The Economics of Second Trimester Abortions: Market Demand

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.

CT scans of shark intestines find Nikola Tesla’s one-way valve

Evolution proves to be just about as ingenious as Nikola Tesla

Credit: Gerald Schömbs / Unsplash
Surprising Science
  • For the first time, scientists developed 3D scans of shark intestines to learn how they digest what they eat.
  • The scans reveal an intestinal structure that looks awfully familiar — it looks like a Tesla valve.
  • The structure may allow sharks to better survive long breaks between feasts.
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Are we really addicted to technology?

Fear that new technologies are addictive isn't a modern phenomenon.

Credit: Rodion Kutsaev via Unsplash
Technology & Innovation

This article was originally published on our sister site, Freethink, which has partnered with the Build for Tomorrow podcast to go inside new episodes each month. Subscribe here to learn more about the crazy, curious things from history that shaped us, and how we can shape the future.

In many ways, technology has made our lives better. Through smartphones, apps, and social media platforms we can now work more efficiently and connect in ways that would have been unimaginable just decades ago.

But as we've grown to rely on technology for a lot of our professional and personal needs, most of us are asking tough questions about the role technology plays in our own lives. Are we becoming too dependent on technology to the point that it's actually harming us?

In the latest episode of Build for Tomorrow, host and Entrepreneur Editor-in-Chief Jason Feifer takes on the thorny question: is technology addictive?

Popularizing medical language

What makes something addictive rather than just engaging? It's a meaningful distinction because if technology is addictive, the next question could be: are the creators of popular digital technologies, like smartphones and social media apps, intentionally creating things that are addictive? If so, should they be held responsible?

To answer those questions, we've first got to agree on a definition of "addiction." As it turns out, that's not quite as easy as it sounds.

If we don't have a good definition of what we're talking about, then we can't properly help people.

LIAM SATCHELL UNIVERSITY OF WINCHESTER

"Over the past few decades, a lot of effort has gone into destigmatizing conversations about mental health, which of course is a very good thing," Feifer explains. It also means that medical language has entered into our vernacular —we're now more comfortable using clinical words outside of a specific diagnosis.

"We've all got that one friend who says, 'Oh, I'm a little bit OCD' or that friend who says, 'Oh, this is my big PTSD moment,'" Liam Satchell, a lecturer in psychology at the University of Winchester and guest on the podcast, says. He's concerned about how the word "addiction" gets tossed around by people with no background in mental health. An increased concern surrounding "tech addiction" isn't actually being driven by concern among psychiatric professionals, he says.

"These sorts of concerns about things like internet use or social media use haven't come from the psychiatric community as much," Satchell says. "They've come from people who are interested in technology first."

The casual use of medical language can lead to confusion about what is actually a mental health concern. We need a reliable standard for recognizing, discussing, and ultimately treating psychological conditions.

"If we don't have a good definition of what we're talking about, then we can't properly help people," Satchell says. That's why, according to Satchell, the psychiatric definition of addiction being based around experiencing distress or significant family, social, or occupational disruption needs to be included in any definition of addiction we may use.

Too much reading causes... heat rashes?

But as Feifer points out in his podcast, both popularizing medical language and the fear that new technologies are addictive aren't totally modern phenomena.

Take, for instance, the concept of "reading mania."

In the 18th Century, an author named J. G. Heinzmann claimed that people who read too many novels could experience something called "reading mania." This condition, Heinzmann explained, could cause many symptoms, including: "weakening of the eyes, heat rashes, gout, arthritis, hemorrhoids, asthma, apoplexy, pulmonary disease, indigestion, blocking of the bowels, nervous disorder, migraines, epilepsy, hypochondria, and melancholy."

"That is all very specific! But really, even the term 'reading mania' is medical," Feifer says.

"Manic episodes are not a joke, folks. But this didn't stop people a century later from applying the same term to wristwatches."

Indeed, an 1889 piece in the Newcastle Weekly Courant declared: "The watch mania, as it is called, is certainly excessive; indeed it becomes rabid."

Similar concerns have echoed throughout history about the radio, telephone, TV, and video games.

"It may sound comical in our modern context, but back then, when those new technologies were the latest distraction, they were probably really engaging. People spent too much time doing them," Feifer says. "And what can we say about that now, having seen it play out over and over and over again? We can say it's common. It's a common behavior. Doesn't mean it's the healthiest one. It's just not a medical problem."

Few today would argue that novels are in-and-of-themselves addictive — regardless of how voraciously you may have consumed your last favorite novel. So, what happened? Were these things ever addictive — and if not, what was happening in these moments of concern?

People are complicated, our relationship with new technology is complicated, and addiction is complicated — and our efforts to simplify very complex things, and make generalizations across broad portions of the population, can lead to real harm.

JASON FEIFER HOST OF BUILD FOR TOMORROW

There's a risk of pathologizing normal behavior, says Joel Billieux, professor of clinical psychology and psychological assessment at the University of Lausanne in Switzerland, and guest on the podcast. He's on a mission to understand how we can suss out what is truly addictive behavior versus what is normal behavior that we're calling addictive.

For Billieux and other professionals, this isn't just a rhetorical game. He uses the example of gaming addiction, which has come under increased scrutiny over the past half-decade. The language used around the subject of gaming addiction will determine how behaviors of potential patients are analyzed — and ultimately what treatment is recommended.

"For a lot of people you can realize that the gaming is actually a coping (mechanism for) social anxiety or trauma or depression," says Billieux.

"Those cases, of course, you will not necessarily target gaming per se. You will target what caused depression. And then as a result, If you succeed, gaming will diminish."

In some instances, a person might legitimately be addicted to gaming or technology, and require the corresponding treatment — but that treatment might be the wrong answer for another person.

"None of this is to discount that for some people, technology is a factor in a mental health problem," says Feifer.

"I am also not discounting that individual people can use technology such as smartphones or social media to a degree where it has a genuine negative impact on their lives. But the point here to understand is that people are complicated, our relationship with new technology is complicated, and addiction is complicated — and our efforts to simplify very complex things, and make generalizations across broad portions of the population, can lead to real harm."

Behavioral addiction is a notoriously complex thing for professionals to diagnose — even more so since the latest edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), the book professionals use to classify mental disorders, introduced a new idea about addiction in 2013.

"The DSM-5 grouped substance addiction with gambling addiction — this is the first time that substance addiction was directly categorized with any kind of behavioral addiction," Feifer says.

"And then, the DSM-5 went a tiny bit further — and proposed that other potentially addictive behaviors require further study."

This might not sound like that big of a deal to laypeople, but its effect was massive in medicine.

"Researchers started launching studies — not to see if a behavior like social media use can be addictive, but rather, to start with the assumption that social media use is addictive, and then to see how many people have the addiction," says Feifer.

Learned helplessness

The assumption that a lot of us are addicted to technology may itself be harming us by undermining our autonomy and belief that we have agency to create change in our own lives. That's what Nir Eyal, author of the books Hooked and Indistractable, calls 'learned helplessness.'

"The price of living in a world with so many good things in it is that sometimes we have to learn these new skills, these new behaviors to moderate our use," Eyal says. "One surefire way to not do anything is to believe you are powerless. That's what learned helplessness is all about."

So if it's not an addiction that most of us are experiencing when we check our phones 90 times a day or are wondering about what our followers are saying on Twitter — then what is it?

"A choice, a willful choice, and perhaps some people would not agree or would criticize your choices. But I think we cannot consider that as something that is pathological in the clinical sense," says Billieux.

Of course, for some people technology can be addictive.

"If something is genuinely interfering with your social or occupational life, and you have no ability to control it, then please seek help," says Feifer.

But for the vast majority of people, thinking about our use of technology as a choice — albeit not always a healthy one — can be the first step to overcoming unwanted habits.

For more, be sure to check out the Build for Tomorrow episode here.

Why the U.S. and Belgium are culture buddies

The Inglehart-Welzel World Cultural map replaces geographic accuracy with closeness in terms of values.

According to the latest version of the Inglehart-Welzel World Cultural Map, Belgium and the United States are now each other's closest neighbors in terms of cultural values.

Credit: World Values Survey, public domain.
Strange Maps
  • This map replaces geography with another type of closeness: cultural values.
  • Although the groups it depicts have familiar names, their shapes are not.
  • The map makes for strange bedfellows: Brazil next to South Africa and Belgium neighboring the U.S.
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