Categories: News, Newsletter Issue 2022:3


Health Economics Research and the Implications of Overturning Roe v. Wade

By Angélica Meinhofer, Assistant Professor at Weill Cornell Medicine’s Department of Population Health Sciences

Interviewees
Kelly Jones, Assistant Professor at American University’s Department of Economics
Theodore Joyce, Professor at Baruch College’s Department of Economics and Finance
Jason Lindo, Professor at Texas A&M University’s Department of Economics
Sarah Miller, Associate Professor at University of Michigan’s Department of Business Economics and Public Policy
Caitlin Myers, Professor at Middlebury College’s Department of Economics
Mayra Pineda-Torres, Assistant Professor at Georgia Institute of Technology’s School of Economics
David Slusky, Professor at University of Kansas’ Department of Economics

On June 24, 2022, the United States Supreme Court overturned Roe v. Wade (410 U.S. 113), the landmark 1973 Supreme Court decision that affirmed the constitutional right to an abortion [1]. The court’s decision to overturn Roe v. Wade gives states the authority to establish their own abortion policies. Since then, 12 states have already banned most abortions and 2 states have banned abortions at 6 weeks of pregnancy[1] (before most women know they are pregnant) [2]. Additional bans are expected, as states litigate over abortion access in courtrooms. About half of U.S. states are expected to ban abortions or impose limits on the procedure. 

The Supreme Court’s decision will impact a large number of women in the U.S., one in four of which will have an abortion by age 45 [6]. Research demonstrates that abortion bans severely affect people in marginalized groups [6-8]. About 75% of abortion patients are low income: 49% living at less than the federal poverty level and 26% living at 100-199% of the poverty level [6]. Moreover, abortion rates are highest among Black and Hispanic women [6,7].

Health economics research can help decision-makers elucidate the implications of state abortion bans, as well as the role of public health and other policy responses in mitigating the adverse outcomes associated with these bans. I interviewed Drs. Kelly Jones, Assistant Professor at American University’s Department of Economics; Theodore Joyce, Professor at Baruch College’s Department of Economics and Finance; Jason Lindo, Professor at Texas A&M University’s Department of Economics; Sarah Miller, Associate Professor at University of Michigan’s Department of Business Economics and Public Policy; Caitlin Myers, Professor at Middlebury College’s Department of Economics;  Mayra Pineda-Torres, Assistant Professor at Georgia Institute of Technology’s School of Economics; and David Slusky, Professor at University of Kansas’ Department of Economics. They shared their thoughts about the health, healthcare, economic, demographic, and equity implications of overturning Roe v. Wade, ongoing research that can help inform policymakers and expectant parents, current gaps in the literature, and future research directions. For more discussion on these topics, you can view the recording of ASHEcon’s webinar “The Economics of Reproductive Healthcare”.

Q1: What are some of the health, healthcare, economic, demographic, and equity implications of overturning Roe v. Wade?

Pineda-Torres: Before talking about all the different implications of overturning Roe, we should consider that even before Roe was overturned, finding an abortion provider and the arrangements around it (time out of work/daycare and expenses related to the trip(s) to the facility) represented an important barrier to having an abortion and, for some demographic groups, these barriers were big enough to prevent them from getting an abortion. However, some women still could make these arrangements and get an abortion. Now that Roe has been overturned, for the residents of states implementing abortion bans, the reality will be different. Abortion bans are an issue for everyone who may require reproductive healthcare, not only for some demographic groups.

In terms of healthcare and health implications, since so many abortion facilities will stop providing abortion services and open facilities will likely face an excess demand for their services, the immediate impact we can expect is that many women will be unable to interrupt unwanted pregnancies, and this will force them to carry such pregnancies to term. This will be reflected in decreases in abortion rates and increases in birth rates. However, even for those women able to interrupt their pregnancy, the timing in which they are able to do so may not be the desired one, and they may end up getting an abortion in a later stage of pregnancy, which is riskier (relative to earlier stages) and more expensive. We should also consider that some of the facilities that have closed or will close not only offer abortion services. They may be health care facilities also providing contraception, testing, treatment, and preventive care services. Therefore, patients relying on such facilities to provide these services may also be affected.

Regarding the economic implications of overturning Roe, we have learned from the existing literature that I describe in more detail in the next question that having access to abortion services has allowed women and other abortion users to delay marriage and motherhood and pursue higher investments in education and career. Not only do abortion users benefit from gaining abortion access, but their families and next generations have also enjoyed those benefits. However, we know from the evidence on the impacts of abortion restrictions that losing access to abortion services decreases educational investments and causes financial hardship for women unable to interrupt a pregnancy. Given these findings, we can expect overturning Roe to alter women’s life trajectory and contribute to widening gender inequalities.

In terms of demographics, overturning Roe has the potential to deepen economic inequalities across different population groups, particularly low-income people and women of color. We know from the existing research that both abortion legalization and some abortion restrictions have been more impactful for Black women than white women. This may be explained by the fact that Black women have higher rates of unmet needs for contraception, and they report higher unintended pregnancy and abortion use. They are also more likely to live in poverty, which increases the barriers they face to accessing reproductive health care. This, in combination with a legacy of experimentation and inadequate reproductive health care for Black women, has created a mistrust toward the healthcare community that has deterred them from seeking care.

Jones: A large body of evidence documents that when access to abortion is restricted, abortion use declines (leading to an increase in unintended births), abortion timing is delayed (increasing the cost and risk of services and further hindering access due to gestational limits), and fertility increases (especially for young women and poor women).

A smaller body of work documents that women facing restricted access to abortion have poorer economic outcomes. Access to abortion as a teen has been documented to increase women’s educational attainment. Access to abortion in adolescence and early adulthood has been shown to also increase attainment of professional careers, personal income, and family income and to reduce debt delinquency, bankruptcy, and eviction. In many of these cases, the economic benefits of access to abortion are documented primarily or exclusively among disadvantaged women (Black women in the U.S. and poor minority women in Israel). This suggests that limiting abortion access exacerbates existing economic inequality.

Finally, several studies document that children born to women with abortion access have better economic outcomes on average both as children and as adults (income/poverty, education, employment, crime, etc.). However, these effects are primarily driven by selection, rather than a dynamic whereby abortion access makes an existing individual better off than they would have been (as is the case for the impacts on women). Although, one study does document that existing children are better off when their mother is able to access a wanted abortion of a later pregnancy. The studies discussed here are cited in the next question.

Joyce: The first order effect should be on abortions, but we are unlikely to learn much at the population level because of a lack of data on abortions and the likely increase in illegal medication abortions. Unlike births, there is no reciprocal reporting between states of induced termination certificates, as compared to birth certificates. Moreover, not all states, most notably California, report induced abortions to the CDC. In short, we have no national registry of abortions.  The Guttmacher Institute surveys abortion providers every three years but they simply gather total counts by state with no information of the patient’s state of residence. Thus, New Mexico may see a large rise in abortions performed in the state but the Guttmacher survey sheds no light as to which states women came from. Therefore, the most reliable indicator of pregnancies that might have been terminated prior to a ban will be a change in births. But again, the story is complicated. In the years prior to Roe, many women traveled to New York primarily but to California and Washington as well for a legal abortion (see Joyce et al., 2013). This migration caused a major decrease in birth rates. In fact, the decline in birth rates after New York’s legalization in 1970 far exceeded the fall in birth rates following Roe. The context in 2022 is very different from 1970. Abortion will be legal in more states, which lessens travel distance.  Information regarding available clinics is on the internet instead of through clandestine networks. Financial support for low-income women is better due to the abortion funds. And finally, illegal abortion through medication is much safer and more accessible than illegal abortion in 1970. If birth rates fell between 5 and 10% between 1970 and 1973, I expect birth rates to rise in states with bans by between 1 and 2% in the first few years at most. This is not to say state bans will not cause tremendous hardship for many women, but that pain will not be reflected in population statistics. Thus, if birth rates don’t rise much then the impact on labor force participation, completed schooling, and marriages will also be muted.

Lindo: The effects will be too vast to fully describe because they will be so extensive and far-reaching. Some people will be able to travel to obtain abortions out of state, but for some of these individuals that cost will be catastrophic. Some of these individuals will resort to home-based approaches to inducing abortion without medical provider’s aid or supervision; and others will have children they would not have had otherwise. Though people seeking abortions come from all walks of life, a majority have low incomes and are economically disadvantaged. There is a large and rigorous base of evidence showing that they are made more economically disadvantaged with more limited access to abortion. It’s also the case that young women are disproportionally represented among those typically seeking abortions. These women will suffer economically from negative impacts on educational attainment and early career investments. It’s also important to keep in mind that people of color will be disproportionally affected in these ways. As such, these economic effects will exacerbate racial and ethnic inequality. 

The effects are happening right now and they’ll grow over time. Each day there will be people who have a child they would not have had otherwise, and their lives will be altered permanently. With each passing day, there will be more and more people who are on this altered path that involves lower levels of education, lower labor force participation, and poorer economic conditions generally. And so, the overall economic effects will grow over time as the number of people on this path grows. Given that household resources are important determinants of children’s economic success, the effects will extend into the next generation as well. There may also be broader economic effects if people and/or businesses migrate as a result of these legal changes.

 Miller: A large body of research shows that childbearing has substantial and wide-ranging effects on parents, with large impacts on employment and earnings found particularly on mothers (e.g., Kleven et al. 2021, Sandler and Szembrot, 2019). To the extent that those in states with abortion bans are unable to obtain this care elsewhere, we can expect negative employment and earnings effects to materialize. It is also likely that the most disadvantaged will be the least able to travel out of state to obtain an abortion, generating further inequality.

There are also several important studies that look at the effect of abortion legalization in other countries. For example, both the legalization of abortion in Spain and the expansion of access to abortion in Norway led to improvements in women’s educational attainment (Gonzalez et al. 2021; Molland, 2016). Expansion of access to abortion in Israel resulted in a shift towards more higher paying and flexible employment (Brooks and Zohar, 2022). We can expect these effects, but in the opposite direction, as access to abortion care dramatically falls in the wake of the overturning of Roe v. Wade.

 Myers: When the dust settles, about half of U.S. states are likely to ban abortion. Updating my 2019 projections (Myers et al, 2019) to reflect the most current information about the locations of providers and effects of travel distance (Myers, 2021), if the 25 likely states do ultimately fully ban abortion, then 54% of U.S. women aged 15-44 would experience an increase in travel distance from an average of 35 miles in May 2022 to 282 miles after the bans. I project that about 76% of these women will find a way to reach the providers that remain, while about 24% will be trapped by distance and poverty, resulting in an average 3.4% increase in births in counties where distances increase. This corresponds to a 1.8% increase in births nationally. Of course, there are many unknowns that may influence these ultimate outcomes, including the effects of abortion travel funds and women’s willingness to use black-market mail-order medications to self-manage abortions. But all currently available information suggests the majority of women who are unable to reach a provider will give birth as a result. The key thing to keep in mind is that this is an inequality story: it’s the poorest and most vulnerable women who end up trapped.

Q2: What are important studies in the health economics literature that can shed light regarding the sequelae of overturning Roe v. Wade, and help inform the implementation of policies for mitigating adverse outcomes?

Pineda-Torres: Previous studies have informed us on how changes to abortion access can affect different dimensions of people’s lives. The evidence from these studies is fundamental to understanding what to expect now that Roe has been overturned. I will mention the findings of some studies, but I want to emphasize that the policies or changes explored in such studies may have not prevented all people looking for an abortion from getting it. This is because some people could have still been able to comply with such laws and get an abortion in their state of residency or by traveling to a nearby state without such restrictions. For example, someone looking for an abortion in a state with a two-trip mandatory waiting period could have been able to comply with the two separate visits to the clinic with no major issues, whereas, for someone else, the separate visits to the clinic may have represented a major nuisance that affected when, where and if they got an abortion. In the end, although a mandatory waiting period made it harder for some women to get an abortion by preventing some of them from getting it in an early stage of pregnancy or from getting it at all (Lindo and Pineda-Torres, 2021; Myers, 2021; and Altindağ and Joyce, 2022), it did not make it impossible for ALL women. However, overturning Roe means that the residents of some states are completely losing access to abortion services. Therefore, the findings of the studies I mention below may provide lower bounds of the potential impacts we can expect from overturning Roe.

In terms of healthcare and health impacts, the evidence from the implementation of targeted regulations of abortion providers (TRAP laws) is highly informative because it speaks of a situation where abortion services could disappear. These policies require abortion facilities to comply with specific requirements to operate. However, some of these requirements could be impossible for facilities to comply with, obliging them to close. The most widely studied TRAP law is HB2, implemented in Texas in 2013. This bill included a requirement for physicians providing abortion services to have admitting privileges in a hospital located no more than 30 miles away. Almost half of the facilities in the state could not comply with this requirement, and they closed, increasing the distance that women had to travel to the nearest abortion facility and generating an excess demand for services in the remaining open clinics. This caused decreases in abortion rates and increases in birth rates (Quast, Gonzalez, and Ziemba, 2017; Fischer, Royer, and White, 2018; Lindo et al., 2020). Similar evidence was observed in Wisconsin, where clinic closures decreased abortion rates and increased birth rates (Venator and Fletcher, 2020). But this evidence is not specific to Texas and Wisconsin. In a recent study, my coauthor, Kelly Jones, and I document that TRAP laws implemented across the country increase teen births relative to states that did not implement such policies. However, now that Roe has been overturned and some states have forbidden abortion access in almost all circumstances, this could be comparable to a situation where all abortion facilities could not comply with a TRAP law and closed. Then, I expect this to reflect on bigger impacts on abortion and birth rates than the ones reported in the cited studies.

Regarding the economic impacts of abortion access, an array of studies focused on the legalization of abortion in the U.S. has shown that legal and safe abortion access provided economic benefits for women and their families. In general, women who gained access to abortion services in the 1970s were more likely to delay marriage and motherhood (Myers, 2017), which reflected in higher probabilities of completing high school and enrolling in college (Angrist and Evans, 2000), and higher labor force participation (Kalist, 2004). Some studies have shown that the next generation also benefited by being less like to live in poverty and relying on public assistance during childhood and adulthood (Gruber, Levine, and Staiger, 1999; Ananat, Gruber, Levine, and Staigner, 2009; Whitaker, 2011). Although these studies focus on a different era and women have gained some economic advancement in the last few decades, they still inform us on how women and their families have benefited from legal abortion access and, therefore, how eroding that access can potentially affect their educational investments, careers, and welfare.

The evidence from studies focused on more recent policies that restrict abortion access confirms that detrimental access to abortion services still affects women’s economic outcomes, despite the economic advancements of the last decades. For example, from the findings of the Turnaway Study, which followed women who sought an abortion between 2008 and 2010, we have learned that women who were denied an abortion due to gestational limits faced higher financial distress six months to 4 years after being denied an abortion relative to those women in the study that could get the abortion. This includes a higher likelihood of facing poverty, unemployment, public assistance, delinquent debt, bankruptcy, and eviction (Miller, Wherry, and Foster, 2021). Similarly, Kelly Jones and I found that Black women exposed to TRAP laws during adolescence are less likely to initiate and complete college than their unexposed counterparts (Jones and Pineda-Torres, 2022).

Jones:

Impacts of abortion access on women’s economics outcomes

Angrist & Evans (2000); Brooks & Zohar (2021); Foster, Biggs, Ralph, et al. (2018); Jones (2021); Jones & Pineda-Torres (2021); Miller et al. (2020).

Impacts of abortion access on children’s economic outcomes

Ananat et al. (2009); Donohue & Levitt (2001); Foster, Biggs, Raifman, et al. (2018); Foster, Raifman, et al. (2018); Gruber et al. (1999); Whitaker (2011).

Impacts of abortion access on abortion use & fertility:

This is a sub-sample of the large number of papers in this area: Ananat et al. (2007); Bitler & Zavodny (2001); Fischer et al. (2018); Guldi (2008); Kelly (2020); Lindo et al. (2020); Lindo & Pineda-Torres (2019); C. Myers (2021); C. K. Myers (2017); C. Myers & Ladd (2020); Venator & Fletcher (2020).

Joyce:

Levine, P. B., Staiger, D., Kane, T. J., & Zimmerman, D.J. (1999); Joyce, T. et al. (2013); Joyce, T.  (2011); Myers, C. K. (2017).

Lindo: Economists are too quick to focus on a small number of studies when there is an enormous amount of useful evidence from a large number of studies. Based on the literature as a whole, I would emphasize that there is overwhelming evidence that making abortion care harder to obtain has significant effects on abortion and childbearing. Even ignoring the descriptive evidence and qualitative evidence outside of economics, the list of studies demonstrating these effects is extremely long. Some examples include:

Levine et al. (1999); Gruber et al. (1999); Myers (2017); Jones (2021), Angrist & Evans (2000); Quast et al. (2017); Fischer et al. (2018); Lindo et al. (2020); Venator & Fletcher (2020); Myers (2021); Lindo & Pineda-Torres (2021); Joyce et. al. (1997); Joyce & Kaestner (2000); Joyce & Kaestner (2001).

Of course, there is a much broader literature on the widespread effects of making health care harder for individuals to access. Some examples include:

Buchmueller et al. (2006); Currie & Reagan (2003); Kelly et al. (2020).

In terms of effects on education and economic outcomes, I would highlight the following:

Miller et. al. (2021); Angrist & Evans (2000); Lindo et al. (2020); Jones, K. (2021); Jones, K. & Pineda-Torres, M. (2021).

Also relevant are rigorous studies of causal effects have repeatedly documented large and persistent reductions in earnings caused by childbearing:

Aguero and Marks (2008); Adda, Dustmann and Stevens (2017); Kleven, Landais and Sogaard (2019); Sandler and Szembrot (2019)

And studies documenting the effects of early childbearing on education:

Klepinger, Lundberg & Plotnick (1999); Fletcher & Wolfe (2009); Ashcraft, Fernandez-Val, & Lang (2013); Schulkind & Sandler (2019).

And studies examining effects of changes in contraception access:

Goldin and Katz (2002); Bailey (2006); Guldi (2008); Hock (2008); Bailey (2009), Bailey et al. (2011), Guldi (2011); Bailey, M. J. and Lindo, J. M. (2018).

And the large literature showing how more-limited economic resources has detrimental effects on children:

Black, Devereux, Løken & Salvanes (2014); Dahl & Lochner (2012); Milligan & Stabile (2011); Akee, Copeland, Costello, & Simeonova (2018); Aizer, Hoynes & Lleras-Muney (2022); Barr, Eggleston & Smith (2022).

Miller: In a post-Roe world, delays and increased travel cost will become increasingly relevant for those seeking abortions in some states. So I think the papers by Lindo and Pineda-Torres (2021), Altindag and Joyce (2022), and Myers (2021) on mandatory waiting periods are going to be important, along with research on travel distances for abortion seekers such as Lindo et al. (2020), Myers (2021) and Lu and Slusky (2019). I would also highlight the incredible work of Diana Greene Foster of the Turnaway Study. This study collected longitudinal data on those seeking wanted abortions, some of whom were denied abortions on the basis of the gestational age of the pregnancy. The study provides a fascinating look into the lives of the women who were put in this position. I especially recommend her book to anyone interested in this topic, although she has several academic articles as well (e.g., Foster et al., 2018). I would also point interested economists to my own work in collaboration with her and Laura R. Wherry that links participants of the Turnaway Study to a decade of credit records to trace out the impact of the abortion denial on financial outcomes for six years after the policy. This paper provides an analysis of the Turnaway Study data through what I might call an “economist’s lens,” using methods that would be familiar to economists (Miller, Wherry, and Foster, 2021)

Myers: I know I cannot do this extensive and rich literature justice in a blurb. I’ll point interested researchers to the economists’ amicus brief in Dobbs and associated Brookings report (Myers and Welch, 2021), which can serve as literature reviews.

Q3: In your opinion, what are key gaps in this literature and future areas of inquiry that health economists should prioritize?

 Pineda-Torres: Most of the evidence on the health impacts of abortion access has focused on abortion use, abortion timing, and fertility. However, other health aspects may be affected by abortion access, such as preventive care. Also, most of the evidence on the economic impacts of abortion access comes from the legalization of abortion in the 1970s, and the evidence from a more recent era is limited. This is another area that should be explored to have more information on how overturning Roe could affect families today.

Jones: Regarding the impacts on women, we know a lot about how access to abortion affects abortion use and fertility. The evidence on how abortion access impacts other outcomes of interest is much more limited. There are a few new studies, mostly focused on teen access, but there is still a lot of room for growth. Overall, we mainly have evidence about how abortion access affects women and their children, but not really anyone else. I think the next frontier is how abortion (in)access affects businesses in terms of access to skilled labor and in terms of cost of employee benefits.

 Joyce: How to get data on medication abortions; maybe claims data or better pharmaceutical data on sales.

Lindo: One key gap is with regards to firm behavior. I haven’t seen anything on that front and it would be helpful to get IO economists involved in studying this area. It’s also critical that we build on the existing evidence base to monitor how the effects might be evolving. Moreover, as I mentioned above, the effects are likely to be extensive and there are many economic and social outcomes that have yet to be studied using rigorous methods for identifying causal effects.

Miller: One area that presents a lot of challenges on this topic is the lack of data about those who seek abortions, including those who would like to get an abortion but are unable to due to the recent changes in the law. What will happen to the women who can no longer get a wanted abortion in their state? Being able to bring in new data to characterize this population—either by partnering with data agencies or providers, or collecting data directly via surveys—would be a huge contribution.

Myers: One key new question is the role abortion funds supporting interstate travel and online organizations shipping medication abortion pills might play in a post-Roe world. Either has the potential to blunt the impacts of increased travel distances, but the extent to which these are viable outlets for otherwise trapped women remains to be seen.

Slusky: My work has shown that preventive care rates decrease when abortion clinic close, and these decreases are larger for women of low educational attainment and for Hispanic women (Lu and Slusky (2016); Slusky (2017); Ellison et al. (2021)). What we don’t know is the long-term consequences of these declines, e.g., on mortality rates due to cancers that are detected later.

Q4: What are some resources (i.e., datasets, funding, training, blogs, news sources) that health economists interested in studying reproductive health should be aware of?

Pineda-Torres: Guttmacher Institute’s newsletter is a great way to be informed about the status of reproductive health care in the U.S. and other countries promptly. They usually release notes and articles related to current policies and changes in the reproductive healthcare landscape. Furthermore, Guttmacher Institute collects information on different aspects of reproductive health care (not just abortion access) and releases this data at the state level. It is available to download from their Data Center. Another relevant source of information is The CDC Abortion Surveillance System, which reports data on different aspects of abortion care at the state level. This information has been collected since the 1980s. I also recommend following the work of experts in the area, such as Caitlin Myers. She is one of the most knowledgeable researchers and experts in the economics of reproductive health care. In the context of the U.S., other researchers who have done great work in this area and whose work is relevant to understanding the current abortion landscape include Sarah Miller, Kelly Jones, Heather Royer, Elizabeth Ananat, Marianne Bitler, Jason Lindo, Ted Joyce, Robert Kaestner, David Slusky, Onur Altindag, and myself (shameless self-promotion), among others. In the context of other countries, there are excellent studies from Libertad Gonzalez, Tom Zohar, Christian Pop-Eleches, Damian Clarke, and Eirin Molland. This is not an exclusive list, so I apologize for forgetting to include someone.

Jones:

Data on abortion access

Caitlin Myers has available panel data on abortion clinic locations since 2009. Guttmacher has an alternative version of this information, with restrictions since the 1970s. Jones and Pineda-Torres have constructed a detailed data set on the full legal history of TRAP laws, which will be available upon publication. Myers has created data on the history of policies relating to waiting periods and parental involvement, and other state-level policies related to abortion, contraception, and public assistance.

Data on outcomes of interest

Abortion use panel data are available from Guttmacher and CDC. They differ in how abortions to out-of-state residents are recorded. They offer limited disaggregation. One researcher has collected improved data from states’ departments of health (more disaggregated by age and race); these data are currently proprietary. The National Survey of Family Growth has very detailed histories of fertility, including abortion use. However, NSFG staff project that abortion use is underreported in these data by about 40%. Also, be aware that the state of residence is restricted information, which sometimes limits usefulness. Larger datasets like American Community Survey and Current Population Survey do have limited information on fertility, with rich information on economic welfare. Smaller data sets with more detailed fertility information are often not well-suited to policy analyses due to small sample size in any given state.

Lindo: See all of the papers I reference in response to the prior questions.

Miller: I would encourage economists to read widely as there is a lot of interesting and high-quality work being done in other fields that can inform our own analysis.

Myers:

Data on abortion facility locations and travel distances: I maintain a database of abortion facilities in operation since 2009, and am currently updating it monthly to stay apace with the shifting landscape of access in the wake of Dobbs. I publish a county-by-month panel of travel distances to the nearest provider at Open Science Framework (https://osf.io/8dg7r/) and also provide an application form to access the restricted-use data with identifying information about providers. There also are two other sources with information on abortion facilities: the Guttmacher Institute (see Bearak et al., 2017) and ANSIRH Abortion Facility Database. ANSIRH’s database provides a snapshot of facilities currently in operation and does not afford a panel. Guttmacher’s database provides periodic snapshots from 1973 to 2017, but it is not yet updated to reflect recent closures and I believe it may be difficult for outside researchers to gain access.

Data on congestion at abortion facilities: I conducted surveys of appointment availability at open facilities in March, June, July, and August of 2022, and I plan to continue these surveys for at least a year. I’ll post measures of congestion in abortion service regions based on appointment availability as well as the concept of “average service population” (see Lindo et al., 2010) to Open Science Framework within the next year. My survey is modelled after one the Texas Policy Evaluation Project (TxPEP) conducted in Texas for about the past decade.

Data on abortion policy: Researchers who are interested in the legalization of abortion and contraception in the 1960s-1970s and in young women’s legal rights to consent to each should check out my new paper (Myers, 2022) and the accompanying dataset at Open Science Framework (https://osf.io/wu56n/) covering these policies from 1960 to present. Researchers who are interested in mandatory waiting periods can find policy coding in my working paper on the effects of these laws (Myers, 2021.) Researchers who are interested in panels of controls variables for other healthcare and reproductive policies can find them in the replication package for my paper with Dan Ladd on parental involvement laws (Myers and Ladd, 2020; replication package at ICPSR). I’m always updating these datasets for my own work. Please reach out if you have questions or want to see if there’s a newer version. Finally, Kelly Jones and Mayra Pineda-Torres have collected and coded detailed panel data on supply-side regulations or “TRAP laws.”

Data on births: The NCHS develops and recommends standard birth certificates, and all states cooperate with the federally mandated reporting of birth certificate data. Researchers can apply through the NCHS for restricted-use data with identifiers for county or state of residence. These data are made available at no cost and do not require a visit to an RDC.

Data on abortions: In contrast to births, there is no federal mandate for abortion reporting. The NCHS does encourage states to report and relay information about abortions, and publishes annual reports (currently available for 1973-2019) with state-level totals. However, these reports are missing key states (currently, California, Maryland, and New Hampshire) and the counts are likely incomplete in other states. In addition, because not all states collect information on state of residence, measures of abortion by state of residence (as opposed to state of occurrence) are likely incomplete. The Guttmacher Institute affords a second source of information on state-level abortions by state of occurrence and residence at irregular intervals. These data are based on the CDC reports augmented with information Guttmacher collects in periodic provider surveys. A panel of Guttmacher’s state-level estimates of pregnancies, births, and abortions by state can be found at Open Science Framework (https://osf.io/kthnf/). Finally, I have recently completed collection of county-level resident abortion counts from 33 states that publish this information. I describe these data in my working paper on travel distances (Myers, 2021) and will publish them to Open Science Framework within a year.

Slusky: I would recommend the work of Swedish economist Hanna Mühlrad. Beyond economics, I recommend reading the work of Chavi Eve Karkowsky, a maternal-fetal medicine specialist (i.e., a high-risk pregnancy doctor). Her book is excellent, as are her frequent editorials and magazine pieces.

References

  1. https://www.guttmacher.org/abortion-rights-supreme-court
  2. https://www.nytimes.com/interactive/2022/us/abortion-laws-roe-v-wade.html
  3. https://www.pewresearch.org/fact-tank/2022/06/24/what-the-data-says-about-abortion-in-the-u-s-2/
  4. https://www.pewresearch.org/religion/2022/05/06/americas-abortion-quandary/
  5. https://www.guttmacher.org/article/2022/06/long-term-decline-us-abortions-reverses-showing-rising-need-abortion-supreme-court
  6. https://www.guttmacher.org/news-release/2017/abortion-common-experience-us-women-despite-dramatic-declines-rates
  7. https://www.kff.org/womens-health-policy/state-indicator/abortions-by-race/?currentTimeframe=0&sortModel=%7B%22colId%22:%22Location%22,%22sort%22:%22asc%22%7D
  8. https://econofact.org/health-and-economic-effects-of-reduced-access-to-abortion
  9. https://www.guttmacher.org/article/2022/02/medication-abortion-now-accounts-more-half-all-us-abortions
  10. https://www.cdc.gov/reproductivehealth/data_stats/abortion.htm
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[1] Pregnancy is calculated as starting at the date of last menstrual period.