Last year, the Supreme Court ruled in Dobbs v. Jackson Women's Health Organization conferred that abortion is not a constitutional right. The Dobbs case effectively reversed Roe v. Wade, which meant that the question of abortion's legality has since been determined by the states. The anti-abortion side thought of it as a win for fetuses everywhere and an affirmation of life over death. The pro-abortion side lamented because they viewed it as an essential part of reproductive health being eroded. Regardless of which side of the abortion debate you are on, it seemed that this court case would have resulted in fewer abortions.
It makes economic sense that there would be fewer abortions. When you legalize something, you get more of it. When you ban something, you get less of it. In states where abortions have been limited or altogether illegal, it becomes harder to procure an abortion. Roe was lax abortion law to begin with, so it makes sense that Dobbs would definitionally be more restrictive. In May 2022, I wrote a piece about a month before the Dobbs ruling about what would happen if Roe were reversed. I highlighted some abortion projections in the event of a Roe reversal, which predicted fewer abortions. I then walked through the intuition of why the number of abortions would go down, but more modestly than many on the pro-abortion side thought. My reasons ranged from the inelastic demand for abortion services to such workarounds as traveling to another state or the increased prevalence of abortion pills.
Regardless of the magnitude, I was expecting that the number of abortions would have decreased in a post-Roe America. In spite of best predictions, the unpredictable happened since Dobbs became law: the number of abortions increased. Last Thursday, the pro-abortion Guttmacher Institute released a new dashboard showing monthly abortion data. In the dashboard, it shows that the number of abortions in the first half of 2020 were 465,000. For the first half of 2023, that figure was 511,000. What that means is that 46,000 abortions were performed in the first half of 2023 than in the first half of 2020.
Given the economics of bans, this finding is perplexing at first glance. An economic ban restricts supply, which means fewer goods or services. Punishments for violating a ban deter some, whereas others are deterred by the cost and/or travel to another state where abortion services are legal. Especially since abortion rates were declining (see Pew chart below) in large part due to contraceptive availability, it makes me all the more curious about this uptick in abortion services.
That is the catch with counterintuitive realities. I am fond of saying that something is only counterintuitive because we do not understand it. By digging deeper, we can make sense of the paradox that lays before us. Once the logic and understanding is laid out, it ceases to be counterintuitive. Here are a few theories as to why there was such a difference between 2020 and 2023:
1. COVID lockdowns. This one seems plausible. Shutting down large swathes of the economy resulted in lower consumer spending and lower GDP. If people were cautious to meet up in person, it would stand to reason that this would apply to women seeking abortion providers. However, if we look at the CDC's most recent Abortion Surveillance report (Table 1), we see that abortion services only decreased from 629,898 in 2019 to 620,327 abortions in 2020. It is technically a decrease. However, its lack of statistical significance suggests that lockdowns are likely not the major culprit.
2. Increased abortion clinics in border states. In response to Dobbs, states with legal abortion opened 16 new abortion clinics. Much of these clinics came into being to absorb patients traveling from states where abortion is illegal. This does not create additional demand nearly as much as it acts an imperfect substitute. Why imperfect? Because there are some women in states where abortion is banned who cannot travel far enough to have the procedure. While there are some women who live in the state where is legal and would have an abortion because there is a closer clinic, it is doubtful that it would cause that much of a shift. Plus, the Guttmacher data show that some of the largest increases come from two non-border states: California and New York.
3. Telehealth and the FDA. In December 2021, the Food and Drug Administration (FDA) allowed for abortion medication to be prescribed via telemedicine. By removing this barrier, the FDA made it easier to access abortion medication, especially for those who lived far away from an abortion clinic or a doctor's office. I was unable to procure market data for abortion pills, but it makes sense that removing such a restriction would increase supply, which would increase the quantity of [chemical] abortions performed. Conversely, this NPR report illustrates some of the legal grey areas that can hinder some of that increase in access.
4. Are more people having sex or getting pregnant? An abortion is not something you can buy en masse and stockpile in your house. It's not even a service you can use frequently, such as Uber, getting a massage, or going for a mani/pedi. You cannot have an abortion if you're simply feeling in the mood. You cannot go up to a cashier and order 20 abortions for yourself in a single day. It does not work like that.
An abortion is a procedure is in response to pregnancy. Pregnancy only happens to women of a certain age who have their eggs fertilized by sperm. It is not something that happens often in life. Most women who get an abortion are having their first abortion (Pew), which indicates how rare of a procedure it is. Abortion is something that cannot be done by anybody. It is something a certain group of people can do under specific circumstances.
That is why I have to ask if more people are engaging in the act that results in pregnancy. Contraception usage among women has remained steady between 2017 (CDC) and 2022 (KFF). If it declined, I could see how that would cause an uptick in pregnancies, and by extension, abortions. If it were demand-based, you would think that it is because more women are getting pregnant.
At least for teens, the HHS data show that teen pregnancy has been on the decline. What is interesting is that since 2008, there has been a rising rate of those under 35 who have not had sex in the past year (Institute of Family Studies).
5. Is it because fewer people want children? It is true that fewer people want to have children. However, the United States has had a declining birth rate since before Roe v. Wade became law (World Bank). Especially since fewer people are having sex, there would need to be a drastic shift to justify a huge shift in abortion over such a short period of time.
Conclusion: Such demand-drivers as sexual activity, desire to have children, or contraceptive usage do not seem to be driving abortion services. The border state theory seems to be minimal at best. Lockdowns did not play a big role since the numbers did not greatly vary from before the pandemic.
If any of the theories make sense, it is the increased prevalence in chemical abortions. The percent of abortions induced by medicine have increased since mifepristone and misoprostol were approved by the FDA in 2001. By 2020, a majority of abortions were reported to be medication-based (see Guttmacher data below). The FDA approving this medication being prescribed in telehealth services served to accelerate the supply of abortion goods and services, thereby increasing the quantity of abortions performed.
This acts as a reminder that markets are not static and based on one determinant, but rather dynamic systems. There are many moving parts in a given market or in the economy as a whole. That is another discussion for another time about economics. But here is another economic argument to consider. Regardless of whether a ban on abortion exists, there is a demand for abortion services. As I mentioned when writing about a ban on TikTok and a menthol cigarette ban, bans can be circumvented and it is often not easy putting the kibosh on something like abortion. For the anti-abortion/pro-life side, this means that there is a lot more work to be done. For the pro-abortion/pro-choice side, providing abortion services is more complicated, but you should feel some solace knowing that abortion is not going anywhere. If one thing is clear, it is that the abortion debate in this country is far from over.
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