The Economics of Second Trimester Abortions: Market Demand

This is the first of two posts on the topic of the market for second trimester abortions. Later on in the week we will talk about the impact of government policies on the supply side of that market. Before we do that, I want to start with a discussion of the economic factors that are contributing to the demand for late abortions in the United States.

The U.S. is one of very few industrialized nations in which it is possible for a woman to have an abortion in the second trimester of pregnancy for reasons other than medical necessity. Without going into why that is the case from a legal perspective, there are economic factors that suggest that even if all countries allowed second trimester abortions, there would still be higher demand for them in the U.S. than in other wealthy nations.

Keeping this international comparison in mind, the following is a list of several examples, rather than an exhaustive list, of economic factors that influence the demand side of the market for abortions after the first 12 weeks of pregnancy.

Price:

Imagine that a woman who has just discovered that she is almost five weeks pregnant (which is the length of time, measured from the date of her last period, that it takes women, on average, to make this discovery). She decides immediately that she wants to terminate the pregnancy, but has no savings or access to credit (which is a very realistic assumption to make for low-income earners) and, on top of that, is unable to ask family and friends for help because knows that they will not support her decision.

The average cost of an abortion in the U.S. varies from $451 (if done at 10 weeks gestation) up to $1,500 (at 20 weeks gestation). In thirty-two states in the U.S., there is no financial assistance available to low-income women who want to have an abortion for reasons other than life-threatening medical problems or if the pregnancy is the result of rape or incest. If our woman happens to be unlucky enough to live in a state that does not help low-income women pay for abortions, she has no choice but to save enough of her earning to pay for that procedure.

Now, imagine that she is earning the federal minimum wage of $7.25 and working 40 hours a week. That gives her a take home pay of $290 under the very unrealistic assumption that she has no deductions from her paycheck. The federal poverty limit says that a woman with no children needs $208 per week in income to pay for the basic necessities of life. If she is capable of saving almost 30% of her wages — $80 per week — then it will take her about 6 weeks to save enough money for the procedure.

With any luck, by the time she gets her last paycheck she can just make the cut-off for a first trimester abortion.

Now, consider this: 42% of women having abortions live on an income that falls below the federal poverty level – they are making less than the $208 per week needed to pay for the basic necessities of life – and 53% of women having abortions between weeks 16 and 20 gestation are women in this low income bracket.

Among women who both had second trimester abortions, and would have preferred to have one earlier in the pregnancy, 36% said the delay was caused by a need to raise the enough money to pay for the procedure.  

The U.S. isn’t the only nation that makes women pay for abortions, but it is the only one, that I know of, in which abortions for low-income women go unsubsidized by governments.

Accessible health care:

Now, consider the same woman in our scenario, but now not only does she earn minimum wage but she has no access to a health care provider who not only can confirm a pregnancy but, more to the point, to tell her how many weeks pregnant she is.

What are the chances that when she arrives for the procedure she discovers she is further along in the pregnancy than she thought? For example, she could have thought that she was only twelve weeks pregnant when really she was 16 weeks pregnant.

Not being able to determine the gestation of pregnancy is particularly a problem for adolescent women whose periods are still irregular, women who have recently given birth and women who are recovering from a recent abortion. Those women, and others with low health literacy, are at a higher risk of having a second trimester abortion than are women who have access to a family doctor.

As a proxy measure of how the U.S. compares to other industrial nations in terms of accessible health care for pregnant women, according to CIA World Factbook in terms of the mortality rate of women related to pregnancy and childbirth, the U.S. ranks 51st in the world between Lebanon and Saudi Arabia and, at 24 deaths per 100,000 women each year, has a maternal mortality rate almost three times as high as other industrial nations.

Abstinence training in school:

Adolescent women discover their pregnancies much later than other older women, and not surprisingly then, a higher proportion of adolescents women have second trimester abortions than do women in general. Adolescents represent 12% of all women having abortions after 12 weeks gestation compared to 16% of women between the ages of 15 and 19.

Adolescents between the ages of 18 and 19 were 1.36 times more likely to be having an abortion in the second trimester than were women between the ages of 2-24. So a country (or state) with a high teen pregnancy rate will have women who have abortions later in their pregnancies, on average, than in a country (or state) with a low teen pregnancy rate.

The U.S. has the highest teen pregnancy rate in the developed world. There are a variety of reasons why that is the case but, regardless of whether or not abstinence training is one of them, teaching students a sexual health program that both fails to teach women how to recognize the signs that they are pregnant and creates a culture of shame around pre-martial sex will contribute to late abortions for adolescent girls.

In addition, abstinence programs make it difficult for girls to find the information they need in order to have abortions. For some women, certainly, this lack of information will prevent them from having an abortion altogether, but for others it will only push the abortion into later in the pregnancy.

Other countries teach purely abstinence programs in schools, but those countries almost exclusively have less developed economies. Most industrial nations provide their students a health education program that at least recognizes that some students are sexually active.

Anti-abortion violence and harassment:

The purpose of anti-abortion violence and harassment of women is to increase the cost of an abortion in the hope of preventing women from terminating their pregnancies. These costs include not only the emotional cost of having to deal with protestors, but also financial costs if women need to travel to other areas for abortions in order to avoid the turmoil.

Anti-abortion harassment and violence doesn’t just increase the costs to clients. The need to protect clients and workers raises the costs for providers as well. If these costs are passed on to consumers then harassment increases the direct, as well as indirect, cost of abortions.
This increase in the costs of abortion might prevent some women from having abortions, although according to evidence that we have discussed here the effect of violence on abortion rates is small and short-lived.

What is likely, though, is that the additional cost of travel and/or having to face angry protestors will delay, rather than prevent, women from terminating their pregnancies, contributing to the need to provide second trimester abortions to women.

The U.S. is by no means the only country in which people object to, and protest against, abortion. It is, however, one of the few in which local governments have abdicated their role to protect women from that harassment. In fact, as we will see when we talk about market supply for second trimester abortions later this week, some of the policies imposed by state governments with the goal of reducing women’s access to second trimester abortions use a similar tactics to those used by antiabortion organizations.

References:
Rachel K. Jones and Lawrence B. Finer (2012). “Who has second-trimester abortions in the United States?” Forthcoming in Contraception. (http://www.sciencedirect.com/science/article/pii/S0010782411006251)

Lawrence B. Finer, Lori F. Frohwirth, Lindsay A. Dauphinee, Susheela Singh, and Ann M. Moore (2006). “Timing of steps and reasons for delays in obtaining abortions in the United States.” Contraception, Vol. 74(4): pp 334-344.

Rachel Jones and Kathryn Kooistra (2011).  Abortion Incidence and Access to Services In the United States, 2008.” Perspectives on Sexual and Reproductive Health, Vol. 43:pp. 41–50.