Policy Changes and Pregnancy Outcomes A long-standing issue in the demography of reproduction is whether the availability of abortion services affects how pregnancies are resolved. The standard economic argument is that increased availability lowers the time cost associated with accessing abortion services and thereby increases demand. Although numerous studies have demonstrated a strong correlation between abortion rates and the number of abortion providers in an area, most lack a convincing identification strategy with which to overcome the simultaneous determination of the supply and demand of abortion services. In this study we take advantage of a sudden withdrawal of abortion services in Texas and their partial restoration 12 to 20 months later to identify the effect of the availability of abortion services on pregnancy resolution. Beginning January, 2004, Texas law required that all abortions 16 or more weeks' gestation be performed in an ambulatory surgical center. In January, 2004, not one of Texas's 54 non- hospital abortion providers met the requirements of a surgical center. The effect was immediate and dramatic. The published number of abortions performed in Texas at 17 weeks of gestation or later dropped from 3066 in 2003 to only 403 in 2004, a decline of 87 percent or 2663 abortions. How, therefore, were these pregnancies resolved? Did women adjust to the law by obtaining abortions earlier in pregnancy? Was there an increase in abortions 16 weeks or later to Texas residents in neighboring states? Were abortions to Texas residents obtained out of state associated with age, race, ethnicity and travel distance? How do the answers to each of these questions change as late-term services were partially restored in Dallas, Austin and Houston? The study is possible because we have unique individual-level data on all abortions that occurred in Texas, Arizona, Arkansas and Oklahoma from 2001 to 2006 and all births to residents in the same states over the same period. Not only do we have demographic information on each pregnant woman, but we can measure distance in miles from the woman's county of residence to the nearest county with an abortion provider that offers late-term services within and outside of Texas. The sudden withdrawal of services within Texas provides an exogenous change in our distance measure. Another unique aspect of is that we have individual-level data on all abortions to residents of Texas performed in Arkansas and Oklahoma that will enable us to characterize Texas residents who travel to these states in response to the law. We also have aggregate data on abortions to Texas residents in New Mexico, Louisiana and Colorado. Thus, we can describe in more detail than has been possible previously the response by pregnant women to unanticipated changes in the availability of late-term abortion services. There are approximately 50,000 abortions performed after 15 weeks gestation annually in the U.S. The requirement that these abortions be performed in an ambulatory surgical center greatly reduces the availability of late-term abortion services as relatively few facilities can afford to meet these standards. The result may be an increase in abortions performed later in pregnancy as women take longer to arrange and finance the procedure. Abortions performed later in pregnancy are at greater risk of complications. ? ? ?
| Joyce, Ted (2010) Parental consent for abortion and the judicial bypass option in Arkansas: effects and correlates. Perspect Sex Reprod Health 42:168-75 |
