“You want me to discuss that?” Donna Crane, vice president of policy at NARAL Pro-Choice asks me, her voice rising. Yes, I do. I want to know what will happen if the current attacks on free or subsidized birth control in the US continue until only the well-off can afford family planning. “It would be a world none of us would want to live in,” says Crane. “Women would be forced to get pregnant against their will ... it would be an unjust, dystopian place.”

The idea of restricting subsidized family planning services – that is all the various forms of available birth control covered by insurance or free clinics – may seem an odd idea. After all, the Center for Disease Control and Prevention named contraception one of the 10 most important advances in public health in the 20th century, right up there with access to clean drinking water.

Virtually all women in the US who are able to get pregnant use some form of contraception at some point in their lives. According to the Guttmacher Institute, a woman who plans to have two children in her lifetime would have to spend around 30 years avoiding getting pregnant by accident.

Despite that, Crane says she has seen every type of attack on subsidized contraception, including attempts to defund Title X, a federal program that provides family planning services, the defunding of Planned Parenthood, which is often the main provider of family planning in an area and the latest challenge to the family planning mandate in the Affordable Care Act, which is set to be heard by the Supreme Court this month.

The Guttmacher Institute estimates that in 2013 there were around 20 million women in the US who needed free or subsidized contraception in order to afford it. The number of women who need access to free birth control has increased in the last few years, says Kinsey Hasstedt, a policy analyst at Guttmacher, because of the economic recession.

The dystopian world Crane sees would affect much more than individual women. The economy as a whole would suffer tremendously, she says. Long gone are the post-WWII years when one salary – often one blue collar salary – was enough to support a family. These days about two-thirds of households are dual earners. Women are the primary breadwinners in around 38% of households as of 2013, according to the Bureau of Labor Statistics.

Those numbers represent a lot of employees doing vital jobs, and a lot of money going back into the economy each time a woman pays rent, buys groceries or even goes out for an evening out with friends. Less earning potential and fewer women able to work full time would mean less economic growth for the US as a whole.

“When you shackle half of society, then they are not able to be productive,” says Crane. Having unplanned pregnancies, and multiple children that they are not ready, or financially able, to take care of, would lead to fewer women being able to advance in their careers, or work full time.

In surveys of women asking why they use birth control, the top reasons are to be able to finish their education and make sure they are financially secure, points out Gretchen Borchelt, vice president for Reproductive Rights & Health at the National Women’s Law Center. “We know that contraception contributes to economic stability,” points out Hasstedt.

Currently around 50% of pregnancies in the US are unplanned, a number that encompasses the vast majority of teen pregnancies. Teen mothers are less likely to complete a degree, says Borchelt, which in turn impacts their lifelong earning potential. Without free contraception, pregnancy rates – including teen pregnancy – are estimated to increase by 60%, says Hasstedt.

The economy would not only be hit with a decrease in full time workers and educated employees, there would also be a huge cost in taking care of all those pregnancies and babies. Every $1 invested in family planning is a saving of $7 to the government, according to estimates by the Guttmacher Institute. Those savings estimates are conservative, says Hasstedt, and only deal with the savings in healthcare from the costs of a birth and infant care, without taking into consideration the lost earning potential of the mother.

Without free contraception, there would also be many more sick women and preterm babies. When births are spaced too closely together, there is a greater risk to the baby, such as low birth rate and preterm birth. If a woman has a chronic condition like diabetes or hypertension, pregnancy can exacerbate the condition, which would also add costs to the healthcare system.

The restrictions on subsidized contraception have gone hand in hand with restrictions on access to abortion providers, says Hasstedt. However, she says without publicly supported contraception, abortion rates would be 60% higher. Several states have already restricted abortion access to the point where all but one clinic in a state have closed.

With continued restrictions on abortion providers, wealthier women would still be able to go out of state to get an abortion, but poor women would be priced out of an abortion, says Borchelt. Poorer women would turn to other methods for abortions, as they did before it was legalized, which are often dangerous or ineffective, says Borchelt.

Crime would also potentially increase with the increase of unwanted pregnancies. According the the Donohue-Levitt hypothesis, published in the Quarterly Journal of Economics and popularized in the book Freakonomics, economist Steven Levitt argues that the decline in crime seen in the 1990s is directly related to the legalization of abortion in 1973.

The Donohue-Levitt hypothesis argues in part that abortion gave women who were not ready to provide a nurturing home to a child a chance to delay pregnancy until they had the stability and financial means to take care of the child. They thus avoided bringing children into unstable homes with potential drug use, extreme poverty or abuse, which could all lead to higher potential for criminal activity later in life for the child.

The availability of free contraception is the “most effective way to help women avoid a situation where they need an abortion”, points out Hasstedt.

If free contraception leads to better health, less cost in the long term for the government, and more economic opportunity, and even potentially less crime, it seems counterintuitive to limit its access. “It’s unbelievable that in 2016 we are fighting against efforts to erect barriers to contraception,” says Borchelt.

While opponents of free contraception often equate contraception with abortion, which they oppose, Crane says not everyone opposes contraception on those grounds. “I think what is really operating is they don’t want women to have sexual autonomy, they want a literal and figurative price for women to enjoy sex,” explains Crane. A price that in reality would be paid by all of society for years to come.