The hidden costs of abortion restrictions

It has been nearly a year since the Supreme Court’s controversial passage of Dobbs v. Jackson (2022), overturning the constitutional right to an abortion in the United States. While abortion has been a highly contested and polarizing issue for decades, the changes implemented since this ruling have ignited fierce debate nationwide, given the dynamic landscape of state policies that restrict access. Many are worried about the consequences of these policy changes — the effects will not be fully measurable for years to come. However, there are econometric methods that, in conjunction with real-world data, allow researchers to study the potential implications of these policy changes without waiting for the consequences.

Generally, in medical research, when we want to determine the benefits or consequences of a given treatment, patients are randomly placed into either treatment or control groups in a randomized controlled trial. This gold-standard method for drawing scientific conclusions isn’t possible in abortion access research; it would be entirely unethical to randomize patients to receive abortion care, and the impact of abortion on physical, mental and financial consequences would take decades to fully realize.

However, we can still study the impact of abortion restrictions using rigorous econometric methods with real, historical data. Targeted Regulation of Abortion Providers (TRAP) laws have been in effect in many states for decades, specifically to circumvent the protections of freedom of choice afforded by Roe v. Wade (1973). Such laws impose unnecessary and burdensome requirements on abortion providers, including building laws that regulate clinics as ambulatory surgical centers (even for clinics only providing medication abortion) or requiring providers to have admitting privileges at a local hospital. These TRAP laws are often impossible or cost-prohibitive to abide by, and can result in many clinics shutting down or relocating entirely. From 2011 to 2016, states enacted 334 abortion restrictions, accounting for 30 percent of all abortion restrictions passed since abortion legalization in 1973.

Because states historically implemented TRAP laws to circumvent Roe vs. Wade, researchers can, and have, used these laws to quantify the impacts of restricted abortion access. The findings are clear: there are significant physical, mental, financial and equity consequences of restricting abortion access.

Specifically, the implementation of TRAP laws is associated with increased maternal morbidity in labor and an increased incidence of self-induced abortions, which are often unsafe and can result in serious physical harm. Moreover, these laws can result in higher out-of-pocket expenses and travel costs for abortion seekers, which make accessing care even more difficult for low-income individuals. Further, lack of access to abortion is associated with greater financial instability, reduced credit access and higher rates of receiving public assistance.

Though 25 percent of women in the United States will have an abortion by the end of their child-bearing years, individuals seeking an abortion are most commonly from already minoritized groups: recent data has found that 46 percent of women seeking an abortion were never married, 62 percent were a racial minority, and 49 percent were below the federal poverty line. Thus, restricted access to abortion has financial consequences for already marginalized groups. These economic burdens also resonate in the economy through the intergenerational transmission of poverty and inequality, more reliance on public assistance, increased healthcare costs and decreased productivity.

One common argument against access to abortion is the potential adverse mental health impacts on individuals who receive abortions. However, the data does not bear this out. In fact, it shows reduced access to abortion can lead to adverse mental health outcomes, including increased anxiety and depression. In a recent study, 95 percent of individuals who received an abortion said, five years later, that it had been the right choice for them. In addition, women who received an abortion were more likely to become pregnant intentionally in the next five years. Those who already had children at home were less likely to live in poverty, relative to individuals denied abortions.

While access to safe and legal abortion has been a contentious issue for decades, the medical and economic literature have concluded that the benefits far outweigh the costs.

It is critical to recognize the importance of safe and legal abortion as a fundamental human right. From real, historical data, we can see that denying access to abortion services not only violates bodily autonomy but also perpetuates systemic inequalities and injustices. We cannot continue to restrict or deny access to abortion services. It is time to learn from the past and take action for reproductive justice by demanding the protection of safe and legal abortion.

Ashley L. O’Donoghue, Ph.D., is an economist at the Center for Healthcare Delivery Science at Beth Israel Deaconess Medical Center, and an instructor of medicine at Harvard Medical School. She is an applied microeconomist with a focus on health economics. (Twitter @shley_odonoghue)

Savannah Adkins, Ph.D., is a lecturer in the Department of Economics at Bentley University. She is an applied microeconomist with a focus on gender economics. (Twitter @AdkinsSavy)