Behavior and Social Issues, 24, 56-67 (2015). © Marshall Medoff. Readers of this article may copy it without
the copyright owner’s permission, if the author and publisher are acknowledged in the copy and the copy is
used for educational, not-for-profit purposes. doi: 10.5210/bsi.v.24i0.5635
THE IMPACT OF STATE ABORTION POLICY ON THE PRICE OF AN ABORTION
Marshall Medoff1
California State University, Long Beach
ABSTRACT: This study empirically examines whether restrictive state abortion laws increase the
price charged by abortion providers as a result of complying with the laws. The empirical results
found that, over the period 2000-2011, state enforcement of a two-visit law and a TRAP law are
associated with an increase in the real price charged by abortion providers of 19% for a two-visit
law and 25% for a TRAP law. These empirical results suggest that these two restrictive state
abortion laws reduce the demand for an abortion in a state by between 13% and 15% for a twovisit law and between 17% and 19% for a TRAP law.
KEYWORDS: abortion, state abortion policy, restrictive abortion laws
To date, there have been no studies that have examined the relationship between restrictive
state abortion laws and the price charged by abortion providers. This paper addresses the gap in
the literature by empirically examining two important public and social policy questions: Do
restrictive state abortion laws increase the price charged by abortion providers? And, if so, Does
the increase in the price charged by abortion providers, as a result of complying with the
restrictive state abortion laws, have a significant negative impact on abortion demand (i.e.,
reduce abortion demand)?
The U.S. Supreme Court’s 1973 Roe v. Wade decision gave women the constitutional right
to have an abortion, but it did not mandate the provision of abortion services. States were
permitted to enact and enforce various laws restricting the accessibility of abortion services
provided that the restrictive abortion laws had a compelling interest in protecting a pregnant
woman’s maternal health.
In 1992, the Supreme Court in Planned Parenthood of Southeastern Pennsylvania v. Casey
expanded states’ ability to impose restrictions on a woman’s access to an abortion provided that
the restrictions did not impose an undue burden on a woman’s ability to obtain an abortion.
According to the Supreme Court, a state law or regulation imposes an undue burden if it has “…
the purpose or effect of placing a substantial obstacle in the path of a woman seeking an abortion
of a nonviable fetus.” The ambiguity of the undue burden standard resulted in an expansion of
state laws and regulations that were intended to reduce a woman’s access to an abortion.
Virtually all the research on abortion has focused on whether various restrictive state
abortion laws alter women’s unwanted pregnancy resolution decision-making reducing abortion
demand (i.e., the demand-side of the market). Restrictive abortion laws may have a direct effect
1
The author may be contacted at: [email protected]
56
IMPACT OF STATE ABORTION POLICY
decreasing the likelihood of women terminating an unwanted pregnancy in two ways. First,
restrictive abortion laws may increase the pecuniary costs (e.g., expenses on travel and
accommodations, lost work time, childcare expenses) and the nonpecuniary emotional costs
(e.g., guilt, remorse, regret, humiliation, psychological trauma) incurred by women seeking an
abortion. Second, restrictive abortion laws may decrease the availability of abortion services by
reducing the number of abortion providers resulting in both an increase in women’s search costs
in locating an abortion provider and the time costs associated with obtaining an abortion. The
more restrictive the abortion law, the greater the cost of obtaining an abortion. If abortions
become more costly, women with unwanted pregnancies will have fewer abortions.
Besides having a direct negative effect on abortion demand, restrictive state abortion laws
may also have an indirect negative effect on abortion demand. Previous research has found that
women with unwanted pregnancies are relatively sensitive to increases in the price of an
abortion. An increase in the price of an abortion by 10% has been found to reduce a state’s
abortion ratio (the number of abortions per 1000 pregnancies) by 7% to 8% (Medoff, 1988;
Garbacz, 1990). Restrictive abortion laws may have an indirect negative effect on abortion
demand by causing an increase in the price charged by abortion providers because of the
additional costs they incur in order to comply with the laws. This higher abortion price, in turn,
may make it more costly (less affordable) to obtain an abortion, thereby pricing some women out
of the abortion market (i.e., reduce abortion demand).
Whether restrictive state abortion laws increase the price charged by abortion providers is an
empirical question of obvious interest to policymakers and researchers. If restrictive state
abortion laws increase the price charged by abortion providers, this would imply that prior
numerical estimates of a negative relationship between particular restrictive abortion laws and
state abortion rates were underestimated since they excluded the positive effect of the laws on
the abortion price (Gohmann & Ohsfeldt, 1993; Blank et al., 1996; Levine et al., 1996; Matthews
et al., 1997; Medoff, 1997, 2007, 2010). This paper, using state-level data for the years 2000,
2005, 2008 and 2011, empirically examines the relationship between restrictive state abortion
laws and the price charged by abortion providers.
Restrictive State Abortion Laws
There are six restrictive abortion laws enacted by states that the Supreme Court has found to
be constitutional.
(1) Medicaid is a jointly funded federal-state health insurance program that provides medical
services for low-income individuals in each state. In 1980, the Supreme Court ruled that a law
passed by Congress, prohibiting federal Medicaid funds from being used to pay for an abortion
and gave states the right to deny state funding of abortions, was constitutional. Many states then
enacted laws that prohibited the use of their public funds to pay for Medicaid abortions for lowincome women. However, some states continued to use their own funds to pay for Medicaid
abortions.
State Medicaid funding of abortions is obviously not a restrictive abortion law since, by
providing coverage for abortion services, states are in effect increasing access to the utilization
of abortion services because cost is no longer a consideration for women who are too poor to pay
for the procedure. However, Dennis and Blanchard (2013) found that providers of Medicaid
abortions had considerable expenses obtaining state reimbursement including slow payment,
telephone and mailing expenses, additional staff and paperwork processing expenses. As such, it
57
MEDOFF
is of interest to determine if in the states that use their own funds to pay for Medicaid abortions
abortion providers are raising the price of an abortion to cover the additional expenses incurred
in seeking reimbursement for performing Medicaid abortions.
(2) Since the 1973 Roe v. Wade decision, the Supreme Court in a series of cases has ruled
that unmarried teen minors (less than eighteen years of age) have a constitutional right to obtain
an abortion. But, states may require that a parent be involved – be notified or give consent –
before an abortion is performed. Parental involvement laws may require additional mailing,
telephone, or record-keeping expenses.
(3) Many states have enacted mandatory counseling laws that require that an abortion
provider give or offer to women state-mandated medical information about abortion (e.g., fetal
development, future health risks, adoption options). Most mandatory counseling states allow the
state-mandated abortion information be provided to the patient by mail, fax, video, the Internet
or read over the telephone before the day of the procedure (i.e., not in person).
(4) Some states have enacted a more prescribed type of mandatory abortion counseling by
requiring that women receive the information in person, usually 24 hours before the procedure.
These two-visit waiting period laws require that women make two separate trips to the provider
in order to obtain an abortion. Two-visit laws may necessitate additional and costly consultation
time with a physician or staff member.
(5) Several states also require that women must first undergo an ultrasound of the fetus
before the abortion is performed. Requiring an ultrasound may significantly increase the cost of
an abortion.
(6) Since the mid-1990s, many states have enacted Targeted Regulation of Abortion
Providers laws (more commonly known by the acronym TRAP laws). TRAP laws apply only to
abortion providers and impose on them a wide variety of onerous and unnecessary physical plant
and staffing requirements. TRAP physical plant laws impose on abortion providers’ mandates on
the size of their office rooms. TRAP staffing laws mandate the hiring and qualifications of
various medical staff professionals. TRAP laws may force abortion providers to increase their
prices in order to cover the additional costs of remodeling or hiring additional staff.
Literature Review
Because of the confidentiality of abortion price data, there exist only three studies in the
current literature that have directly examined the relationship between the price of an abortion
and the demand for abortions. Medoff (1988) was first to estimate the impact of the price of an
abortion on the demand for abortions directly. Using confidential state abortion price data, for
the year 1982, he found that the price of an abortion had a significant (p < .001) negative effect
on a state’s abortion ratio (the number of abortions per 1000 pregnancies). Garbacz (1990), also
using 1982 state data, extended Medoff’s model and found that a 10% increase in the price of an
abortion resulted in a decrease in a state’s abortion ratio by 7%. In a related study Medoff
(2010), using cross-section time-series data over the period of 1982-2005, found that a $50
increase in the real price of an abortion significantly (p < .001) decreases a state’s abortion ratio
by 46 abortions per 1000 pregnancies of women of reproductive age (15-44 years).
Several studies have indirectly examined the impact of the out-of-pocket cost of an abortion
on the demand for abortion. State Medicaid funding of abortions reduces the out-of-pocket cost
of an abortion to zero for low-income women with unwanted pregnancies and as a consequence
one would expect an increase in the demand for abortion due to Medicaid funding in those states.
58
IMPACT OF STATE ABORTION POLICY
Most studies provide empirical support for this prediction. State Medicaid funding of abortions is
found to increase the abortion rate of women of childbearing age (15-44 years) by between 3% to
5%, depending on the time period examined (Blank et al., 1996; Levine et al., 1996; Matthews et
al., 1997; Haas-Wilson, 1997; Gohmann & Ohsfeldt, 1993; Medoff, 1997, 2007, 2010).
In summary, the available empirical evidence supports the proposition that abortion follows
the fundamental law of demand: an increase in the price of an abortion causes a reduction in the
number of abortions performed. The one feature that is common to all of the aforementioned
studies is that none of them took into account the possibility that restrictive state abortion laws
may have an indirect negative effect on abortion demand due to the increase in the price of an
abortion that may result from the higher operating costs imposed on abortion providers from
complying with the laws. As noted by Althaus and Henshaw (1994) some of the extra costs
imposed on abortion providers because of restrictive abortion laws include (1) the hiring of more
staff personnel; (2) longer hours for nurses and medical technicians; (3) greater physician
consultation time; (4) additional mailing and telephone expenses; (5) additional report and
record-keeping expenses; and (6) the legal expenses incurred to ensure that abortion providers
are in strict compliance with the restrictive abortion laws.
Model
In order to measure the impact restrictive state abortion laws have on the price of an
abortion, an inverse supply function is estimated which controls for the medical environment
(sellers, inputs and input prices) in a state. The abortion price equation to be estimated is:
Abortion Pricest = b0 + b1 Abortions Suppliedst + b2 Nursesst + b3 Physiciansst
(1)
+ b4 Medical Wagesst + b5 Restrictive Abortion Lawsst ,
s = 1, 2, …, 50; t = 2000, 2005, 2008, 2011
The dependent variable, Abortion Price, is the real (inflation-adjusted) price of an abortion
(in year 2011 dollars) during the first trimester of pregnancy in each state s during time period t =
2000, 2005, 2008, 2011. Thus there are 200 observations. The average state abortion price (in
year 2011 dollars) over the time period 2000-2011 was $562.74 with a standard deviation of
$136.58. Over the period 2000-2011, the real abortion price increased from $511 to $626. In
2011, the abortion price ranged from a high of $818 in Montana to a low of $341 in Maryland.
The price of an abortion in each state is from the Guttmacher Institute, which directly surveys all
abortion providers in a state. The sample years 2000, 2005, 2008 and 2011 are used because
these were the only years the Guttmacher Institute collected the price of an abortion in each state.
The quantity of Abortions Supplied is the number of abortions performed per 1000 women
of childbearing age (15-44 years) in state s during time period t. The remaining independent
variables represent the inputs available and the cost of the inputs used by providers to supply
abortion services. The variable Nurses, the number of nurses per 100,000 resident population in
state s during time period t, reflects the availability of a complementary input used by physicians
in providing abortion services. The variable Physicians, the number of physicians per 100,000
resident population, represents the number of physicians potentially capable of performing
59
MEDOFF
abortions. Medical Wages is the average weekly wage (in year 2011 dollars) of employees in
office and clinics of physicians.
Restrictive Abortion Laws is a vector of indicator variables (=1) that represent whether
various restrictive abortion laws were in effect in each state/year. Medicaid Funding is equal to
one if state s used its public funds to pay for abortions for indigent women. Parental Involvement
is equal to one if state s requires parental involvement (either permission or notification) before
an unmarried teen minor can have an abortion. Mandatory Counseling is equal to one if state s
required an abortion provider furnish to women patients state-mandated abortion-specific
medical information before the procedure is performed, but the information does not have to be
provided in person. The variable Two-Visit Law equals one if state s required that the statemandated abortion-specific medical information be provided in person at least 24 hours before
the procedure, thereby necessitating two separate trips to the abortion provider. The variable
Ultrasound equals one if state s has a law requiring that an ultrasound be performed on a woman
patient prior to the abortion procedure. The variable TRAP Law takes the value one if state s
imposes on abortion providers’ physical plant or staffing requirements not imposed on other
comparable physicians/clinics.
Data
The abortion rate and price, by state, for the years 2000, 2005, 2008 and 2011 are from the
Guttmacher Institute. The use of state data is the appropriate unit of measurement because
restrictive abortion laws are enacted by states and it is the heterogeneity of restrictive abortion
laws within and between states that change the cost of providing abortion services. The number
of nurses and physicians are from the U.S. Bureau of the Census, Statistical Abstract of the
United States. The average weekly wage of employees in offices and clinics of physicians is
from the U.S. Department of Labor, Bureau of Labor Statistics. The status of restrictive abortion
laws in each state is from the Guttmacher Institute’s State Policies in Brief. Summary statistics
for all the variables appear in Table 1.
Empirical Results
In equation (1), the number of abortions along with its price reflects the interaction of supply
and demand. That is, the willingness of providers to supply abortion services and the willingness
of women with unwanted pregnancies to purchase abortion services. As such, the price of an
abortion is determined simultaneously with the quantity of abortions (i.e., the abortion price and
the abortion quantity are endogenous). The econometric solution to this problem, as noted by
Greene (2012 ), is to find instruments (variables) for the quantity of abortions supplied in
equation (1) that are correlated with the quantity of abortions supplied, but do not directly affect
the abortion price.
The instruments selected are the percentage of each state’s population that resides in a
metropolitan area and the number of hospitals. Healthcare services (hospitals) tend to locate in
metropolitan areas where a large percentage of a state’s population resides. Both of these
variables are related to the overall level of accessibility and availability of general medical
services in a state, but are unlikely to be significantly affected by the price of an abortion. The
bivariate correlation between the abortion price and (1) the percentage of each state’s population
that resides in a metropolitan area was -.13 (t=1.70) and (2) the number of hospitals was -.11
(t=1.55).
60
IMPACT OF STATE ABORTION POLICY
Equation (1) is then estimated using a two-stage least-squares procedure, whereby the
quantity of abortions supplied is estimated in a first-stage equation with all the exogenous variTable 1. Summary Statistics
Variable
Mean
Standard Deviation
Abortion Price ($)
562.74
136.58
Abortions Supplied
15.13
8.15
Nurses
868.78
155.40
Physicians
254.49
62.74
Medical Wages ($)
812.4
174.47
Medicaid Funding (=1)
.33
.47
Parental Involvement (=1)
.68
.46
Mandatory Counseling (=1)
.51
.50
Two-Visit Law (=1)
.13
.33
Ultrasound (=1)
.23
.42
TRAP Law (=1)
.23
.46
Note. The mean is the average of each variable for all 50 states for the sample years 2000, 2005, 2008,
and 2011. Abortion price is the real (inflation-adjusted) price of an abortion in 2011 dollars. Abortions
supplied are the number of abortions performed per 1000 women of childbearing ages (15-44 years).
Nurses are the number of nurses per 100, 000 resident state population. Physicians are the number of
physicians per 100, 000 resident state population. Medical wages is the average weekly wage of
employees in physicians’ offices and clinics in 2011 dollars.
ables in equation (1) and the two instruments. In the second stage, the abortions supplied variable
in equation (1) is replaced by the predicted values of abortions supplied from the stage one
estimation and equation (1) is then estimated using ordinary least-squares. However, a White
Test of this estimation showed that the null hypothesis of homoscedasticity was rejected (p<
.05). In order to achieve efficient estimates, each variable in equation (1) was weighted by the
square root of the number of women of childbearing age (15-44 years) in each state. The
weighted two-stage least-squares empirical results appear in Table 2 (the White Test of the null
hypothesis of homoscedasticity could not be rejected).
The number of Nurses has a positive and significant (p<.001) association with the price of
an abortion. This result may seem counter-intuitive since a greater availability of nurses would
be expected to decrease the wages paid to nurses and, concomitantly, lower the cost of an
abortion. This relationship is consistent with prior research that difficulty employing nurses at
abortion facilities due to antiabortion activities (e.g., bombs and death threats, murders, stalking,
vandalism, picketing) results in greater wages/salaries for nurses employed by abortion providers
61
MEDOFF
and, concomitantly, higher abortion prices (Medoff, 2003). An increase of 87 nurses per 100,000
resident population (or 10%) increases the real price of an abortion by $74.
Table 2. Regression Results
Dependent Variable
Independent Variables
Abortion Price
(1)
Abortion Price
(2)
Abortions Supplied
31.157
(3.42)****
29.598
(3.70)****
Nurses
.846
(4.12)****
.811
(4.44)****
Physicians
-3.127
(3.00) ****
-3.063
(3.28)****
Medical Wages
-.352
(2.04)**
-.276
(1.87)*
Medicaid Funding
233.035
(3.41)****
223.497
(3.65)****
Parental Involvement
113.113
(1.52)
106.121
(1.60)
Mandatory Counseling
-18.714
(.44)
-.908
(.02)
Two-Visit Law
107.094
(1.96)**
97.789
(1.94)**
Ultrasound
-7.208
(.16)
-53.323
(1.21)
TRAP Law
144.797
(2.99)***
119.638
(2.85)***
R2
.56
.63
Year-Time Indicators
No
Yes
Note. Absolute value of t-statistics in parentheses: * p< .10, ** p< .05, *** p< .01, **** p< .001. Column
1 shows the regression coefficients from the weighted two-stage least –squares estimation of equation (1).
Column 2 shows the regression coefficients from the weighted two-stage least –squares estimation of
equation (1) when year-time indicator variables equal to one for each of the years 2000, 2005 and 2008
were added to the model estimation.
62
IMPACT OF STATE ABORTION POLICY
The number of Physicians has a significant (p<.01) negative association with the price of an
abortion. The larger the number of physicians in a state capable of performing abortions the
lower the price of an abortion. An increase of 25 physicians per 100,000 resident population (or
10%) decreases the real price of an abortion by $78.
The real weekly wage of employees in physicians’ offices and clinics is significantly (p<.05)
negative. This suggests that the inflation-adjusted weekly wage of employees in medical offices
and clinics has fallen over time resulting in little or no increase in the real price of an abortion.
State funding of Medicaid abortions is significantly (p<.001) positively associated with an
increase in the real price of an abortion in a state by $233. This corroborates the finding that
abortion providers in states that fund Medicaid abortions incur significantly higher expenses (i.e.,
paperwork, processing, mailing and telephone, payment delays, staff time) from providing
Medicaid abortions resulting in higher abortion prices (Dennis & Blanchard, 2013).
Parental involvement laws, mandatory counseling laws and requiring an ultrasound are not
significantly associated with an increase the real price of an abortion. These results are not
altogether surprising. Most teen minors involve a parent in their decision to have an abortion and
thus the abortion providers’ cost of notification/consent is minimal (Ralph et al., 2014; Henshaw
& Kost, 1992). In mandatory counseling states the abortion-specific medical information can be
provided to patients in a variety of inexpensive ways ( a video on the Internet, a recording over
the telephone, fax , mail) that represent a negligible increase in the price of an abortion. Virtually
all abortions (92%) are performed in clinics with large caseloads (+400 abortions per year) which
also provide a full range of gynecological and family planning services that typically require an
ultrasound (Jones & Jerman, 2014). The requirement of an ultrasound does not entail any
significant increase in the price of an abortion because the additional abortion patients allows a
provider to amortize (spread out) the capital expenses of the ultrasound over more patients
resulting in a lower fixed cost per patient.
Two-visit laws are significantly (p< .05) positive and are associated with an increase in the
real price of an abortion by $107 or equivalently the enforcement of a two-visit law in a state is
associated with an increase in the price charged by abortion providers of 19% (evaluated at the
sample mean real price of an abortion) − presumably because of the increase in physician/staff
time and expenses required to provide patients the state-mandated abortion information in person
at least 24 hours before the abortion. The enforcement of a TRAP law in a state is significantly
(p< .01) positive and is associated with an increase in the price of an abortion of $144 or
equivalently the enforcement of a TRAP law in a state is associated with an increase in the price
charged by abortion providers of 25% (evaluated at the sample mean real price of an abortion).
The finding that two-visit laws and TRAP laws are significantly associated with an increase in
the price of an abortion implies that even if these restrictive abortion laws do not directly affect
abortion demand, they indirectly reduce abortion demand through their increase on the price
charged by abortion providers.
The price elasticity of demand of a good is a number that measures the responsiveness of the
quantity demanded of a good as a result of a change in its price. The price elasticity of demand
shows the percentage change in the number of abortions performed for every 1% change in the
price of an abortion. Previous estimates of the price elasticity of abortion demand range from .68 to -.77 (Medoff, 1988; Garbacz, 1990). Using the increase in the real price of an abortion that
is associated with a two-visit law from the previous paragraph of 19% times the literature’s
63
MEDOFF
estimates of the price elasticity of abortion demand ( -.68 x 19%; -.77 x 19%) suggests that a
two-visit law is associated with a decrease in the number of abortions performed by between
13% and 15%. Similarly, using the increase in the real price of an abortion that is associated with
a TRAP law from the previous paragraph of 25% times the literature’s estimates of the price
elasticity of abortion demand ( -.68 x 25%; -.77 x 25%) suggests that a two-visit law is
associated with a decrease in the number of abortions performed by between 17% and 19%.
It might be argued the empirical results in Column 1 of Table 2 are spurious since, over the
time period examined 2000-2011, there may be time-varying factors such as changing economic
conditions that may have affected abortion providers equally in all states. If these time-varying
factors were correlated with a state’s restrictive abortion policy, then the estimated coefficients
of the restrictive abortion law variables in Column 1 would be overstated since they would
include some of the effects of the omitted time-varying factors. In order to take into account this
possibility, a year-time indicator model (an indicator variable equal to one for each of the years
2000, 2005, 2008) was included in the estimation of equation (1). The empirical results appear in
Table 2, Column 2.
The empirical results in Table 2, Column 2 show that the estimated coefficients of the
restrictive abortion laws are virtually identical to their respective counterparts that appear in
Column 1 (the null hypothesis of equality of coefficients cannot be rejected). Even after
controlling for time-varying factors, two-visit laws and TRAP laws still had a significantly
positive association with the real price of an abortion and, concomitantly, indirectly reduce
abortion demand through their increase in the price charged by abortion providers.
Empirical Estimates of Structural Changes
In order to determine if the associations between the model predictors in equation (1) and
the abortion price changed, over the time period 2000-2011, the data set was divided into two
time periods and equation (1) was re-estimated. The first time period encompasses the years
2000 and 2005 and the second time period is the years 2008 and 2011. The empirical results
appear in Table 3, Column 1 (for the sample years 2000 and 2005) when there are no controls for
time-varying factors and Column 2 (for the sample years 2000 and 2005) when there are controls
for time-varying factors (year-time indicators) and Column 3 (for the sample years 2008 and
2011) when there are no controls for time-varying factors and Column 4 (for the sample years
2008 and 2011) when there are controls for time-varying factors (year-time indicators). Because
of space limitations, only the regression coefficients for the restrictive abortion laws appear in
Table 3.
The empirical results in Table 3 show that, whether or not there are controls for timevarying factors, the regression coefficients of Medicaid funding, two-visit laws and TRAP laws
are still significantly positive in both time periods and show no structural change (the null
hypotheses of equality of coefficients cannot be rejected between the two time periods). The
empirical evidence in Table 3 shows that the results reported in Table 2 are robust. The empirical
results in Table 3 consistently show that abortion providers in states that fund Medicaid abortions
have higher abortion prices most likely because they incur higher expenses from providing
Medicaid abortions. The enforcement of two-visit laws and TRAP laws in a state is associated
with an increase in the price charged by abortion providers presumably in order to cover the
additional expenses of complying with these laws.
64
IMPACT OF STATE ABORTION POLICY
Table 3. Regression Results
Dependent Variable
Independent
Variables
Abortion Price
(2000, 2005)
(1)
Abortion Price
(2000, 2005)
(2)
Abortion Price
(2008, 2011)
(3)
Abortion Price
(2008, 2011)
(4)
193.808
(2.82)***
189.346
(2.80)***
228.025
(2.44)**
214.731
(2.40)**
Parental
Involvement
90.989
(1.16)
88.120
(1.14)
109.372
(1.13)
90.190
(.98)
Mandatory
Counseling
-26.298
(.67)
-28.285
(.72)
70.282
(.94)
58.777
(.82)
Two-Visit Law
105.006
(1.67)*
110.130
(1.71)*
81.202
(1.17)
74.625
(1.12)
Ultrasound
-2.698
(.05)
-7.021
(.14)
-77.999
(1.19)
-74.197
(1.19)
TRAP Law
81.955
(1.84)*
77.761
(1.79)*
131.687
(1.98)**
129.751
(2.03)**
R2
.72
.72
.65
.68
Year-Time
Indicators
No
Yes
No
Yes
Medicaid
Funding
Note. Absolute value of t-statistics in parentheses: * p< .10, ** p< .05, *** p< .01, **** p< .001.
Column 1 shows the regression coefficients for the restrictive state abortion laws when equation (1) is
estimated only for the sample years 2000 and 2005 and there is no time indicator variable. Column 2
shows the regression coefficients for the restrictive state abortion laws when equation (1) is estimated
only for the sample years 2000 and 2005 and a time-indicator variable equal to one for the year 2000 is
included in the model. Column 3 shows the regression coefficients for the restrictive state abortion laws
when equation (1) is estimated only for the sample years 2008 and 2011 and there is no time indicator
variable, included in the model. Column 4 shows the regression coefficients for the restrictive state
abortion laws when equation (1) is estimated only for the sample years 2008 and 2011 and a timeindicator variable equal to one for the year 2008 is included in the model.
65
MEDOFF
Conclusion
Prior empirical research has found that women with unwanted pregnancies are sensitive to
increases in the price of an abortion. An increase in the price of an abortion causes a decrease in
the demand for abortion. Restrictive state abortion laws may impose additional expenses on the
providers of abortion in order to comply with the laws. As a consequence, restrictive state
abortion laws may increase the price of an abortion as abortion providers pass the additional
costs of complying with the laws on women seeking an abortion. This increase in the price of an
abortion, due to restrictive abortion laws, will reduce the number of abortions performed. This
suggests that restrictive state abortion laws may have an indirect negative effect on abortion
demand through their positive impact on the price charged by abortion providers.
This study empirically examines the impact restrictive state abortion laws have on the price
charged by abortion providers over the period 2000-2011. The empirical results found that two
restrictive state abortion laws – two-visit laws and TRAP laws – were significantly positively
associated with an increase in the price abortion providers charge, presumably from the higher
expenses imposed on abortion providers as a result of complying with each restrictive abortion
law. State enforcement of a two-visit law and a TRAP law is associated with an increase in the
inflation-adjusted price charged by abortion providers by 19% and 25%, respectively. This
implies that the indirect effect of a two-visit law and a TRAP law, through their increase on the
price abortion providers charge, is to reduce the demand for abortions in a state by between 13%
and 15% for a two-visit law and between 17% and 19% for a TRAP law.
The Supreme Court has ruled that restrictive state abortion laws are constitutional as long as
they do not impose an undue burden on a woman’s decision to have an abortion. However, as
noted in 2004 by the Ninth Circuit Court of Appeals in Tucson Woman’s Clinic v. Eden, the
indirect imposition of costs due to the enactment of restrictive state abortion laws may constitute
an undue burden if they increase out-of-pocket cost of obtaining an abortion thereby excluding
many women (i.e., poor, minorities, teens, rural) from exercising their constitutional right of
procuring an abortion.
References
Althaus, F.A. & Henshaw, S. K. (1994). The effects of mandatory delay laws on abortion patients and providers.
Family Planning Perspectives, 26(2), 228-231.
Blank, R. M., George, C. C., & London, R. (1996). State abortion rates: The impact of policies, providers, politics,
demographics, and economic environment. Journal of Health Economics, 15 (5), 513-553. Doi:
10.1016/S0167-6296(96)00494-8.
Dennis, A., & Blanchard, K. (2013). Abortion providers’ experiences with Medicaid abortion coverage policies: A
qualitative multistate study. Health Services Research, 48(1), 236-252. Doi: 10.1111/j.14756773.2012.01443.x.
Garbacz, C. (1990). Abortion demand. Population Research and Policy Review, 9(2), 151-160.
Gohmann, S., & Ohsfeldt, R. L. (1993). Effects of price and availability on abortion demand. Contemporary Policy
Issues, 11(4), 42-55.
Greene, W.H. (2012). Econometric analysis. Englewood Cliffs, New Jersey: Prentice Hall.
Guttmacher Institute (2011). State policies in brief. New York, New York: Guttmacher Institute.
Haas-Wilson, D. (1997). Women’s reproductive choices: The impact of Medicaid funding restrictions. Family
Planning Perspectives, 29(5), 228-233.
Henshaw, S. K., & Kost, K. (1992). Parental involvement in minors’ abortion decisions. Family Planning
Perspectives, 24(2), 196-213.
66
IMPACT OF STATE ABORTION POLICY
Jones, R. K., & Jerman, J. (2014). Abortion incidence and service availability in the United States, 2011.
Perspectives on Sexual and Reproductive Health, 46(1), 3-14. Doi: 10.1363/46e0414.
Levine, P. B., Trainor, A. B., & Zimmerman, D. J. (1996). The effect of Medicaid abortion funding on abortions,
pregnancies and births. Journal of Health Economics, 15(5), 555-578.
Matthews, S., Ribar, D., & Wilheim, M. (1997). The effects of economic conditions and access to reproductive
health services on state abortion rates and birthrates. Family Planning Perspectives, 29(2), 52-60.
Medoff, M. H. (1988). An economic analysis of the demand for abortions. Economic Inquiry, 26(2), 353-359.
Medoff, M. H. (1997). A pooled time-series analysis of abortion demand. Population Research and Policy Review,
16(6), 597-605.
Medoff, M. H. (2007). Price, restrictions and abortion demand. Journal of Family and Economic Issues, 28(4), 583599. Doi: 10.1007/S10834-007-9080-9.
Medoff, M. H. (2010). State abortion policy, targeted regulation of abortion provider laws, and abortion demand.
Review of Policy Research, 27(5), 577-594. Doi: 10.1111/j.1541-1338.2010.00460.
Medoff, M. H. (2003). The impact of anti-abortion activities on state abortion rates. Journal of Socio-Economics,
32(3), 265-282.
Ralph, L., Gould, H., Baker, A., & Foster, D. G. (2014). The role of parents and partners in minors’ decisions to
have an abortion and anticipated coping after abortion. Journal of Adolescent Health, 54(4), 428-434. Doi:
10.1016/j.jadohealth.2013.09.021
U.S. Bureau of the Census (2003, 2007, 2011, 2012). Statistical abstract of the United States, 2002, 2006, 2010,
2011. Washington, D.C.: Government Printing Office.
U.S. Department of Labor, Bureau of Labor Statistics (2012). Hours and earnings, states and areas, 2000-2011.
Washington, D.C.: Government Printing Office.
67