Article

Regulating Abortion: Impact on Patients and Providers in Texas

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Abstract

The state of Texas began enforcement of the Woman’s Right to Know (WRTK) Act on January 1, 2004. The law requires that all abortions at 16 weeks gestation or later be performed in an ambulatory surgical center (ASC). In the month the law went into effect, not one of Texas’s 54 non-hospital abortion providers met the requirements of a surgical center. The effect was immediate and dramatic. The number of abortions performed in Texas at 16 weeks gestation or later dropped 88 %, from 3642 in 2003 to 446 in 2004, while the number of residents who left the state for a late abortion almost quadrupled. By 2006, an ASC had opened in 4 major cities down from 9 in 2003 but the abortion rate 16 weeks or more gestation remained 50 percent below its pre-Act level. Regulations of abortion providers that require new facilities or costly renovations could have profound effects on the market for second trimester abortions.

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... The average cost for an abortion in the first trimester ranges from $500-675, going up to a range of $825-2500 in the second semester and $750-5000 for a third trimester abortion Jones et al., 2013;Jones & Finer, 2012;Shattuck, 2017). These costs are substantial because the majority of abortion patients are not financially stable (Ibis Reproductive Health, 2016) and have fewer resources to identify early pregnancies, afford safe and timely abortions, and/or travel and stay in a town hundreds of miles away from home (Colman & Joyce, 2011;Gerdts et al., 2016;Gold & Hasstedt, 2016;Jones et al., 2013). Furthermore, the ranges presented above do not include associated costs, such as childcare, lodging (Jones et al., 2013), and travel, which are often necessary because many towns in the U.S. do not have nearby clinics and there are 24 h waiting periods between the required first and second visits in some states (e.g. ...
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The devastating effects of natural hazards uncover and exacerbate social inequalities, yet reproductive health outcomes are often overlooked. Despite a small but growing literature on gender and disaster-related impacts, there are no studies to date to our knowledge on the intersection of abortion and disasters, which is important because abortion is common in the U.S. and is a critical component of comprehensive reproductive healthcare yet is routinely inaccessible due to a lack of health insurance coverage and other policy barriers. This is a qualitative case study of 8 individuals who required abortion services in Texas at the time of Hurricane Harvey. The study sample comes from caller data from a local Texas abortion fund. We present caller demographics, which reveal nonwhite patients in later trimesters struggling economically. Callers display a need for funding, particularly for travel, and were affected by interpersonal and sexual violence. We conclude with policy and research implications for disaster planners, domestic violence organizations, state and federal officials, and health insurers.
... Texas provides a good setting within which to assess the impact of multiple clinic-based restrictions imposed simultaneously. Two prior studies focused on Texas suggest that TRAP laws can result in a significant decline in the rate of abortions performed after implementation [4, 15]. TRAP laws may impose greater obstacles to women's access to abortion care compared to patient-focused restrictions such as mandated counseling and ultrasound requirements [9, 16]. ...
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Background: In November 2013, Texas implemented three abortion restrictions included in House Bill 2 (HB 2). Within six months, the number of facilities providing abortion decreased by almost half, and the remaining facilities were concentrated in large urban centers. The number of medication abortions decreased by 70% compared to the same period one year prior due to restrictions on this method imposed by HB 2. The purpose of this study was to explore qualitatively the experiences of women who were most affected by the law: those who had to travel farther to reach a facility and those desiring medication abortion. Methods: In August and September 2014, we conducted 20 in-depth interviews with women recruited from ten abortion clinics across Texas. The purposive sample included women who obtained or strongly preferred medication abortion or traveled ≥50 miles one way to the clinic. The interview guide focused on women's experiences with obtaining services following implementation of HB 2, and a thematic analysis was performed. Results: Women faced informational, cost and logistical barriers seeking abortion services, and these obstacles were often compounded by poverty. Two women found the process of finding or getting to a clinic so onerous that they considered not having the procedure, although they ultimately had an abortion; another woman decided to continue her pregnancy, in part because of challenges in getting to the clinic. For two women, arranging travel required disclosure to more people than desired. Women who strongly preferred medication abortion were frustrated by the difficulty or inability to obtain their desired method, especially among those who were near or just beyond the gestational age limit. The restricted eligibility criteria for medication abortion and difficulty finding clinics offering the method created substantial access barriers. Conclusions: Medication abortion restrictions and clinic closures following HB 2 created substantial barriers for women seeking abortion in Texas.
... This is the first study to our knowledge to describe women's experiences shortly after abortion clinic closures due to a restrictive abortion law. Previous research suggests that some restrictions do prevent women from obtaining abortions, especially when they force women to travel farther to obtain services [1,15,16,17]; however, none has documented the experiences of women unable to obtain their desired abortion. We collaborated with providers to implement a novel recruitment strategy and were able to conduct interviews with women from this difficult-to-study group. ...
... This is the first study to our knowledge to describe women's experiences shortly after abortion clinic closures due to a restrictive abortion law. Previous research suggests that some restrictions do prevent women from obtaining abortions, especially when they force women to travel farther to obtain services [1,15,16,17]; however, none has documented the experiences of women unable to obtain their desired abortion. We collaborated with providers to implement a novel recruitment strategy and were able to conduct interviews with women from this difficult-to-study group. ...
... This is the first study to our knowledge to describe women's experiences shortly after abortion clinic closures due to a restrictive abortion law. Previous research suggests that some restrictions do prevent women from obtaining abortions, especially when they force women to travel farther to obtain services [1,15,16,17]; however, none has documented the experiences of women unable to obtain their desired abortion. We collaborated with providers to implement a novel recruitment strategy and were able to conduct interviews with women from this difficult-to-study group. ...
... Policy analysis using administrative data is common (Mueser, Troske, & Gorislavsky, 2007) but to highlight the extent to which researchers leverage the potential of states' administrative records we turn to recent policy analysis con-ducted by Colman and Joyce (2011). In their study of the effects of a Texas law (the Woman's Right to Know Act) on abortion rates after 16 weeks' gestation, Colman and Joyce (2011) collected individual-level abortion records from the Texas Department of State Health Services and the states surrounding Texas from 2001 to 2006 to determine the law's effect. ...
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... More recently, states have passed laws focused on the " supply " side of abortion that makes it more difficult for facilities to provide services [2]. One of the few studies on supply-side restrictions found a substantial decline in the number of abortions performed after 16 weeks to Texas women following enactment of a law requiring later procedures to be performed at ambulatory surgical centers (ASCs) [4]. In July 2013, the Texas legislature enacted House Bill 2 (HB2) that put into place four supply-side abortion restrictions: abortions are banned after 20 weeks " post-fertilization " excluding certain exceptions; physicians performing abortion must have admitting privileges at a hospital within 30 miles of the facility; the provision of medical abortion must follow the labeling approved by the Food and Drug Administration Contraception 90 (2014) 496 – 501 (with some allowances for drug dosages); and all abortion facilities must meet the standards of an ASC. ...
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Objectives: In this paper, we estimate the average effect of two common TRAP (targeted regulation of abortion providers) laws on abortion rates using a novel longitudinal database of state-level policy shifts. Study design: We merged several sources of policy, abortion, and sociodemographic data from 1991-2014. We used a difference-in-differences design to control for time-fixed state-level characteristics and common factors affecting abortion trends across all states, as well as measured time-varying state-level factors that may impact TRAP enforcement and abortion rates. We used generalized linear models with cluster-robust standard errors to obtain our estimates. Results: Enforcement of ambulatory surgical center (ASC) laws reduced the abortion rate by 1.25 abortions per 1000 women aged 15-44 (95% CI: -3.39, .89), and admitting privilege laws increased the abortion rate by .57 abortions per 1000 women aged 15-44 (95% CI: -.68, 1.83), but neither effect was statistically distinguishable from zero. Our findings were robust to the inclusion of covariates and various sensitivity analyses. Conclusion: Our results suggest that ASC and admitting privilege laws did not, on average, lead to a meaningful change in abortion rates. Implications: US abortion rates are currently at record lows, but our findings suggest that TRAP laws are not a meaningful driver of this trend. However, this does not mean that these laws are without consequence in a particular state (or a given year). Researchers should assess the average long-run impact of TRAP laws on other outcomes in the future.
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Beginning August 8, 1992, a woman in the state of Mississippi had to wait 24 hours after in-person receipt of state-mandated information regarding abortion and birth complications, fetal development, and alternatives to abortion before an abortion could be performed. To analyze the effect of the law on the abortion and birth rates of Mississippi residents. A retrospective analysis of abortion and birth rates before and after the law in Mississippi as contrasted with abortion and birth rates in 2 comparison states, Georgia and South Carolina. Neither Georgia nor South Carolina enforced a mandatory delay law, but both states began enforcement of parental notification statutes during the study period. Female residents of reproductive age in Mississippi, Georgia, and South Carolina between 1989 and 1994. We compared birth rates, abortion rates, the percentage of late abortions, and the percentage of abortions performed outside the state of residence for all women and then by age and race before and after August 1992 among women of Mississippi, Georgia, and South Carolina. We found that rate ratios (RRs) of resident abortion rates (rate after law implementation/rate before law implementation) declined 12% more in Mississippi than in South Carolina (95% confidence interval [CI], 8%-15%) and 14% more in Mississippi than in Georgia (95% CI, 10%-17%) in the 12 months after the law went into effect. Rate ratios for white adults declined 22% more in Mississippi than in South Carolina (95% CI, 17%-27%) and 20% more in Mississippi than in Georgia (95% CI, 15%-25%). Changes among nonwhite adults and white teens were more modest but also statistically significant (P<.05). For all women, RRs of the percentage of abortions performed after 12 weeks' gestation increased 39% more in Mississippi than in either South Carolina or Georgia (P<.05); the increase in the percentage of abortions after 12 weeks' gestation was observed for white and non-white adults (P<.05). We also show that the percentage of abortions performed out of state increased 42% more among women in Mississippi relative to women in South Carolina after the law (95% CI, 34%-50%). The timing of the decline in abortion rates in Mississippi, the lack of similar declines in comparison states, the rise in percentage of late abortions and abortions performed out of state and the apparent completeness of abortion reports suggest that Mississippi's mandatory delay statute was responsible for a decline in abortion rates and an increase in abortions performed later in pregnancy among residents of Mississippi. The effect of delay laws in other states will likely depend on whether statutes require 2 separate visits to the abortion provider (ie, clinics, hospitals, or physicians' offices where abortions are performed) and the availability of abortion services.
Article
This study examined the effects of parental involvement laws on the birth rate, in-state abortion rate, odds of interstate travel, and odds of late abortion for minors. Poisson and logistic regression models fitted to vital records compared the periods before and after the laws were enforced. In each state, the in-state abortion rate for minors fell (relative to the rate for older women) when parental involvement laws took effect. Data offered no empirical support for the proposition that the laws drive up birth rates for minors. Although data were incomplete, the laws appeared to increase the odds of a minor's traveling out of state for her abortion. If one judges from the available data, minors who traveled out of state may have accounted for the entire observed decline in the in-state abortion rate, at least in Missouri. The laws appeared to delay minors' abortions past the eighth week, but probably not into the second trimester. Several empirical arguments used against and in support of parental involvement laws do not appear to be substantiated.
Article
This article examines the effect of abortion legalization on fertility rates in the United States. Fertility rates were compared over time between states that varied in the timing of abortion legalization. States legalizing abortion experienced a 4% decline in fertility relative to states where the legal status of abortion was unchanged. The relative reductions in births to teens, women more than 35 years of age, non-White women, and unmarried women were considerably larger. If women did not travel between states to obtain an abortion, the estimated impact of abortion legalization on birth rates would be about 11%. A complete recriminalization of abortion nationwide could result in 440,000 additional births per year. A reversal of the Roe v Wade decision leaving abortion legal in some states would substantially limit this impact because of the extent of travel between states.
Article
State laws regulating abortion have increased markedly in the wake of recent Supreme Court decisions. We test whether laws that require minors to notify or obtain consent from a parent before receiving an abortion affect the likelihood that a pregnancy will be terminated. We use individual data on births and abortions from three southern states, South Carolina, Tennessee, and Virginia. We find that South Carolina's parent consent statute is associated with a decline of 10 percentage points in the probability of abortion among non-black minors of 16 years of age. We find no effect for any other age or racial group and conclude that the impact of parental involvement laws on the pregnancy resolution of minors is not large.
Article
This paper uses data on abortion rates by state from 1974-1988 to estimate two-stage least squares models with fixed state and year effects. Restrictions on Medicaid funding for abortion are correlated with lower abortion rates in-state and higher rates among nearby states. A maximal estimate suggests that 19-25% of the abortions among low-income women that are publicly funded do not take place after funding is eliminated. Parental notification laws for teen abortions do not significantly affect aggregate abortion rates. A larger number of abortion providers in a state increases the abortion rate, primarily through inducing cross-state travel.
Article
Mississippi mandates that a woman seeking an abortion must first receive, in person, information about the fetus and alternatives to abortion. She must then wait at least 24 hours before having an abortion. It is not clear how such mandatory delay requirements affect the timing during pregnancy at which abortion occurs. The data for analysis, from the Mississippi Department of Health, are 34,748 abortions obtained by residents in the six-year period surrounding the law's enactment in August 1992 (i.e., from August 1989 through July 1995). The records were stratified by location of the nearest provider, so abortions to women whose nearest provider is in-state comprised the "treatment group" (N = 28,975), while abortions to women whose nearest provider is in a neighboring state with no such law comprised the "control group" (N = 5,773). Probit regressions were used to assess effects on the likelihood of a second-trimester abortion, and ordinary least-squares regressions were used to determine effects on gestational age at the time of the abortion. After enactment of the law, the proportion of second-trimester procedures increased by 53% (from 7.5% of abortions to 11.5%) among women whose closest provider is in-state, but it increased by only 8% (from 10.5% to 11.3%) among women whose closest provider is out-of-state. And although the overall abortion rate declined among women in the treatment group over the period (from 11.3 procedures per 1,000 women aged 15-44 to 9.9), the rate of second-trimester procedures increased among these women (from 0.8 per 1,000 women aged 15-44 to 1.1). The law was independently associated with delays in obtaining an abortion: Once the law went into effect and net of all covariates, the proportion of second-trimester abortions increased by nearly three percentage points more among women living closest to an in-state provider than among those living closest to an out-of-state provider. The law increased the mean gestational age of the fetus at the time of the procedure by approximately four days. Women who live closest to abortion providers in other states were relatively unaffected by the law. The proportion of abortions performed later in pregnancy will probably increase if more states impose mandatory delay laws with in-person counseling requirements.
Article
To determine whether mifepristone-misoprostol medical abortion is more acceptable to some American women than to others. Using previously reported acceptability data from a large US multicenter study (n = 2121), we conducted a more detailed analysis to test whether characteristics such as race/ethnicity, education, age, gestational age, and geographic location affect acceptability. In the United States, Asian women were more than twice as likely as other women to choose this method because they believed it was safer, while white women were twice as likely to select it because they considered it more natural. More educated women were likely to select this method to show support for greater choice and were more pleased about being able to avoid surgery. Particular features of the protocol also appealed to different women. White and African-American women as well as women with more education would feel significantly more comfortable taking one or both of the drugs at home than they would in the clinic. Nearly all groups of women were equally satisfied with this method and found it highly acceptable. The data showed surprisingly few differences among women's overall satisfaction level, their willingness to choose the method again, or to recommend it to others. Mifepristone-misoprostol medical abortion has widespread appeal to a broad range of women, but different women choose and prefer this method for different reasons.
Article
This paper uses data on the distribution of abortions by weeks of gestation to examine the relationship between abortion restrictions and the timing of abortions. State-level data from 1974 to 1997 indicate that adoption of parental involvement laws for minors or enforcement of mandatory waiting periods is positively associated with the post-first trimester percentage of abortions. However, autocorrelation-corrected specifications indicate that enforced parental involvement laws increase the share of later-term abortions by lowering the first trimester abortion rate rather than by delaying abortions. Medicaid funding restrictions generally do not have a significant effect on the timing of abortions in our results.
Article
This study explained the variation in US state abortion demand due to the price of services, the net of insurance cost of birth services, the ability to pay, contraceptive use, individual attitudes regarding abortion, and government policy affecting cost of benefits of terminating an unintended pregnancy or of carrying to birth. The empirical model uses pooled data from 48 states for 1982, 1984, 1985, and 1987. Prices are deflated to 1977 dollars. Another two-staged least squares model is based on cross-sectional state level data for 1985. The dependent variable is the log of abortion per 1000 pregnancies. Other variables pertain to income, education, labor force, family planning, tax, aid to families with dependent children, religion, and abortion-related measures. The results of the cross-sectional analysis are consistent with Medoff's and Garbacz's findings. The estimated coefficient of per capita income is positive with a point elasticity ranging from 0.62 to 1.0. The model with the most complete specifications has an abortion price elasticity range from -0.75 to -1.3 and is statistically significant when religion measures are excluded. The Hausman test shows the pro-choice variable significantly correlated with the error term. The net price of birth services is not statistically significant. Catholic religion and no religion are only significant when the abortion provider variable is excluded. The suggestion is that the effect of Catholicism is ambiguous. In the pooled analysis, the fixed effects model is used to control for abortion attitudes and other unobserved factors. Abortion demand includes abortion per 1000 pregnancies, the ratio of abortions to pregnancies, and the logarithm of abortions per 1000 pregnancies. Higher income is associated with a higher abortion rate and elasticities of 0.76 and 0.35 and is associated with a higher pregnancy rate. The abortion ratio is found to be elastic with respect to price, and price elasticities are sensitive to choice of state abortion attitude measures. The availability of family planning services reduces the rate of pregnancy as well as the abortion rate and ratio.
Article
A woman's ability to obtain an abortion is affected both by the availability of a provider and by access-related factors such as cost, convenience, gestational limits and the provision of early medical abortion services. In 2001-2002, The Alan Guttmacher Institute surveyed all known abortion providers in the United States, collecting information on their delivery of abortion services and on the number of abortions performed. A minority of abortion providers offer services before five weeks from the last menstrual period (37%) or after 20 weeks (24% or fewer), but the proportions have increased since 1993. Providers estimate that one-quarter of women having abortions in nonhospital facilities travel 50 miles or more for services, and that 7% are initially unsure of their abortion decision. The majority of providers (59%) say that these clients usually receive abortions during a single visit. An average self-paying client was charged $372 for a surgical abortion at 10 weeks in 2001, up from $319 in 1997; only 26% of clients receive services billed directly to public or private insurance. Early medical abortions are becoming increasingly available but are more expensive than surgical abortions. More than half (56%) of providers experienced antiabortion harassment in 2000, but types of harassment other than picketing have declined since 1996. Abortion at very early and late gestations and early medical abortion are more available than before, but charges have increased and antiabortion picketing remains at high levels. Thus, many women still face substantial barriers to obtaining an abortion.
Article
Nearly half of unintended pregnancies and more than one-fifth of all pregnancies in the United States end in abortion. No nationally representative statistics on abortion incidence or on the universe of abortion providers have been available since 1996. In 2001-2002, The Alan Guttmacher Institute (AGI) conducted its 13th survey of all known U.S. abortion providers, collecting information for 1999, 2000 and the first half of 2001. Trends were calculated by comparing the survey results with data from previous AGI surveys. From 1996 to 2000, the number of abortions fell by 3% to 1.31 million, and the abortion rate declined 5% to 21.3 per 1,000 women 15-44. (In comparison, the rate declined 12% between 1992 and 1996.) The abortion ratio in 2000 was 24.5 per 100 pregnancies ending in abortion or live birth, 5% lower than in 1996. The number of abortion providers decreased by 11% to 1,819 (46% were clinics, 33% hospitals and 21% physicians' offices); clinics provided 93% of all abortions in 2000. In that year, 34% of women aged 15-44 lived in the 87% of counties with no provider, and 86 of the nations 276 metropolitan areas had no provider. About 600 providers performed an estimated 37,000 early medical abortions during the first six months of 2001; these procedures represented approximately 6% of all abortions during that period. Abortions performed by dilation and extraction were estimated to account for 0.17% of all abortions in 2000. Abortion incidence and the number of abortion providers continued to decline during the late 1990s but at a slower rate than earlier in the decade. Medical abortion began to play a small but significant role in abortion provision.
Article
This paper considers the impact of the introduction of laws requiring parental involvement in a minor's decision to abort a pregnancy. State-level data over the 1985-1996 period are used to examine abortion, birth, and pregnancy outcomes, while microdata from the 1988 and 1995 National Surveys of Family Growth (NSFG) are utilized to examine sexual activity and contraception. Quasi-experimental methods are employed that examine whether minors' fertility outcomes were affected in those locations that introduced these laws following their introduction and occurred for minors but not other women. I find that parental involvement laws resulted in fewer abortions for minors resulting from fewer pregnancies; there is no statistically significant impact on births. The reduction in pregnancy seems to be attributable to increased use of contraception rather than a reduction in sexual activity.
Article
To determine factors associated with delay of induced abortion into the second trimester of pregnancy. Using audio computer-assisted self-interviewing, 398 women from 5 to 23 weeks of gestation at an urban hospital described steps and reasons that could have led to a delayed abortion. Multivariable logistic regression identified independent contributors to delay. Half of the 70-day difference between the average gestational durations in first- and second-trimester abortions is due to later suspicion of pregnancy and administration of a pregnancy test. Delays in suspecting and testing for pregnancy cumulatively caused 58% of second-trimester patients to miss the opportunity to have a first-trimester abortion. Women presenting in the second trimester experienced more delaying factors (3.2 versus 2.0, P < .001), with logistical delays occurring more frequently for these women (63.3% versus 30.4%, P < .001). Factors associated with second-trimester abortion in logistic regression were prior second-trimester abortion, delay in obtaining state insurance, difficulty locating a provider, initial referral elsewhere, and uncertainty about last menstrual period. Factors associated with decreased likelihood of second-trimester abortion were presence of nausea or vomiting, prior abortion, and contraception use. Abortion delay results from myriad factors, many of them logistical, such as inappropriate or delayed referrals and delays in obtaining public insurance. Public health interventions could promote earlier recognition of pregnancy, more timely referrals, more easily obtainable public funding, and improved abortion access for indigent women. However, accessible second-trimester abortion services will remain necessary for the women who present late due to delayed recognition of and testing for pregnancy. II-2.
Article
On January 1, 2000, Texas began enforcement of a law that requires physicians to notify a parent of a minor child seeking an abortion at least 48 hours before the procedure. We assessed changes in the rates in Texas of abortions and births (events per 1000 age-specific population) before enforcement of the parental notification law (1998 to 1999) and after enforcement (2000 to 2002). We did this by comparing the rate changes among minors 15 to 17 years of age at the time of conception (i.e., those who were subject to the law) with those of teens 18 years of age at the time of conception (i.e., those who were not subject to the law). After enforcement of the law, abortion rates fell by 11 percent among 15-year-olds (rate ratio, 0.89; 95 percent confidence interval, 0.83 to 0.94), 20 percent among 16-year-olds (rate ratio, 0.80; 95 percent confidence interval, 0.76 to 0.85), and 16 percent among 17-year-olds (rate ratio 0.84; 95 percent confidence interval, 0.80 to 0.87), relative to the rates among 18-year-olds. Among the subgroup of minors 17.50 to 17.74 years of age at the time of conception (who would have been subject to the parental notification law in early pregnancy), birth rates rose by 4 percent relative to those of teens 18.00 to 18.24 years of age (rate ratio, 1.04; 95 percent confidence interval, 1.00 to 1.08). The adjusted odds ratio for having an abortion after 12 weeks' gestation among minors 17.50 to 17.74 years of age as compared with 18-year-olds was 1.34 (95 percent confidence interval, 1.10 to 1.62). The Texas parental notification law was associated with a decline in abortion rates among minors from 15 to 17 years of age. It was also associated with increased birth rates and rates of abortion during the second trimester among a subgroup of minors who were 17.50 to 17.74 years of age at the time of conception.
Article
We studied the steps in the process of obtaining abortions and women's reported delays in order to help understand difficulties in accessing abortion services. In 2004, a structured survey was completed by 1209 abortion patients at 11 large providers, and in-depth interviews were conducted with 38 women at four sites. The median time from the last menstrual period to suspecting pregnancy was 33 days; the median time from suspecting pregnancy to confirming the pregnancy was 4 days; the median time from confirming the pregnancy to deciding to have an abortion was 0 day; the median time from deciding to have an abortion to first attempting to obtain abortion services was 2 days; and the median time from first attempting to obtain abortion services to obtaining the abortion was 7 days. Minors took a week longer to suspect pregnancy than adults did. Fifty-eight percent of women reported that they would have liked to have had the abortion earlier. The most common reasons for delay were that it took a long time to make arrangements (59%), to decide (39%) and to find out about the pregnancy (36%). Poor women were about twice as likely to be delayed by difficulties in making arrangements. Financial limitations and lack of knowledge about pregnancy may make it more difficult for some women to obtain early abortion.
Article
We evaluated the presence of misclassification bias in the estimated effect of parental involvement laws on minors' reproductive outcomes when subjection to such laws was measured by age at the time of pregnancy resolution. Using data from abortion and birth certificates, we evaluated the effect of Texas's parental notification law on the abortion, birth, and pregnancy rates of adolescents aged 17 years compared with those aged 18 years on the basis of age at the time of pregnancy resolution and age at conception. On the basis of age at the time of the abortion or birth, the law was associated with a fall of 26%, 7%, and 11% in the abortion, birth, and pregnancy rates, respectively, of 17- relative to 18-year-olds. Based on age at the time of conception, the abortion rate fell 15%, the birth rate rose 2%, and the pregnancy rate remained unchanged. Previous studies of parental involvement laws should be interpreted with caution because their methodological limitations have resulted in an overestimation of the fall in abortions and underestimation of the rise in births, possibly leading to the erroneous conclusion that pregnancies decline in response to such laws.
Article
Accurate information about abortion incidence and services is necessary to monitor levels of unwanted pregnancy and women's ability to access abortion services. All known abortion providers in the United States were contacted for information about abortion services in 2004 and 2005. This information, along with data from the U.S. Census Bureau, was used to examine national and state trends in numbers of abortions and abortion rates, proportions of counties and metropolitan areas without an abortion provider, and accessibility of abortion services. An estimated 1.2 million abortions were performed in the United States in 2005, 8% fewer than in 2000. The abortion rate in 2005 was 19.4 per 1,000 women aged 15-44; this rate represents a 9% decline from 2000. There were 1,787 abortion providers in 2005, only 2% fewer than in 2000. Some 87% of U.S. counties, containing 35% of women aged 15-44, did not have an abortion provider in 2005. Early medication abortion, offered by an estimated 57% of known providers, accounted for 13% of abortions (and for 22% of abortions before nine weeks' gestation). The average amount paid for an abortion at 10 weeks was $413-after adjustment for inflation, $11 less than in 2001. The numbers of abortions and the abortion rate continued their long-term decline through 2005. Reasons for this trend are unknown but may include improved access to and use of contraceptives or decreased access to abortion services.
Article
Variations in the availability of abortion providers may impact the demand for abortions since greater provider availability reduces the travel cost associated with acquiring an abortion. This paper applies a fertility-control model to estimate the responsiveness of abortion demand to travel-cost variations using county-level data on the state of Texas. Abortion rates as well as pregnancy rates appear to be sensitive to availability-induced variations in the travel cost of abortion services. In particular, the results suggest that residents in counties with longer travel distances to the nearest abortion provider have lower abortion rates and lower pregnancy rates. Copyright 1996 by Oxford University Press.
Article
Time and value are related concepts that influence human behaviour. Although classical topics in human thinking throughout the ages, few environmental economic non-market valuation studies have attempted to link the two concepts. Economists have estimated non-market environmental values in monetary terms for over 30 years. This history of valuation provides an opportunity to compare value estimates and how valuation techniques have changed over time. This research aims to compare value estimates of benefits of a protected natural area. In 1978, Nadgee Nature Reserve on the far south coast of New South Wales was the focus of the first application of the contingent valuation method in Australia. This research aims to replicate that study using both the original 1978 contingent valuation method questionnaire and sampling technique, as well as state of the art non-market valuation tools. This replication will provide insights into the extent and direction of changes in environmental values over time. It will also highlight the impact on value estimates of methodological evolution. These insights will help make allocating resources more efficient.
Article
Empirical researchers commonly invoke instrumental variable (IV) assumptions to identify treatment effects. This paper considers what can be learned under two specific violations of those assumptions: contaminated and corrupted data. Either of these violations prevents point identification, but sharp bounds of the treatment effect remain feasible. In an applied example, random miscarriages are an IV for women’s age at first birth. However, the inability to separate random miscarriages from behaviorally induced miscarriages (those caused by smoking and drinking) results in a contaminated sample. Furthermore, censored child outcomes produce a corrupted sample. Despite these limitations, the bounds demonstrate that delaying the age at first birth for the current population of non-black teenage mothers reduces their first-born child’s well-being.
dshs.state.tx.us/CHS/VSTAT/vs03/data.shtm#abort (last accessed November 27The impact of restricting Medicaid financing for abortion 25 rFigure 1: Counties with Late-term Abortion Services in Texas and Nearby States
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Comparison states: 32 states All women 0.79 -0.48* -60
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Panel B -Comparison states: 32 states All women 0.79 -0.48* -60.31 14.71 0.21 1.44 --- --- --- --- ---
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Counseling and waiting periods for abortion. State policies in brief
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Guttmacher Institute (2009). Counseling and waiting periods for abortion. State policies in brief. http://www.guttmacher.org/statecenter/spibs/spib_MWPA.pdf. Accessed November 11, 2009.
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Center for Reproductive Rights. Targeted Regulation of Abortion Providers (TRAP): Avoiding the TRAP. November 1, 2007. http://reproductiverights.org/en/document/targetedregulation-of-abortion-providers-trap-avoiding-the-trap. Accessed December 2, 2009.
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Targeted Regulation of Abortion Providers (TRAP): Avoiding the TRAP
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Center for Reproductive Rights. Targeted Regulation of Abortion Providers (TRAP): Avoiding the TRAP. November 1, 2007. http://reproductiverights.org/en/document/targetedregulation-of-abortion-providers-trap-avoiding-the-trap. Accessed December 2, 2009.
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