case.
How Your Company Can Act
Business leaders specifically those outside of HR, can play a critical role in sponsoring opportunities for executives to mitigate the negative economic impact of reproductive rights restrictions and broader women’s health access with the following actions:
Business leaders—especially those outside HR—can sponsor initiatives that help executives mitigate the economic impact of reproductive rights restrictions and gaps in women’s health access through the following actions:
📌 Know what ‘good’ looks like when it comes to reproductive health benefits. It matters to talent management and retention.
- Employers can use Reproductive and Maternal Health Compass to benchmark their benefits with their free diagnostic survey. The RMH Compass team offers an individualized report and confidential performance feedback in the interest of supporting employers to improve their reproductive health benefits. They offer resources such as sample policies for improving travel stipends for employers wishing to cover reproductive health related medical travel to questions for a benefits broker to identify benefits already covered by your employee sponsored health plan.
- Consider the role of telehealth in your benefits offerings, especially if you employ frontline workers who often need flexible clinical care options outside of typical business hours. In states with reproductive rights restrictions, Nurx conducted a survey highlighting that women often experience longer wait times for in-person care, shame in the in-person care setting, and have a strong interest in using telehealth.
📌 Stay on top of potential changes to preventive care access: monitor Kennedy v. Braidwood, and educate yourself on threats to preventive health. If the court rules in favor of Braidwood, health plans would no longer be required to cover preventive services recommended after 2010 by the U.S. Preventive Services Task Force (USPSTF) without cost-sharing. Services in scope include: statin use for prevention of cardiovascular disease, colon cancer screening, use of aspirin for the prevention of preeclampsia, HIV testing, and access to PrEP. You can reference an excellent resource hub compiled by the United States of Care here.
📌 Consider the company’s appetite to participate in advocacy work…and the risks of not participating! As highlighted by Dr. Michelle Travis in her recent Forbes piece, the Institute for Women’s Policy Research found that: 56% of employed adults want their companies to advocate for more expansive reproductive health policies, and 43% of employed adults report being more likely to work for companies that actively engage in advocacy actions designed to dismantle reproductive rights restrictions.
- Don’t want to speak out alone? Bring this challenge to an industry group or trade association. Ask them to take up the mantle on behalf of your industry.
- Join advocacy organizations like Don’t Ban Equality
- Have a government relations team? Have them raise this as an issue when they are lobbying on the Hill and meeting with state representatives. Private sector organizations often have more success at getting these points across and making the business case than reproductive health advocacy groups. You can contact Julia Kennedy at the Center for Reproductive Rights to learn more.
Madeleine Livingston is a healthcare business development and strategic growth expert, with deep experience as a digital health startup operator. She currently leads strategic partnerships at Thirty Madison, a virtual-first specialty care company serving over 1 million patients. Her background spans go-to-market strategy and commercialization roles across women’s health startups, from fertility and maternal care to conditions that disproportionately impact women. She currently chairs the board of the Reproductive and Maternal Health (RMH) Compass, a nonprofit advancing RMH benefits for U.S. workers through employer engagement. RMH Compass recently launched the RMH@Work Corporate Index—the first benchmark of RMH benefits among the top 100 U.S. employers—with support from the Ford and W.K. Kellogg Foundations. Madeleine also serves on the working group for the Gates Foundation’s Innovation Equity Forum Innovation Accelerator, a collaborative discovery and development network focused on key women’s health conditions. Additionally, she is an active member of the Women’s Health Advisory Board at Health Action Alliance and the Springboard Women’s Health Council. She advises early-stage healthcare and social impact startups and previously led the Tuck Social Venture Fund. Her investment experience includes work with Female Founders Fund, Amplifyher Ventures, and Flare Capital. She holds a MBA from the Tuck School of Business at Dartmouth.
