Abortion Restrictions and Abortion Rates: Has State Abortion Policy Been

Successful?

Maureen Rand OaMey Mount St. Mary> College

This stucj, tests the hypothesis that state abortion rates are influenced by state restrictions on abortion. Earlier studies have shown mired results. 1 deveIop a model of aborrion rates for the time periodj-om 1988 through 1996 and hypothesize that the adoption of abortion restrictions requiring parental involvement for minors, abortion-specijk informed consent, and waiting periods prior to the procedure lead to lower state abortion rates. I further hypothesize that individual four-year models of the period before and afier the Casey (1992) decision will demonstrate that this effect was strongest in the time period afier the Casey decision. Analysis of the data confirms the first hypothesis that restrictions have a significant impact on abortion rates while controlling for other factors that influence the abortion rate. The second hypothesis is not confirmed, as the eflect is signifcant prior to the Casey decision.

T h i s study seeks to further the knowledge of policymakers and practitioners on the impact of state abortion restrictions on state abortion rates. In the wake of the Webster v. Reproductive Health Services '( 1989) and Planned Parenthood v. Casey ( 1992) Supreme Court decisions allowing increased state regulation of abortion, some states adopted new restrictions and also began to enforce those already on the books. Moreover, anti-abortion groups engaged in a coordinated lobbying effort in the states to pass restrictions on abortion. Even in states where pro-choice opinion is fairly strong, anti- abortion groups often found public support for some restrictions on abortion, especially those requiring parental involvement in a minor's abortion decisions.

Some of the most widely adopted policies have been informed consent requirements mandating abortion-specific state-determined information and counseling; parental involvement requirements; and waiting periods prior to obtaining an abortion, usually 24 hours. During the 1990s, national abortion rates dropped (Henshaw 1998). Many anti-abortion groups have declared victory in the battle to reduce the number of abortions that occur; however, academic studies on both national and state policy have yielded mixed results

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Abortion Restrictions 473

(Hansen 1993; Wetstein 1995; Meier et al. 1996; Mete 2000). This study explores the relationship between abortion regulations and abortion rates at the state level for the years 1988-96. Studies by Susan Hansen (1993) and Kenneth Meier and others (1996) found no relationship between restrictions and abortion rates, while Marshall Medoff (1 988) and Mihriye Mete (2000) have found such a relationship. Because the studies cover different time periods, it is unclear whether the differing results indicate that a change has occurred over time in the relationship between state restrictions and abortion rates. This study seeks to develop a model that will clarify the relationship over time and in relationship to the changing national legal landscape in which the states have made abortion policy.

Abortion policy continues to be an important area for study. While the abortion rate in the United States decreased from 26 per 1,000 women aged 15-44 in 1992 to 23 per 1,000 women in 1996, abortion continued to account for 26 percent of all pregnancy outcomes in 1996. Moreover, 1.37 million abortions were performed nationally in 1996. Furthermore, in the years following the Webster (1 989) and Cmey (1 992) decisions, the state legislatures have become the major arena for abortion policymaking; thus, it is crucial for public policy scholars to gain an understanding ofthe effects of state abortion policy on abortion rates (Halva-Neubauer 1993; Meier et al. 1996).

The Legal and Political Context of State Abortion Policymaking

It has been suggested by Malcom Goggin ( 1993) that a new era of abortion politics began in 1989 with the United States Supreme Court decision in Webster v. Reproductive Health Services and the 1990 decision in Hodgson v. Minnesota. Prior to the Webster ( 1 989) decision, states were prohibited from passing many kinds of restrictions on abortion in the first trimester. In Webster, the Court indicated that it would be receptive to such restrictions. In Hodgson (1990), the Court upheld a Minnesota law requiring teenagers seeking an abortion to obtain the consent of both parents as long as a bypass option was included. Prior to this, the Court had upheld laws requiring the notification or consent of one parent with a judicial bypass option. This new direction on the Court continued with the Planned Parenthood of Southeastern Pennsylvania v. Casey decision in 1992 in which the Court further paved the way for restrictions in upholding most ofthe provisions of a very restrictive Pennsylvania statute. The Court again upheld parental consent provisions and also upheld elaborate informed consent provisions and waiting period restrictions which it had struck down in the past under the trimester

_ _ _ _ _ _ _ _ _ _ _ _ ~ ~ ~~

474 Politics 6 Policy Vol.31 No.3

framework set out in 1973 in Roe v. Wude (McFarlane and Meier 200 1 ). The only restriction not upheld by the Court in the Cusey (1992) decision was spousal consent (Men, Jackson, and Klerman 1995). The case is also important because three justices in ajoint opinion used the new "undue burden" standard, explicitly renouncing the trimester framework laid out in Roe v. Wade.

Important political developments took place following the Webster ( 1989) and Cmey (1992) decisions as well. Goggin (1993) points out that in addition to the conservative shift on the Supreme Court, an increase in opposition to abortion occurred, along with an increase in state legislative action on abortion and an increase in lobbying and protest activities by members of anti-abortion groups. In the first few months alone following the Webster (1989) decision, nearly 40 bills regulating abortion were introduced in state legislatures (Goggin 1993). Goggin also provides evidence that anti-abortion groups stepped up their efforts to influence abortion policy in the states following the Webster (1 989) decision and relates that in 1992 militant groups like Operation Rescue escalated the level of abortion clinic violence (Goggin and Wlezein 1993; Goggin 1993).

While many articles regarding the effect of abortion restrictions on access to abortion were published in the period just following Webstec Hodgson, and Cmey, the subject has received less attention in recent years. Although the Court has not handed down any major decisions dealing directly with abortion restrictions since 1992, the time is ripe for assessing the impact of abortion restrictions on abortion rates in the two eras of abortion politics. Numerous articles during the 1990s mentioned the Webster and Cusey decisions, the expectation that they will lead states to pass more restrictions, and the thought that it would take time before the situation could be assessed more fully (Hansen 1993; Goggin 1993; Halva-Neubauer 1993; Meier et al. 1996). Some speculated that with an increase in restrictions, an impact on abortion rates may emerge (Hansen 1993; Meier et al. 1996). This study seeks to revisit that question now that sufficient time has passed for an assessment to be made.

Glen Halva-Neubauer (1993) has argued for the importance of national policy such as Supreme Court decisions on state policy. It appears that states responded to the 1989 Webster decision and the 1992 Casey decision by passing more abortion restrictions. For example, 15 states were enforcing parental involvement laws in 1991, while 30 states were doing so in 1999. While the Court had permitted parental involvement laws, the 1989 and 1992 Supreme Court decisions further demonstrated to the states that the Court

Abortion Restrictions 475

would uphold abortion regulations. The decisions also clarified which types of regulations would be upheld. Perhaps this gave states confidence that they would not be spending time and money facing court challenges if they adopted a restriction, or at least that they could have confidence that the regulations would be upheld if challenged. In the case of mandatory waiting periods, only two states had restrictions prior to the Cusey decision. In 1999, seven years after the decision upheld a mandatory waiting requirement explicitly for the first time, 19 states had adopted waiting periods and 14 states were enforcing this regulation. An additional regulation that states are adopting with more fiequency is one requiring abortion-specific, state-directed informed consent. The Court struck down elaborate informed consent rules in 1983 and again in 1986. The Cusey decision in 1992 was the first to uphold elaborate informed consent regulations similar to those struck down previously. Twenty states had adopted this policy by 1999 (McFarlane and Meier 2001). These facts suggest that Supreme Court decisions appeared to influence state policymaking. Mete (2000) has also demonstrated empirically that states did pass more regulations in response to national policy.

A Model of Abortion Determinants

The purpose of this study is to determine whether or not state restrictions requiring parental involvement, informed consent, and waiting periods have in fact reduced the number of abortions performed. The periods prior to and after the Cmey decision will be compared to determine whether this relationship has changed and may contribute to some of the conflicting findings in the research. The year of the Casey decision, 1992, has been chosen as the cutoff year for comparison because Casey specifically upheld the three restrictions that have been so popular with states in the 1990s: parental involvement, informed consent, and waiting periods. Additionally, the Court upheld the first two restrictions for the first time in 1992.

While, many anti-abortion groups have pointed to dropping national abortion rates as a sign of the effectiveness of state restrictions, scholarly studies of this relationship have shown mixed results (Meier et al. 1996; Medoff 1997; Mete 2000). The difficulty in making this determination is that states in which less demand for abortion occurs will have an easier time passing restrictions (Meier et al. 1996). Cross-sectional models and models that do not account for all other factors associated with abortion rates run the risk of showing that abortion restrictions lead to lower abortion rates when the reverse is in fact the case: states with lower abortion rates may adopt restrictions.

476 Politics 6 Policy Vol.31 No. 3

Unlike previous models of the relationship between abortion regulations and state abortion rates, I develop two models-ne of the pre-Casey years and one of the post-Cmey years-in order to determine whether or not a change occurs in the effect of abortion regulations after the Casey decision. Many previous studies looked at either a cross-section in time or the time period prior to the Casey decision. Some of these studies found no effect on abortion rates for the single year or time period studied (Hansen 1980; Meier et al. 1996). However, other studies have found a relationship between abortion rates and abortion restrictions, including Medicaid funding restrictions (Medoff 1988; Gohmann and Ohsfeldt 1993; Meier and McFarlane 1993; Blank 1996). Restrictions have also been found to reduce the number of available providers, which in turn has been found to lower abortion rates (Gohmann and Ohsfeldt 1993). The Mete (2000) study did find effects of abortion restrictions on abortion rates in the time period from 1986-96. The study looked at five major restrictions: counseling bans, abortion-specific informed consent, waiting periods, parental involvement, and public funding. The study by Meier and others (1 996), on the other hand, took a broader approach and looked at 23 restrictions including feticide and fetal disposal laws that do not directly restrict access to abortion. Another difference between the Meier and others’ (1 996) study and Mete’s (2000) study is that Mete controlled for a range of factors individually that influenced both the supply and demand of abortion, while the Meier study included only some of these factors in addition to the lagged abortion rate to account for other past differences in abortion rates. The authors explain that this ensures that factors that explain overall state abortion rates are controlled so that the model is only accounting for the change in abortion rates (Meier et al. 1996). However, they control individually for some ofthese factors, such as the black population, urban population, and abortion providers.

The Mete (2000) study found that the number of restrictions adopted by states have increased in response to Supreme Court decisions, yet does not address the question of whether the effects of restrictions found on abortion rates becomes significant only after the Casey decision. A direct comparison of the two time periods may help shed some light on why previous studies have shown no effects, while Mete’s study finds effects of abortion restrictions on state abortion rates. This study seeks to build on Mete’s (2000) findings and further explore the relationship of abortion restrictions and state abortion rates and possible changes in this relationship over time.

I hypothesize that the effects of the restrictions will be greatest in the post-Casey model as the more restrictive environment in the states raises the

Abortion Restrictions 477

cost of abortion that may lead to a drop in abortion demand. A study has not been done that compares the pre- and post-Casey periods to determine whether this national policy set by the Supreme Court has had an influence on the relationship between abortion regulations and abortion rates. While national abortion rates have been dropping, state abortion rates vary a great deal; therefore, this study filis a gap in the research and will help researchers gain a better understanding of the effects of national policy on state abortion rates.

Abortion Rates The dependent variable is the state abortion provider rate per 1,000

women aged 15144 as reported by the Allan Guttmacher Institute’s (AGI) abortion provider survey. This data is preferred over the United States Center of Disease Control and Prevention (CDC) data reported in “Abortion Surveillance Summary’’ in Morbidity and Mortality Weekly Report, as the latter has been found to underreport the actual number of abortions performed in a state (Meier et al. 1996; Mete 2000). The source used for the AGI abortion data was the State Politics & Policy Quarterly Data Resource (2002). The AGI Abortion rates for 1995 and 1996 and abortion provider rates are taken from Henshaw (1998).

Abortion Restrictions Abortion restrictions are measured by using a scale ranging from “0” to

“3.” Four major restrictions are covered: restrictions on minors’ access to abortion, which may include parental consent; parental notification or counseling requirements; waiting periods of any duration, usually 24 hours; and abortion-specific informed consent provisions. Data on restrictions were obtained from various years ofthe National Abortion and Reproductive Rights Action League’s (NARAL) annual report on reproductive rights and from Merz, Jackson, and Klerman (1 995). Only laws that were being enforced by the state in the year coded are included in the measure, since many state abortion restrictions have been enjoined by federal courts. The abortion restrictions variable is simply the total number of these policies a state was enforcing in each year between 1988 and 1996.

Control Variables In order to develop an accurate model of the effect of abortion restrictions

on state abortion rates, control variables have been included in the model based on models developed in previous studies of the determinants of state

~ ~ ~~

478 Politics & Policy Vol.31 No.3

abortion rates. The relevant control variables have been confirmed by past research: the abortion provider rate; percentage of female legislators; urban population percentage; black population percentage; the percentage of democrats in the legislature, called democratic legislative strength; female labor force participation rate; and the forcible rape rate (Meier et al. 1996; Mete 2000). Data for the control variables come from various years of the U.S. Bureau of the Census’ Statistical Abstract of the United States, and for available years, data for the blackpopulation, rape rates, female labor force participation rate, and the percentage of female legislators were obtained in electronic format from the State Politics & Policy Quarterly Data Resource (2002).

Several demographic factors have been associated with the demand for abortion in a given state. The urban population is measured as the percentage of the state’s residents who live in urban areas and has been found to be associated with higher rates ofabortion. The black population is measured as the percentage of blacks residing in the state. Previous studies have found that blacks have higher rates of abortion than whites (Meier et al. 1996). Additionally, a higher percentage of females in the workforce has been found to increase the abortion rate in a state. The rationale is that working women have fewer children than women who are in the home as they have less time available to care for them. An additional factor that has been found to raise the demand for abortion is the rape rate. While rape is not a common reason given by individual women for seeking an abortion, it has been found to be directly associated with abortion rates even while controlling for urban population (Luker 1984; Mete 2000). The rape rate is measured by the number of reported forcible rapes per 100,000 population. Two political variables have also been associated with abortion rates: Democratic legislative strength and female legislators. Many Democrats and female legislators are pro-choice. States with high percentages of both are expected to have higher abortion rates. While we would expect these factors to influence abortion policy preferences, it also can be argued that political support for access to abortion in the state will lead to higher abortion rates due to a higher demand for abortion. Since legislators are elected, higher percentages of Democrats and females should reflect a climate of both elite and citizen support for abortion (Mete 2000).

Another important variable has been found to affect the supply of abortion in a state. The number of abortion providers is measured by the number of providers per million persons in a state. Fewer providers have been linked to lower abortion rates (Meier et al. 1996; Mete 2000). Nebraska, Hawaii, and Alaska are omitted from the analysis because data for several control variables

Abortion Restrictions 479

is unavailable. Nebraska has a nonpartisan legislature, so no data is available for the Democratic percentage in the legislature. Also, data for Alaska and Hawaii is not available for many of the independent variables.

Results

The findings are reported in Tables 1,2, and 3. Table 1 shows results for the full model of the time period from 1988-96. Table 2 shows results from the four pre-Casey years only, while Table 3 shows the results solely for the four post-Casey years in the dataset. A generalized least squares (GLS) technique available in the software package STATA 6.0 was used, as ordinary least squares (OLS) models showed problems of heteroscedasticity indicated by a significant Cook and Weisberg test and autoconelation, Rho = .8606. This frequently occurs in pooled time-series data because one dataset includes both data for all states at one cross-section in time as well as data across time for each state. The STATA XTGLS procedure used here is designed for pooled time-series data with complex error structures such as those at issue here.

The Wald statistic for each of the three models indicates that all models are highly significant at the .OOO level (see Tablesl-3). The percentage ofthe population that resides in urban areas is significant at the .OOO level in all three models, with a positive sign as expected. The same is not true for the black population percentage, which does not reach statistical significance. This result is consistent with previous findings in some studies, yet conflicts with the result of others (Mete 2000; Meier et al. 1996). The female labor force participation variable is also not significant in any of the models. This is consistent with Mete’s (2000) findings. An alternative explanation is that perhaps working women are more able to afford to have children; however, no negative relationship is present either, which might be associated with this theory.

In terms of the political variables, the overall model reveals that the percentage of Democrats in the state legislature is positively associated with abortion rates as expected and is significant at the .OOO level (see Table 1). Democrats tend to be pro-choice, and a high percentage in the legislature may reflect a state culture that is more accepting of abortion. The variable does not reach significance in the two four-year models, yet the sign is in the expected direction. Perhaps the time-series is too short to reveal the relationship. As for the percentage of females in the legislature, the variable is highly significant in both the overall model and the pre-Cusey model (see Tables 1 and 2). However, the sign is not in the expected direction. Higher

~

480 Politics 6 Policy Vol. 31 No.3

percentages of females in the state legislature are in fact associated with lower demand for abortion in these two models. This may be attributed to a state population of women that is more economically dependent and may

Table 1. Determinants of State Abortion Rates 1988-1996: The Overall Impact of State Abortion Restrictions

Abortion Provider Rate

Percentage of Female Legislators

Urban Population Percentage

Black Population Percentage

Democratic Legislative Strength

Female Labor Force Participation Rate

Forcible Rape Rate

Abortion Restrictions

Constant

N of Observations N of States Wald Chi Square (8) Prob. > Chi Square Log Likelihood

Qs Standard Coefficient Emr

.79 .04

-.I3 .03

23 .o 1

-.03 .03

4.65 1.16

.05 .03

.05 .o 1

-.42 -17

-8.1 1.9

422 47

16 16.79 O.oo00

-1 061 -79 1

Z-Test

22.66

-5.1

23.60

-1 32

4.0

157

43

-2.4

42

Significance

0.000

0.000

0.000

0.186

0.000

0.1 I6

0.000

0.016

0.000

Note: The dependent variable is abortions per 1,000 women age 15-44, as reported by the Allan Guttmacher Institute.

Abortion Restrictions 481

Table 2. Determinants of State Abortion Rates 1988-1991: The Overall Impact of State Abortion Restrictions

Abortion Provider Rate

Percentage of Female Legislators

Urban Population Percentage

Black Population Percentage

Democratic Legislative Strength

Female Labor Force Participation Rate

Forcible Rape Rate

Abortion Restrictions

Constant

N of Observations N of States Wald Chi Square (8) Prob. > Chi Square Log likelihood

GLS Standard Coefficient Error Z-Tcst Significance

.79 .04 18.93 O.OO0

-.07 .03 -2.1 0.036

27 .o 1 22.44 O.OO0

.o 1 .03 38 0.70 1

2.44

-.03

.49 1.63 0.102

.a -1.1 1 0266

.04 .02 2.6 0.010

-.77 2 -3.4 0.00 1

-3.8 23 -1.6 0.105

188 47

1330.85 O.oo00

-353.46

Note: The dependent variable is abortions per 1,000 women age 1 5 4 4 , as reported by the Allan Guttmacher Institute.

482 Politics Or Policy Vol. 31 No. 3

Table 3. Determinants of State Abortion Rates 1993-1996: The Overall Impact of State Abortion Restrictions

Abortion Provider Rate

Percentage of Female Legislators

Urban Population Percentage

Black Population Percentage

Democratic Legislative Strength

Female Labor Force Participation Rate

Forcible Rape Rate

Abortion Restrictions

Constant

N of Observations N of States Wald Chi Square (8) Prob. >Chi Square Log likelihood

GLS Standard Coefficient Emr Z-Test Significance

.60 .w 6.5 O.OO0

-.03 .05 -.52 0.60 1

22 .03 7.8 O.OO0

.06 .05 1.01 0.3 10

1.42 2.18 .65 0.515

.04 .04 157 0.1 16

.08 .04 43 O.OO0

.03 25 .I30 .897

-8.4 4 2 0.019

188 47

226.95 O.oo00

-389.5 1 1 17

Note: The dependent variable is abortions per 1,000 women age 15-44, as reported by the Allan Guttmacher Institute.

~~ --

Abortion Restrictions 483

have less need to choose abortion as hypothesized in the case of female labor force participation.

Turning to the abortion supply variable, abortion provider rate, the number of abortion providers per million persons is highly significant in all three models at the .OOO level, and the sign is in the expected positive direction. This demonstrates that the supply of abortion services from providers is an important factor in determining state abortion rates and is consistent with the findings of previous studies (Meier et al. 1996; Mete 2000).

In examining the results for the research variable, abortion resfiictions, the coefficient is highly significant at the .OOO level in the overall model in Table 1 and the pre-Casey model in Table 2. However, the variable does not reach statistical significance in the post-Casey model in Table 3. These findings are consistent with the first research hypothesis stating that abortion restrictions are related to higher abortion rates, yet not with the second hypothesis that this relationship would appear strongest in the post-Casey era. The overal I findings confirm Mete’s (2000). It is unclear why the post-Casey model does not show a relationship. The adoption of abortion restrictions and their enforcement results in lower state abortion rates for the period from 1988 to 1991. This includes the years just prior to and just following the Webster ( I 989) decision. Perhaps this finding can be explained by the broader political forces in play at the time. As Halva-Neubauer ( 1 993) has pointed out, the late 1980s and early 1990s were a time of renewed pro-life and Christian Right activity and influence in the state legislatures, which may have contributed to a climate of less acceptance of and demand for abortions. The conservative direction of the Court in this time period may actually reflect this trend rather than having lead to it.

These findings demonstrate that abortion restrictions do have the effect intended by anti-abortion legislators, interest groups, and activists: they reduce the number of abortions performed in a state. That the findings differ from those of Meier and others (1996) may be due to several factors. First, the time period of the studies differed. The study by Meier and others (1 996) covered the time period between 1982 and 1992, while this study covered 1988-96, which is more similar to that covered in the Mete (2000) study. The abortion restriction variable differed from the 1996 study, which used a much broader measure of abortion restrictions. The variable used in this study is much more similar to Mete’s (2000), which found similar results. Also the statistical procedures used differed. We can be confident in the results for this particular study because using generalized least squares corrected both major statistical problems and will provide a more conservative estimate of

484 Politics Policy Vol.31 No.3

the relationship between abortion regulations and abortion rates because autocorrelation tends to make insignificant results appear significant. While abortion restrictions were significant in both the OLS and GLS models, other relationships-such as those for the black population and the female workforce rate-that appeared significant in OLS disappeared when GLS was used.

Discussion

These findings have many implications for public policy. This study shows that abortion regulations do in fact have real effects on abortion rates. Some pro-choice advocates have argued that restrictions do not keep women from seeking abortions, yet they raise the cost and impose an additional burden on women in an already difficult situation. However, the results of this study indicate that abortion restrictions are not simply symbolic actions that demonstrate that a state disapproves of abortion on moral grounds: abortion restrictions do in fact reduce abortion rates.

While proponents of abortion restrictions appear to be correct in stating that abortion rates have dropped in part as a result of abortion restrictions, other impacts of abortion restrictions that are beyond the scope of this project require study. Several questions come to mind. What are the economic and health outcomes for those women who cannot obtain abortions due to the restrictions? Do waiting periods have negative impacts on women’s health? Are unplanned pregnancies reduced? Are children raised by the women giving birth or is adoption chosen over abortion? For those who obtain abortions, what impact have the restrictions had? In terms of restrictions on minors’ access, the restrictions do result in fewer abortions; however, the implications for policy outcomes obviously do not end here. Are the outcomes positive in terms of the well-being of teenage parents and their children? Is the lower rate simply the result of fewer teenagers becoming pregnant? Do parents offer more support when parental involvement is required? Do those who do not obtain abortions as a result of parental support raise their children, or do they use adoption services? Beyond simply knowing that state restrictions on abortion do lower abortion rates, further research must continue on the effects of these restrictions on economic and health outcomes for both parents and children. Additionally, as the results of this study show that the relationship between abortion restrictions and abortion rates may have changed since 1991, further study of this relationship should continue in the future.

Abortion Restrictions 485

Appendix

Cases

Hodgson v. Minnesota 497 U.S. 4 1 7 (1 990)

Planned Parenthood of Southeastern Pennsylvania v. Casey, 112S.Ct.2791 (1992)

Roe v. Wade 410 U.S. 113 (1973)

Webster v. Reproductive Health Services 492 U.S. 490 (1989)

486 Politics 43 Policy Vol. 31 No. 3

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