Economics of Abortion: Recession and Contraception Among Key Factors

For the first time since 1981, the long-term decline in U.S. abortions has stalled. And experts are pinning the blame on the recession. In other words, when it comes to abortions, American consumers behave much as they do when buying cars: when they have less money, they are more likely to opt for a used car, rather than splurging on the latest model. I'll explain that further shortly.

The new data comes from the Guttmacher Institute in New York, which periodically surveys U.S. abortion providers. Researchers found that in 2008, there were 19.6 abortions per 1,000 women aged 15-44. While this is significantly below the 1981 peak (29.3 abortions for every 1,000 women), it is virtually unchanged from the 2005 rate (19.4 abortions). Likewise, the total number of abortions in 2008 (1.21 million) was essentially unchanged from 2005.

While there are many possible causes for this latest trend, the chief suspect is the recession that hit in 2008, which altered the economic calculations (and savings accounts) of many American families.

"Abortion numbers go down when the economy is good and go up when the economy is bad, so the stalling may be a function of a weaker economy," said Michael New, a University of Alabama political science professor.

In this sense, abortion can be thought of as an "inferior good" -- i.e. something a consumer would demand less of if they had a higher level of real income. While abortions aren't cheap (in 2009, according to the Guttmacher Institute, the average amount paid for a non-hospital abortion with local anesthesia at 10 weeks' gestation was $451), they are far cheaper than having a baby. (The average cost of having a child in the hospital in America in 2005 was between $5,000 and $10,000.)

If that all sounds like a very rational and clinical account of an issue that is usually portrayed in red-hot, polarizing terms, that's a good thing, at least as far as I'm concerned. Because if, like me, you'd like to envision a country where -- in the immortal words of Bill Clinton, abortion is "safe, legal and rare" -- then we need to start looking at the cold, hard facts around abortion rather than crafting policy based on our emotions.

So, while we're at it, let's look at some other numbers that ought to impinge upon this debate:

The cost of contraception. If it makes more economic sense to abort a fetus rather than to have a child, then presumably we should be thinking about the cost of alternatives to pregnancy. Co-pays on birth control currently run from $15 a month to $50 (or more) a month. But that's not affordable for many Americans, either. According to a national poll conducted for Planned Parenthood last year among women 18 to 34, 55 percent said that the cost of birth control had made it difficult to consistently use prescription birth control at some point in their lives. (Bear in mind that more than half of all abortions are sought by women in their 20s.)

In theory, the health care reform bill passed last year should ameliorate this burden, given that it will soon require insurance companies to offer preventive services to their customers at no cost. But for the moment at least, the Health and Human Services Department has decided not to include contraception in its list of "essential" preventive health care services exempted from co-payments or deductibles, at least until it has given the issue further study.

While it's impossible to know the rationale behind this decision, conservative groups such as the Family Research Council -- not to mention the Catholic Church -- have lobbied strongly against including contraception in the preventive health category. In the meantime, in a separate study, the Guttmacher Institute found that 18 percent of women on the pill in households that make less that $75,000 a year have resorted to inconsistent pill use to save money.

So if the idea is to have fewer abortions -- but contraception is prohibitively costly for the most fertile groups of women . . . well, you do the math. As Amanda Marcotte wrote in Slate earlier this year, "There's a reason that the United States has the highest teen pregnancy and abortion rates in the developed world, and that's because we're just not as good at using consistent contraception. And that it's a major hassle and expense to get it is a big part of the reason."

The Availability of Abortion. So much for demand. What about supply? In the decade after Roe v. Wade (1973), the number of sites providing abortion across the country almost doubled from about 1,500 to more than 2,900, according to the Gutt­macher Institute. But by 2000 the number shrank back to about 1,800 -- a decline of 37 percent from 1982. Many doctors simply don't want to endure the vitriol, violence and -- on occasion, murder -- which extreme pro-life movements have employed against abortion providers. As a result, many doctors have opted out of the procedure altogether, leaving it to private clinics to pick up the slack.

There's also been a geographic narrowing over time of where -- in the United States -- women can obtain an abortion. According to the Guttmacher Institute, 87 percent of U.S. counties -- home to 35 percent of women of reproductive age -- have no abortion provider. In a recent op-ed in The New York Times, Linda Greenhouse notes that as more and more states enact new obstacles to abortion (e.g. the Oklahoma law requiring women seeking an abortion to first get an ultrasound), you get a "shrinking handful of doctors able to provide abortions in a hostile regulatory climate."

Greenhouse likens this situation to Ireland, where a recent, much-publicized ruling by the European Court of Human Rights held that Ireland can continue to uphold its near-total ban on abortions, so long as it offers women an "accessible and effective procedure" to demonstrate that they qualify for life-saving exceptions. Short of that, women seeking an abortion must continue to travel abroad, and all the expense -- financial, medical and psychological -- that implies. Greenhouse's concern is that de facto if not de jure, the United States is rapidly becoming like Ireland in requiring women to travel for this procedure.

The number of protests. And then there's the question of protests. Even as abortion levels held more or less steady from 2005, incidents of harassment in front of abortion provider offices rose between 2000 and 2008. Again, according to the Guttmacher report, the proportion of large non-hospital providers (those offering 400 abortions or more) reporting anti-abortion harassment rose to 89 percent in 2008, from 82 percent in 2000. Harassment was particularly common among providers of all sizes in the Midwest and the South. Picketing was the most common form of harassment (reported by 55 percent of providers), followed by picketing combined with blocking patient access to facilities (21 percent).
None of us wants to see more abortions.

But I, for one, don't want the United States to become Ireland.

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