هزینه سقط جنین، رفتار جنسی و نرخ بارداری

This paper empirically examines the question: Do the direct (price) and indirect (restrictive abortion laws) costs of obtaining an abortion have an impact on the likelihood of women becoming pregnant? Using the economic model of fertility control, the empirical results find that increases in the real price of obtaining an abortion cause a statistically and numerically significant decrease in the pregnancy rate of all women of childbearing age (15–44 years) and teens (ages 15–19). A state parental involvement law is also found to decrease the pregnancy rate of all women of childbearing age and an even numerically larger decrease for teens. A state Medicaid funding restriction of abortion, waiting period law, and mandatory counseling law do not have a statistically significant impact on the pregnancy rate of either group. Taken together the empirical results are consistent with the hypothesis that women's sexual behavior is influenced by the direct and indirect cost of obtaining an abortion.

The USA Supreme Court's 1973 Roe v. Wade decision held that, prior to fetal viability, a woman has a constitutional right to obtain an abortion. What is noteworthy about the Roe v. Wade decision is that while it established a woman's right to have an abortion, the decision did not mandate a woman's unrestricted access to an abortion. In the ensuing years after the Roe v. Wade decision other Supreme Court rulings gave states the discretion to restrict a woman's access to an abortion provided that the restriction did not constitute a substantial obstacle. Many states did, in fact, enact various restrictive abortion laws resulting in substantial interstate differences in a woman's ability to obtain an abortion. There are four types of restrictive abortion laws that have been adopted by states and ruled to be constitutional by the U.S. Supreme Court. In 1976, the U.S. Congress passed what has become known as the Hyde amendment, that prohibited the federal Medicaid government program, which provides health insurance to the poor, from using federal funds to pay for abortions. Abortion funding for low-income women was left to the discretion of each individual state. Many states voted to ban the use of their public funds to pay for Medicaid abortions for indigent women. Parental involvement laws require a parent be notified or give permission before an unmarried minor may obtain an abortion. A parental involvement law is permitted provided a state has a judicial bypass provision that allows the unmarried minor to petition a judge for permission to obtain an abortion. Since 1992, some states have enacted and enforced mandatory waiting period laws. Waiting period laws require that all women seeking an abortion must wait a specified time period (usually 24–48 h) before the procedure can be performed. Many states also require that a woman receive mandatory counseling before the abortion. Mandatory counseling laws require that a woman receive (and in some cases pay for) state mandated informational material about the abortion procedure. Typically the material includes information about health risks, fetal development, adoption agencies, and the availability of financial assistance. All four state restrictive abortion laws increase the effective total cost (the direct and indirect costs) to a woman of obtaining an abortion. The direct cost to a woman of obtaining an abortion is the price of the abortion procedure. The indirect costs of restrictive abortion laws are the financial costs (e.g., lost work time, more visits to a provider, travel expenses) and emotional costs (e.g., guilt, shame, regret) incurred by a woman in complying with a restrictive abortion law. Restrictive state abortion laws make it more difficult and costly for a woman to obtain an abortion. The interstate variations in restrictive abortion policies provide researchers the opportunity to address the question of what effect the direct and indirect costs of an abortion have on the pregnancy resolution decision. Most researchers have used the economic model of fertility control developed by Becker (1960) and extended by Michael (1973) that emphasizes the decision-making process in which a pregnant woman compares the costs and the benefits of having a child in making the pregnancy resolution decision. In general, the literature has found empirical support for various basic economic hypotheses: abortion follows the fundamental law of demand, is a normal good (increases) with respect to income, and the greater the opportunity cost of a woman having a child the greater the abortion demand (Medoff, 1988 and Medoff, 1998). An equally important, though largely unexamined public and social policy question is: Do the direct and indirect costs of an abortion affect women's risky sexual behavior? Do higher abortion costs affect women's decisions about their frequency of sexual contact and/or contraceptive use? Studies that use individual-level survey data on sexual activity to examine this question suffer from several methodological shortcomings. First, self-reported survey data on sexual activity is notoriously unreliable. Considerable measurement error exists in the responses to a sex survey due to untruthful, incorrect, exaggerated, and unreliable answers to intimate questions about a personal and private area of one's life. Second, typically survey data contains very little information about an individual's personal characteristics, particularly economic information. Third, most sex surveys only ask respondents if they were, or were not, sexually active and ignore the frequency and regularity of sexual activity. Another way to address the question of whether abortion costs affect women's risky sexual behavior is to examine state pregnancy rates. If abortion costs alter women's decisions to engage in less risky sexual behavior (i.e., less frequent sexual activity and/or more frequent contraceptive use) this should result in a reduction in the likelihood of women becoming pregnant. In other words, since the likelihood of becoming pregnant is highly correlated with risky (unprotected) sexual activity, pregnancy rates represent an excellent proxy for risky sexual activity. While there is considerable research on whether abortion costs affect the demand for abortion, researchers have only just begun to formally address the question of whether abortion costs affect the likelihood of women becoming pregnant. One of the reasons few studies have examined pregnancy rates directly has to do with the method used to calculate a state's pregnancy rate. A state's pregnancy rate is derived by adding the number of abortions performed in the state plus the number of live births. State abortion data is available from two different sources: the Centers for Disease Control (CDC) or the Alan Guttmacher Institute (AGI). The CDC publishes state abortion figures on an annual basis based upon information supplied by state public health departments. The CDC acknowledges that its state abortion figures are incomplete and underreported. Not all states provide abortion figures to the CDC every year. Not all abortion providers within a state report figures to their state public health agencies every year. In addition, the CDC abortion figures are only reported by the state in which the abortion was performed (state of occurrence) rather than by state of residence. An occurrence-based state abortion figure ignores interstate travel by women to obtain an abortion. This distinction is particularly important because restrictive abortion laws may induce women (especially minors) to seek abortions in nearby states without such restrictive laws. The use of occurrence-based state abortion rates to compute a pregnancy rate will create an upward bias (a larger impact than actually exists) in the estimated impact of restrictive abortion laws on pregnancy rates because abortion rates are underestimated in those states with restrictive laws and overestimated in contiguous states without such laws. The Alan Guttmacher Institute is generally acknowledged (even by the CDC) to collect more accurate and comprehensive state abortion data because their figures are based on information provided directly by abortion providers rather than indirectly from information collected by state public health agencies. The AGI uses a consistent collection methodology, but it does not collect state abortion data every year. The AGI does report abortion rates by state of residence, but only on an even more limited basis. This paper empirically addresses the question of whether the direct (price) and indirect (restrictive abortion laws) costs of abortion affect the pregnancy rates (by state of residence), using cross-section state data pooled over the years 1982, 1992, and 2000. This study complements and extends previous research in a number of significant ways. The years 1982, 1992, and 2000 are chosen for analysis because these three sample years are the only years in which the AGI reports both the number of abortions by state of residence (used in the calculation of pregnancy rates) and the cost of obtaining an abortion. The use of state data is the appropriate unit of analysis because it is the heterogeneity of state restrictive abortion laws that change the effective cost of obtaining an abortion and concomitantly may alter women's behavior regarding sexual activity and contraception that affect the likelihood of a pregnancy. The advantage of using pooled cross-section time-series data is that, by increasing the number of observations, it improves the statistical efficiency of the estimation. These three sample years also provide the opportunity to use census data to measure only the socioeconomic characteristics of women of childbearing age. Many of the previous studies, because of the unavailability of data, were forced to omit or use inadequate proxies for many relevant economic variables. In addition, using state-level data over the period 1982–2000 makes it possible to examine a wider array of restrictive abortion laws (particularly more recent changes in restrictive laws since 1992) and is sufficiently long enough to detect causal changes in women's sexual behavior as a result of changes in state restrictive abortion laws. The most significant and important difference between this paper and prior research is that this study explicitly includes the price (direct cost) of an abortion in its estimation. Virtually all prior research on the impact of restrictive abortion laws on the incidence of abortions or births do not include the price of an abortion in a state in their estimation. This is because the price of an abortion is not available on a year-to-year basis between the two sample periods 1982–1992 and 1992–2000. The three sample years 1982, 1992, and 2000 used in this paper are the only years that the AGI collects the price of obtaining an abortion in each state. Past research, by not including the abortion price in their estimation of the impact of restrictive abortion laws on a variety of health outcomes, implicitly assumes that an increase in abortion demand will not affect the abortion price. This is clearly a methodologically flawed assumption, as pointed out by Levine (2004, p. 144) since “[abortion] prices are determined by the behavior of those who supply abortion services and those who demand them.” The failure to control for the abortion price may overstate the estimated impact of restrictive abortion laws because restrictive abortion laws increase not only the indirect costs (financial and emotional costs incurred by a woman complying with the law) of obtaining an abortion, but they also increase the direct cost (price) of providing an abortion. As noted by Althaus and Henshaw (1994), there are additional operating costs imposed upon an abortion provider in order to comply with the various restrictive abortion laws. These additional operating expenditures increase the cost of providing abortion services resulting in a higher abortion price. State differences in abortion prices reflect, in part, differences in state restrictive abortion laws (i.e., state abortion prices and state restrictive abortion laws are correlated). The exclusion of a state's abortion price in an estimation means that the impact of restrictive abortion laws are overstated because they include some of the effects of the omitted abortion price. Inclusion of the abortion price is not only a necessary condition to obtain an unbiased estimate of the effect of restrictive abortion laws, but the empirical impact of the abortion price, by itself, is of interest to researchers.

This paper uses the economic model of fertility control to empirically examine if the direct (price) and indirect (restrictive abortion laws) costs of an abortion have an impact on women's sexual behavior. The results reported in this paper provide empirical support for this contention. Increases in the real price of an abortion cause a statistically and numerically significant decline in the pregnancy rate of all women of childbearing age and teens (ages 15–19). Similarly, a parental involvement law induces a decline in the pregnancy rate of all women of childbearing age and an even numerically larger decrease in the teen pregnancy rate. A state Medicaid restriction on abortion funding, waiting period law, and mandatory counseling law are found not to have a statistically significant impact on either the pregnancy rate of all women of childbearing age or teens. Taken together the empirical results support the hypothesis that women's sexual behavior is influenced by the direct cost of obtaining an abortion and to a lesser extent the indirect costs of obtaining an abortion either by reducing the frequency of sexual activity and/or increasing the use of effective contraception.