The effects of economic conditions and access to reproductive health services on state abortion rates and birthrates. (ARTICLES).(Statistical Data Included)

The effects that such factors as wages, welfare policies and access to physicians, family planning clinics and abortion providers have on abortion rates and birthrates are examined in analyses based on 1978-1988 state-level data and longitudinal regression techniques. The incidence of abortion is found to be lower in states where access to providers is reduced and state policies are restrictive. Calculations indicate that decreased access may have accounted for about one-quarter of the 5% decline in abortion rates between 1988 and 1992. In addition, birthrates are elevated where the costs of contraception are higher because access to obstetrician-gynecologists and family planning services is reduced. Economic resources such as higher wages for men and women and generous welfare benefits are significantly and consistently related to increased birthrates; however, even a 10% cut in public assistance benefits would result in only one birth fewer for every 2l2 women on welfare. Economic factors showed no consiste nt relationship with abortion rates.

Policy discussions concerning factors that influence reproductive behavior reach a level of intensity seldom matched by other matters of public discourse. Especially controversial have been discussions regarding the effects of Medicaid funding restrictions, 24-hour waiting periods and parental consent requirements for minors on the incidence of abortion; the effects of family planning programs on rates of births and abortions; and incentives for out-of-wedlock childbearing attributed to the Aid to Families with Dependent Children (AFDC) program.

These questions reflect more general but perhaps less widely publicized issues that are well suited to economic analysis, such as the cost and accessibility of reproductive health services and changes in women's and men's economic opportunities. Economic models are particularly useful for sorting out the determinants of reproductive behavior in the United States because of the substantial heterogeneity that characterizes not only the population's values and preferences, but also its economic resources and access to different types of health care. (*)

Accordingly, economists have conducted numerous empirical studies of the socioeconomic and political determinants of fertility in the United States. This literature, which is summarized elsewhere, [1] has recently expanded to include research on the determinants of abortion. (2) While researchers have generally found support for basic economic hypotheses, a number of specific results, including most of the policy questions raised above, remain in dispute.

However, there remain unexplored issues and weaknesses in the literature. An important shortcoming of many studies is the omission of relevant economic and policy variables. For instance, analyses of women's abortion decision-making have failed to include the gender-specific measures of economic resources and labor-market opportunities that have commonly appeared in studies of fertility. Both types of studies have tended to include only limited measures reflecting access to reproductive health services. A related problem, which recent analyses have begun to address, involves potentially confounding effects from unobserved and imperfectly measured variables. Finally, only a few studies have examined abortion and fertility behavior in tandem. [3]

In this article, we investigate the determinants of annual abortion rates and birthrates using state-level data from the years 1978-1988. The analysis is based on an economic model in which the behavior leading to pregnancy and to pregnant women's decisions on whether to carry the pregnancy to term depends on the women's resources, direct costs, opportunity costs, attitudes and preferences for children.

Our empirical analysis complements and extends previous research in several respects. First, we consider a comprehensive set of explanatory variables. To describe the direct costs of contraception, abortion and births, we include longitudinal variables for the number and geographic distribution of family planning clinics, abortion providers and obstetrician-gynecologists within states. State policy indicators are used to measure access to reproductive health services. To describe resources and opportunity costs, we include state- and year-specific measures of women's and men's property incomes (i.e., nonwage) and available wage rates. To gauge the political and social climate, we examine party affiliations of state executives, legislators' voting records and attitude measures drawn from opinion surveys. For many of our primary variables, we have identified supplemental measures that permit us to check the robustness of our results (i.e., we check whether the estimated effect of each variable maintains its si gn and magnitude and remains significant when assumptions underlying the analytic model change).