Women's reproductive choices: The impact of Medicaid funding restrictions.(Statistical Data Included)

As of January 1997,34 states were enforcing restrictions on Medicaid funding for abortions. Determining whether these restrictions affect women's reproductive decisions was the object of a fixed-effects log-linear analysis using 11 years of data between 1978 and 1992. Results indicate that abortion rates in states with Medicaid funding restrictions are 2% lower than rates in states with no such restrictions. However, when the supply of abortion providers and the demographic characteristics of the state population are taken into account, the difference is no longer statistically significant. Medicaid funding restrictions have no impact on birthrates, and the result is the same regardless of whether the empirical model takes into account provider availability, demographic characteristics and state sentiment toward women and reproductive rights.

In 1973, the U.S. Supreme Court ruled in Roe v. Wade that a right of personal privacy exists under the Constitution and that this right includes a woman's decision of whether or not to terminate a pregnancy. However, the Court also ruled that the right of personal privacy is not unqualified and must be considered against state interests in regulation. Since the 1970s, many states have enacted and begun to enforce various abortion restrictions, such as limits on Medicaid funding for abortion services and requirements that unmarried minors notify or obtain the consent of one or both parents or a judge prior to obtaining an abortion. As of January 1997, 34 states were enforcing restrictions on Medicaid funding for abortions, (*) and 27 states were enforcing parental involvement restrictions (+1)

Have such restrictions influenced women's reproductive decisions? This article presents an empirical analysis of the relationship between government policies and rates of abortions and births, using data for 11 years during the period 1978-1992.

Previous Research

Economic theory and some empirical evidence have suggested that both restrictions on Medicaid funding of abortions and parental involvement requirements lower abortion rates among teenagers, (2) and that Medicaid funding restrictions lower abortion rates among all women of reproductive age. (3) However, other empirical evidence has indicated that state abortion restrictions have no such impact. (4)

The relationship between state-level abortion policies and birthrates is even murkier. Since the birthrate is the product of the pregnancy rate and the ratio of births to pregnancies, state abortion policies may affect birthrates by influencing one or both of these factors. Theory suggests that abortion restrictions may increase the second factor and decrease the first. If levels of sexual activity and contraceptive use remain constant, policies that increase the cost of obtaining an abortion may reduce abortion rates and thus, by increasing the ratio of births to pregnancies, result in higher birthrates.

It has been argued, however, that because increasing the cost of abortion raises the costs of engaging in sexual activity, abortion restrictions may lessen sexual activity and thereby reduce pregnancy rates and birthrates. (5) This argument assumes that individuals have information on abortion restrictions prior to engaging in sexual activity.