Abortion_z

Do profit motives limit a woman’s right to chose abortion?

This week Feministing called the UK Bill that would have banned abortion counseling “anti-choice” legislation. I think they have got that all wrong. The current arrangement gives abortion providers a financial incentive to encourage uncertain women to choose abortion – if that is the case, can we really be certain that each abortion is the woman’s choice? Or is it possible that financial motives are dictating the decisions of some women who might choose otherwise not to terminate their pregnancies?

Consider the following scenario. A British woman is pregnant and is uncertain as to whether or not she wants to keep her baby because the man with whom she has conceived is pressuring her to have an abortion. She goes online and finds one of two independent abortion providers (that together provide over 100,000 abortions a year). She makes an appointment to meet with a counselor whose role is to help her make her decision as to whether or not she should abort. After a 30-minute conversation with the counselor she becomes convinced by the counselor that she cannot care for a baby alone. The organization that provided the counseling for the abortion is paid either privately by the woman (20% of the time) or by the National Health Service. For these services these organizations are paid a total of £60 million (about US $96 million) by the NHS.

This reminds me of another story I heard last year about abortions in India. That story told of how the independent providers of fetus gender identification via ultra-sound technology also provided (very expensive) abortions to those who did not want to give birth to girls. In that story the financial incentive was for those identifying the gender to say that the fetus was female when they were actually uncertain as to the gender. That way they would earn both the fee for the identification and for the abortion if the woman had a preference not to give birth to a female child. So, women with uncertain ultrasound outcomes are encouraged to have abortions because of the financial incentives of the provider.

Now, if there was legislation in India that said that no provider of ultra-sounds could also provide abortions, would anyone be arguing that legislation was “anti-choice”? I don’t think they would, they would say that women have a right be given information that is independent of the financial motives of the provider. That way they are free to make decisions that are in their own best interest and in the interests of their family.

The difference between the India situation that I just described and the case in the UK is that individual counselors working for the abortion providers in the UK do not stand to individually profit from the marginal abortion, whereas the Indian abortion providers do. The chief executive officer of one of the organizations in the UK recently swore that “hand on heart” they would never encourage a woman who was not sure to have an abortion. Perhaps that is true, but wouldn’t it be better to have some structure in place that is a little more formal than one woman swearing to ignore the corporate financial realities of the organization she is responsible for?

The UK Bill that called for counseling of the independent was defeated on Wednesday by the British House of Commons by a margin of 250 votes. Even if that was the right decision to make, that doesn’t mean the Bill never should have been proposed in the first place. It is important to have public debate around these issues and to be certain that individual decision makers (here uncertain pregnant women) understand that those who provide them with information do so in an environment of revenue generation, if not profit maximization.

Personally, I am not sure why the government doesn’t just provide these services. Privatization of the production of public goods is usually undertaken to improve economic efficiency – to maximize the production of a good or service given limited resources. Abortions are not like garbage collection, they shouldn’t be sold off to the most productive service provider, and I am not really sure that abortion maximization is really what we are going for here.  I suspect that is the real complaint of those who brought forward the UK bill – not an attempt to limit a woman’s right to choose.

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