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A Supply-Side Strategy for Lowering Abortion Rates



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In the years following the Roe v. Wade decision, most legislative efforts to prevent abortions have been “demand-side” strategies. In short pro-lifers have attempted to pass legislation to either discourage pregnant women from obtaining abortions or raise the costs of obtaining an abortion. Examples of these types of laws include public-funding restrictions, parental-notice laws, and informed-consent laws. Pro-lifers have succeeded in enacting these laws in a number of states and there is a substantial body of peer-reviewed research documenting the effectiveness of Medicaid funding restrictions and parental-involvement laws

However, a recent article in The New England Journal of Medicine shows that supply-side strategies — strategies aimed at reducing the number of abortion providers — also have promise for lowering abortion rates. The article analyzes the impact of a Texas law which required that all abortions which take place at or after 16 weeks of gestation be performed in either a hospital or an ambulatory surgical center. Ambulatory surgical centers must adhere to more rigorous staffing, reporting, and facility structure requirements than free-standing abortion clinics.

When the Texas law took effect, none of Texas’s non-hospital-based abortion providers met the requirements for an ambulatory surgical center. As such, the average distance to the non-hospital-based abortion provider which performed abortions after 16 weeks increased from 33 miles to 252 miles. Not surprisingly, the number of abortions performed in Texas at or after 16 weeks of gestation fell by 88 percent. While there was an increase in the number of Texas residents seeking late-term abortions in other states, the out-of-state increase did not offset the in-state decline. Tthe year the law took effect saw over 2,000 fewer late-term abortions (both in-state and out-of-state) performed on Texas residents.

The article contrasts this supply-side law to a demand-side law, specifically the Texas informed-consent laws which went into effect in January 2004. The author argues that this informed-consent law failed to reduce the incidence of abortion in Texas. However, the author analyzes the number of abortions, not the abortion rate, and thus fails to account for increases in the population of women of childbearing age. More importantly this Texas informed-consent law is relatively weak because it does not mandate two in-person visits to the abortion provider. There is a growing body of evidence that informed-consent laws which require women to make two separate trips to the abortion provider substantially lower abortion rates.

Overall, there has been relatively little academic research on the impact of these supply-side strategies. However, there is anecdotal evidence of their effects. Following the enactment of an Arizona pro-life law in 2009, Planned Parenthood announced they would stop providing abortions at seven of their ten clinics. The end result has been a 30-percent decline in the number of abortions performed in Arizona. Similarly, supporters of legal abortion stated that Virginia’s new abortion-clinic regulations would result in the closure of in the closure of 17 of Virginia’s 21 abortion clinics. While this may well prove to be an exaggeration, it does demonstrate the concern that supporters of legal abortion have about the potency of clinic regulations.

Since 1982 the number of abortion providers has fallen by a third. This is largely because many abortion providers have retired and younger physicians are less interested in performing abortions. However, some of these supply side strategies may be having an effect as well.  There exists peer reviewed research showing that declines in abortion providers reduce abortion rates. As such, considering that courts have been willing to uphold clinic regulations in many states, these supply side strategies represent a new opportunity for grassroots pro-lifers.

— Michael J. New is an assistant professor of political science at the University of Michigan–Dearborn and a fellow at the Witherspoon Institute in Princeton, N.J.



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