A new study offers a potent reminder of what really matters when it comes to economically empowering women: access to abortion.
Women who are blocked from getting abortions face significant financial distress, including higher amounts of debt and increased rates of bankruptcy and eviction, according to a groundbreaking working paper published last week by the National Bureau of Economic Research.
The paper looks at reproductive rights through an economic lens. It was co-authored by economist Sarah Miller, a professor at the University of Michigan’s Ross School of Business, along with Laura Wherry, a professor at UCLA’s medical school, and Diana Greene Foster, a professor of reproductive sciences at the University of California, San Francisco, who is considered a pioneer in researching women and abortion access.
The economic fallout of being unable to get an abortion and carrying a baby to term lasts for years, they found, when compared with women who have abortions ― and, crucially, compared with those who choose to have an abortion and then go on to have a child later.
In other words, women are suffering financially not simply because they’ve had a child but because they were forced to do so at a time when they weren’t ready or prepared.
“Of course, there’s an economic impact on having a child,” said Kate Bahn, an economist at the Washington Center for Equitable Growth, who praised this study for its methodology. “It’s not just whether you have a child or not but whether you have control over those decisions.”
The study comes at a time when women’s reproductive rights are increasingly imperiled. Simultaneously, female workers have become a crucial part of the economy. Earlier this month, the Labor Department revealed that women now make up a slight majority of workers in the U.S.
The Question No One Was Asking
Though there’s a deep body of evidence showing that access to birth control changes women’s economic outcomes, there’s less research into abortion access.
What makes the study released last week so valuable is a revolutionary data set from UC San Francisco, known as the U.S. Turnaway Study, a survey of about 1,000 women. About 800 of them showed up at 30 abortion clinics in 21 states a few weeks within the gestation time limits set by their state and the clinic, ranging from 10 to 26 weeks pregnant. (The researchers also tracked about 200 women who had abortions in their first trimester, as a control group.)
About 260 of these women were turned away. Of those, 68% carried their pregnancy to term and 32% were able to get an abortion elsewhere, miscarried or had a stillbirth. Another group of women were able to get an abortion.
Researchers recruited these women in 2008 and 2010 and tracked them for five years to find out what their lives were like, calling them up every six months to check in.
It’s Not Just Economic Outcomes, It’s Life Or Death
When Foster first started the research project, there was some discussion ― mostly anecdotal and from those with an agenda ― about how having an abortion might hurt women.
Foster wanted to know: How does not being able to get an abortion affect women?
“It’s one thing to wish you hadn’t needed it,” she told HuffPost. “It’s interesting to know if you wanted one and couldn’t get one, would you be better off?”
In previous studies, Foster and the other researchers tracking these women found that the ones who are turned away from getting abortions have worse mental health in the short term and poorer physical health in the long term if they gave birth.
Women who were turned away also faced an increased risk of physical violence from the man involved in their pregnancy.
Two women who were unable to get abortions died from health-related complications. None of the women who were in the group that got abortions died.
“That’s a horrific death rate, about 1%. About 100 times higher than our national mortality rate,” Foster said, emphasizing that the costs of not getting an abortion aren’t just economic. “The risks of continuing pregnancy are really overlooked in our culture.”
Why This Study Breaks New Ground
Though the previous studies did show that women were economically worse off after they were turned away from the clinic, the data behind that research was self-reported. In other words, those women were surveyed and explained their financial situation to researchers ― a less than perfect method of measuring someone’s financial well-being. It’s the difference between asking someone how much they weigh and making them stand on a scale.
This new study uses a more objective measure to examine women’s financial health, looking at their credit reports (in a way that protected their privacy).
Economist Sarah Miller, upon reading a paper on the Turnaway Study, came up with the idea and reached out to Foster, who encouraged her to work on it.
The credit report data offered a more clear-eyed view of the women’s economic circumstances and this data set was more robust: First off, over the years some women had stopped responding to the survey. The credit report data was still able to capture their information.
Plus, Miller had the idea of looking at the women’s credit reports in the years before the abortion did (or didn’t) happen. That way she could truly get a sense of whether the women who managed to get abortions were somehow already better off financially. They weren’t.
Both groups of women, those who were turned away and the “near-limit” group who made it just before the gestational time limit to the clinic, look similar financially. A majority were in poverty, Miller said.
Because of their more tenuous financial circumstances, it wasn’t surprising that they tended to show up later at an abortion clinic.
These women might take longer to put together the money for care or, especially with fewer and fewer clinics, to plan the logistics of getting to the facility and taking time off work. Fifty-eight percent of the women who were turned away said travel and procedure costs were causes for the delay.
(Another big reason women show up at clinics at later stages in their pregnancies is that it may take some time to even realize they’re pregnant. This is particularly true for younger women.)
Though they start out similarly, the women’s economic fortunes started to diverge at the point where some were turned away from the clinic. Those women saw the amount of debt they had that was 30 days or more past due increase by 78% compared with the women who had accessed abortion.
The Turnaway Study also saw an 80% increase in what it called “court actions,” i.e., bankruptcies, evictions and tax liens.
“You can’t deny the economic consequences of reproductive access in health care,” Miller said.
Miller and her co-authors also wondered if there was any difference in the financial stress faced by the women who were forced to carry their babies to term, compared with the financial stress of simply having a child.
They were able to track women who received abortions and went on later to have another child. They found that their financial picture was not nearly as bad as in the Turnaway Study group.
However, the sample size here was relatively small, and more research needs to be done in this area.
“Part of why women want abortions is because they don’t feel like they could carry to term and afford to have a child,” Foster said. “When they have a child later, they probably feel like they’re in better shape.”
Access Is Harder To Access
Miller said that often women are turned away from clinics later in their pregnancy not simply because they’re past the state’s gestational limit but because the clinic doesn’t have a doctor on staff who can handle the procedure later on in the pregnancy.
In some cases, clinics in states where abortion is permitted up to 20 weeks would have only a nurse practitioner available who could handle abortions only up to 10 weeks.
Yet the idea of improving conditions at abortion clinics around the country seems widely ambitious at a time when abortion access is increasingly imperiled.
Since 2010, a growing number of states have passed restrictions on access. From 2011 through 2019, states enacted 483 new abortion restrictions, according to data from the Guttmacher Institute. Those laws make up 40% of all the restrictions put in place by states since Roe v. Wade legalized the procedure nationally in 1973.
Some of the more common restrictions include mandated waiting periods (a big burden on time-strapped women), mandated counseling, parental notification or consent, limits on public funding (particularly harmful for lower-income women) and so-called TRAP laws that make it harder for clinics to operate. Last year, some states tried to ban abortion after just six weeks into a pregnancy ― when many women don’t even know they’re pregnant yet.
The ultimate aim of these laws is to challenge Roe v. Wade before a Supreme Court that now has a firm conservative majority, with Trump appointee Brett Kavanaugh recently added to the bench.
Some researchers say these recent moves have added an element of urgency to their work.
This couldn’t be more timely, Miller said. Considering all these new restrictions, it’s natural to want to understand the real-world consequences of these policies.
Considering that 1 in 4 women has an abortion during her lifetime, the effects of these restrictions could prove devastating.