Essays on economic aspects of abortion in the united states

Essays on Economic Aspects of Abortion in the United States

BY
SARA BORELL1
B.A., University of Verona, 2001
M.Sc, Collegio Carlo Alberto, 2002
M.A., University of Cergy Pontoise, 2003
M.A., University of Illinois at Chicago, 2006

THESIS
Submitted as partial fulfillment of the requirements
for the degree of Doctor of Philosophy in Economics
in the Graduate College of the
University of Illinois at Chicago, 2011

Chicago, Illinois


UMI Number: 3484945

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This dissertation is dedicated to Davide Furceri, and to my parents Franca and Gigi Borelli

in


ACKNOWLEDGMENTS

I am especially grateful to my supervisor, Robert Kaestner, for his support and supervision over
the past years. 1 could have not accomplished this dissertation without him. I am also grateful to the other
members of my dissertation committee Nathan Anderson, Barry Chiswick, Theodore Joyce and Anthony
Lo Sasso for their feedbacks on my research and encouragement.
Many people contributed in important ways to the completition of my graduate studies. My
parents, Franca and Gigi Borelli, and the rest of my family have been an essential source of support over
the years. They have been always present with their love and encouragement giving me the strength to go
on. Special thanks go to Rosa Berardi, a dear friend, for hosting me at her house. I really felt I have found
another family on the other side of the world.
My thanks extend to my Italian friends who always supported me, especially Lidia Monaco, and
to my UIC classmates for sharing very difficult times on the way. Above all, heartfelt gratitude goes to
Davide Furceri for always being beside me with his love, understanding, patience and encouragement,

sharing this experience with me from the beginning to the end.

SB

IV


TABLE OF CONTENTS
CHAPTER

PAGE

1.

INTRODUCTION
1.1
Background
1.1.1 Review of Abortion Legislation
1.2
Purpose of the Study and Contributions

2.

EFFECT OF PROVIDER SUPPLY ON THE DEMAND OF ABORTION
2.1
Introduction
2.2
Abortion Legislation and Structure of the Abortion Market
2.3
Previous Research on Provider Availability

2.4
Conceptual Framework
2.5
Data
2.6
Empirical Specification
2.7
Results
2.7.1 Baseline Results
2.7.2 Alternative Specifications
2.7.3 Abortion and Marital Status
2.7.4 Provider Size
2.7.5 Endogeneity of Provider Availability
2.8
Conclusions

3.

LONG
3.1
3.2
3.3
3.4
3.4.1
3.4.2
3.5
3.6
3.7
3.7.1
3.7.2

3.7.3
3.7.4
3.8
3.9

4.

CONCLUSIONS
4.1
Overview
4.2
Summary of Contributions
4.3
Discussion

1
1
2
6
14
14
17
21
25
30
37
40
40
41
46

51
54
64

TERM EFFECTS OF ABORTION PARENTAL INVOLVEMENT LAWS
66
Introduction
66
Theoretical Impact of Parental Involvement Laws on Adult Fertility
69
Brief History of Abortion Parental Involvement Laws
71
Previous Research
76
Studies of Current Impact of Parental Involvement Laws
76
Previous Research on the Long Term Effects of Changes in Costs of Fertility Control.. 84
Empirical Specification
88
Data
89
Results
93
Fertility
93
Interpretation of the Results
96
Educational Attainment
98
Labor Market Outcomes

102
Robustness Checks
106
Conclusions
113
116
116
117
122

v


CHAPTER

PAGE

CITED LITERATURE

125

APPENDICES
APPENDIX A
APPENDIX B
APPENDIX C

129
129
130
136

VITA

138

VI


LIST OF TABLES
PAGE

TABLE
I.

ABORTIONS BY STATE OF OCCURRENCE, NCHS AND AGI

32

II.

VARIATION IN DISTANCE BY POPULATION DENSITY

37

III.

DESCRIPTIVE STATISTICS

40

IV.

EFFECT OF DISTANCE ON ABORTION RATES

42

V.

EFFECT OF DISTANCE -DUMMIES-ON ABORTION RATES

43

VI.

EFFECT OF PROVIDER RATE ON ABORTION RATES

44

VII.

EFFECT OF DISTANCE ON ABORTION RATES BY MARITAL
STATUS-WHITES

48

EFFECT OF DISTANCE ON ABORTION RATES BY MARITAL
STATUS-NON-WHITES

49

VIII.

IX.

EFFECT OF DISTANCE ON ABORTION RATES BY MARITAL STATUS
AND AGE

50

X.

EFFECT OF DISTANCE TO A LARGE PROVIDER

53

XL

EFFECT OF DISTANCE ON ABORTION RATES-COUNTIES WITH DISTANT
PROVIDERS

55

XII.

EFFECT OF DISTANCE ON ABORTION RATES-OLDER WOMEN

60

XIII.
XIV.

FIRST STAGE REGRESSION
EFFECT OF DISTANCE ON ABORTION RATES-OLDER WOMEN-COUNTIES
WITH POPULATION DENSITY < 300 RESIDENTS PER SQ. MILE
FIRST STAGE REGRESSION COUNTIES WITH POPULATION DENSITY < 300
RESIDENTS PER SQ. MILE

61

63

XVI.

ABORTION RESTRICTIONS-PERIODS ENFORCED

75

XVII.

EFFECT OF EXPOSURE ON NUMBER OF CHILDREN PER WOMAN -WHITES .. 95

XVIII.

EFFECT OF EXPOSURE ON NUMBER OF CHILDREN PER WOMAN -BLACKS . 96

XIX.

EFFECT OF EXPOSURE ON COMPLETED HIGH SCHOOL - WHITES

XV.

vii

62

99


LIST OF TABLES (continued)
PAGE

TABLE
XX.

EFFECT OF EXPOSURE ON COMPLETED HIGH SCHOOL-BLACKS

100

XXI.

EFFECT OF EXPOSURE ON SOME COLLEGE - WHITES

101

XXII.

EFFECT OF EXPOSURE ON SOME COLLEGE-BLACKS

102

XXIII.

EFFECT OF EXPOSURE ON WHETHER WORKED LAST YEAR-WHITES

103

XXIV.

EFFECT OF EXPOSURE ON WHETHER WORKED LAST YEAR-BLACKS

104

XXV.

EFFECT OF EXPOSURE ON EMPLOYED - WHITES

105

XXVI.

EFFECT OF EXPOSURE ON EMPLOYED-BLACKS

106

XXVII.

EFFECT OF EXPOSURE ON NUMBER OF CHILDREN PER WOMAN
WHITES-LOW MIGRATION STATES

109

EFFECT OF EXPOSURE ON COMPLETED HIGH SCHOOL
WHITES-LOW MIGRATION STATES

110

EFFECT OF EXPOSURE ON SOME COLLEGE
WHITES-LOW MIGRATION STATES

111

EFFECT OF EXPOSURE ON WHETHER WORKED LAST YEAR
WHITES-LOW MIGRATION STATES

112

XXVIII.

XXIX.

XXX.

XXXI.

EFFECT OF EXPOSURE ON EMPLOYED -WHITES
LOW MIGRATION STATES

113

XXXII.

DATA SOURCES

129

XXXIII.
XXXIV.

EFFECT OF DISTANCE ON ABORTION RATES, ALL ARA COUNTIES
EFFECT OF PROVIDER RATES ON ABORTION RATES BY COUNTY OF
OCCURRENCE

130
132

XXXV.

EFFECT OF DISTANCE ON ABORTION RATES - OLDER WOMEN COUNTIES WITH POPULATION DENSITY < 100 RESIDENTS PER SQ. MILE... 133

XXXVI.

FIRST STAGE REGRESSION COUNTIES WITH POPULATION
DENSITY < 100 PER SQ. MILE

VIM

135


LIST OF TABLES (continued)

TABLE
XXXVII.

XXXVIII.

PAGE
EFFECT OF EXPOSURE ON NUMBER OF CHILDREN PER WOMAN
WHITES-ALL CELLS

136

EFFECT OF EXPOSURE ON NUMBER OF CHILDREN PER WOMAN
BLACKS-ALL CELLS

137

IX


LIST OF FIGURES
PAGE

National abortion rate 1973-2005

7

Number of abortion providers 1973-2005

8

States with Parental Involvement laws in effect as of February 2011

11

Probability of provider in county and county population

20

Probability of provider in county and county population density

21

Abortion costs and probability of abortion given pregnancy

29

Abortion costs and probability of pregnancy

29

Abortion costs and probability of abortion

30

Trends in abortion rates, thirteen states area and national trends

33

Total, hospital and non-hospital providers 1973-2005, 50 states-AGI data

35

Counties experiencing a change in distance to the nearest provider, 1979-1988

36

Counties experiencing a change in distance to the nearest large provider, 1979-1988.... 36
Impact of Parental Involvement laws on Fertility

71

Number of states with minors' abortion restrictions, 1973-2011

74

Own children in the household and children ever born (CEB) per woman

91

x


LIST OF ABBREVIATIONS
AFDC

Aid to Families with Dependent Children

AGI

Alan Guttmacher Institute

ARA

Abortion Reporting Area

BEA

Bureau of Economic Analysis

CDC

Center of Disease Control

CEB

Children Ever Born

IV

Instrumental Variables

MPC

Model Penal Code

NCHS

National Center of Health Statistics

NCI

National Cancer Institute

OLS

Ordinary Least Square

PI laws

Parental Involvement laws

XI


SUMMARY
After nationwide abortion legalization in 1973, government policies continued to change
becoming, in general, less favorable to abortion and accessibility of providers started to decline in the
early 1980s. This research analyses the impact of some of these changes on abortion demand. The first
chapter provides some background about abortion in the U.S., in particular the legal issues and framework
that serve as reference to place the results of subsequent chapters into context. It also describes the
purpose of the study and its contributions.
Chapter two examines how changes in accessibility to abortion providers have affected abortion
rates in the U.S. in the 1980s. The analysis of accessibility to abortion providers is important because the
supply of services in this market has been traditionally uneven and restricted compared to other medical
services. State level regulations, violence against providers and stigma impose burdensome constraints on
the provision of abortions and may help to understand both the change in the number of providers over
time and their geographical distribution. While some previous research has examined the association
between abortion availability and abortion rates, these studies have been limited in their ability to provide
estimates of a causal relationship. This is the first study to use a large panel of counties and a fixed effects
approach to obtain robust estimates of the impact of changes in provider availability on abortion demand.

Furthermore, I analyze the effect of changes in abortion services on different groups of women
distinguished on the basis of demographic characteristics which can signal different behavioral responses.
The chapter also addresses the simultaneity problem in the demand and supply of abortion services by
means of an instrumental variable approach. The results show that availability of abortion services is
strongly correlated with abortion rates over the sample period considered. The estimates are robust to a
wide range of specifications and the instrumental variable results suggest that the observed correlation
between abortion rates and provider availability can be plausibly interpreted as causal.
The second part of the dissertation (chapter three) analyses the long term impact of abortion
Parental Involvement laws for minors. Starting in the early 1980s, states instituted laws such that minors

xii


SUMMARY (continued)
were required to either notify a parent(s) or obtain their consent before receiving an abortion. Together,
these laws are referred to as Parental Involvement laws. Today, the majority of states require some form
of parental involvement in minors' abortions. Previous research on parental laws has focused on the shortrun impact on abortion behavior of minors, and to a less extent births. But the effect of parental
involvement laws may go beyond the short-run and affect a woman's in the long-run. In fact, the timing
of first birth (a teen birth) may influence subsequent education choices, marriage, and other factors that
influence fertility. Thus, the purpose of this project is to investigate whether parental laws have impact on
fertility and other socioeconomic outcomes in the long-run. The research design exploits the fact that
states enacted Parental Involvement laws at different times to identify cohorts that have been more or less
exposed to abortion restrictions as minors. The results show that women who were more exposed to
abortion restrictions as minors experience higher fertility later in life and have lower educational
attainment. Some estimates also suggest non-zero effects on labor market outcomes. The results indicate
that Parental Involvement laws may have permanent effects on women's outcomes.
Finally, chapter four summarizes the main contributions of this dissertation, discusses its
limitations and some venues for future research.

xin

1. INTRODUCTION
1.1

Background
In recent decades, significant global changes have occurred in both developed and developing

countries towards legalization and regulation of abortion. This issue has received considerable attention,
and its legality and availability have often generated controversy. In the Unites States, the movements
towards legalization began in the mid-1960s, and legal abortion was suddenly extended to the entire
country in 1973 with the landmark ruling of the U.S. Supreme Court in Roe v. Wade. Since then, abortion
policy has been one of the most contentious issues in the U.S. domestic political agenda. In fact, over the
past four decades, states have enacted laws and administrative rulings mostly aimed at regulating and
limiting whether, when and under what circumstances a woman may terminate her pregnancy, and also at
directly regulating the availability of abortion services.
While the public debate about abortion is usually focused on ideological extremes, the
contribution of economics is potentially important because it is focused on measuring consequences,
which is central to the practical argument surrounding abortion laws and regulations. But why is abortion
an economic issue? From an economic point of view, abortion is an individual choice, which can be
affected by constraints (including economic constraints). These constraints can be altered by policies
which, in turn, affect individual choices. Economic analysis can reveal the importance of these policies
and of economic constraints, and the evidence gathered can be used to assess the consequences and to
design policies targeted at abortion.
The debate about abortion has fueled multiple lines of investigation in economic research: from
the analysis of various types of restrictions and determinants of abortion, to the study of its effect on
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In particular, I consider the impact of changes in the availability of abortion services and of
changes in restrictions to minors' access to abortion. I concentrate on these two topics because they
represent important aspects in the overall decision-making process about appropriate abortion policies. In
fact, over the past decades, the availability of abortion services has been facing increasing regulation and
states have been keeping introducing or amending their original parental involvement statutes to include
new requirements. Furthermore, these topics have not been addressed (or not satisfactorily) by previous
research. More generally, there is an inadequate base of evidence to understand the substantial changes in
abortion that have occurred over time and the consequences of policies targeted at abortion. Therefore,
this dissertation contributes to complement and extend previous work in several ways, with the aim of
providing a better understanding of the behavioral consequences that abortion policies generate.
In order to place the results of subsequent analysis into context, it is important to understand the
institutional background and details of a public policy issue as intricate as abortion. Therefore, the next

section provides a brief description of the judicial decisions and legislative environment related to
abortion. I then describe in more detail the purpose of this study and its contributions.

1.1.1

Review of Abortion Legislation
In the United States, at the time the Constitution was adopted, abortion before "quickening"

(before the fetus first movements could be felt) was legally performed under common law. Starting with
New York in 1828, states started to impose abortion restrictions and by the end of the century it became
an illegal procedure allowed only to preserve a woman's life. The prohibition of legal abortion during
most of the 19th century came under the same anti-obscenity or Comstock laws (1873) that prohibited the
interstate mailing, shipping, or importation of materials of "obscenities," which included the
dissemination of birth control information and services. These state laws survived virtually unaltered
until the 1960s, and before then only the District of Columbia in 1901 and Alabama in 1951 had legalized

1

The language of these statutes varied greatly across states. Some statutes referred to advertising or information
bans; others included explicit sale bans and/or prohibited the prescription of birth control or other contraceptives.


3

abortions to preserve the health of the woman (judicial opinions in Massachusetts State courts also
recognized a health exception).
In 1962, the American Law Institute promulgated the new Model Penal Code (MPC) which
liberalized abortion under limited circumstances including rape, incest, statutory rape and severe physicalmental defects of fetus or mother. In 1965, the Supreme Court decision in Griswoldv.

Connecticut (381

U.S. 471, 1965)2 identified a right to privacy that protected married couples' rights to contraceptives. In
the aftermath of this ruling, state legislatures actively revised their obscenity statutes to permit sales of
contraceptives to married women. In subsequent rulings, the right to privacy was held to apply to
unmarried individuals in Eisenstadt v. Baird (405 U.S. 438, 1972).
In the following years, on the heels of Griswold, pro-abortion activists argued that women's
access to abortion was similarly protected, and they began campaigns to change the laws. In 1966,
Mississippi legalized abortion in case of rape and in the late 1960s few states began to allow abortions
under the MPC provisions. The first were Colorado, North Carolina and California in 1967, followed by
Maryland in 1968, Arkansas, Delaware, New Mexico, Georgia and Oregon in 1969, and South Carolina,
Kansas and Virginia in 1970. Abortion became more broadly available in five states in 1970: New York,
Washington, Alaska and Hawaii repealed their abortion laws while the California Supreme Court (ruling
in late 1969) held that the state's law outlawing abortion was unconstitutional. The legalization of
abortion in these five states then led to several successful legal challenges of state abortion laws in federal
courts (Merz et al. 1995, 1996).
In 1973, the U.S. Supreme Court decisions with its ruling in Roe v. Wade (410 U.S. 113, 1973)
and Doe v. Bolton (410 U.S. 179, 1973) overturned the abortion laws of Texas and Georgia, respectively,
and led to nationwide abortion legalization. 3 The Roe case arose out of a Texas law that prohibited legal

2

In Griswold v. Connecticut the Court held that a Connecticut law which uniquely prohibited the use of
contraceptives to married couples was unconstitutional because it violated the individual's rights to marital privacy.
J

Jane Roe, a 21-year-old pregnant woman was the plaintiff. Henry Wade was the Texas Attorney General. In Doe,
the plaintiff was a woman who was given the pseudonym "Mary Doe" and sued Arthur Bolton, the Attorney General
of Georgia.

4

abortion except to save a woman's life. The Georgia law in question permitted abortion only in cases of
rape, severe fetal deformity, or the possibility of severe or fatal injury to the mother according to the MPC
provision adopted in 1969. Furthermore, the law imposed restrictions on where the abortion could be
performed, that only Georgia residents could get an abortion and it required the approval of a three
doctors-hospital committee.
The Roe Supreme Court ruling was based on the principle that the right to privacy included the
right of a woman to decide whether to have children or abort a pregnancy without state interference. Roe
required a balancing of state's and individuals' rights with respect to abortion and used a trimester
benchmark to define viability. The Court established that a woman could get a legal abortion from
medical professionals for any reason during the first trimester. States could regulate, but not prohibit,
abortions in the second trimester. After the second trimester, when the fetus is viable, a state could restrict
or prohibit abortions except when the mother's life has to be protected. Doe was meant to be read in
conjunction with its more famous Roe counterpart. In Doe, the Court ruled that a woman's right to an
abortion could not be restricted by the state if abortion was performed for reasons of maternal health. The
Court defined health as "all factors - physical, emotional, psychological, familial, and the woman's age relevant to the well-being of the patient." Furthermore, the Court struck down all other provisions of the
Georgia law.
The two Supreme Court's decisions in Roe and Doe left states some room for discretionary state
policies and many went ahead enacting their own abortion regulations. In fact, in the aftermath of
legalization, several states tried to impose their own restrictions on abortion that made more difficult for
women to exercise their rights. In 1976, the Congress adopted the first Hyde Amendment banning the use
of federal Medicaid funds to provide abortions, so that states could rely only on their own funds to pay for
abortions of low income women. Named after the Republican Congressman Henry Hyde of Illinois, the
first version of the Hyde Amendment prohibited the use of federal funds for abortion services (except
when the woman's life was threatened) under all programs administered by the Department of Health and
Human Services, affecting primarily Medicaid. In 1977, a revised Hyde Amendment was passed allowing


5

states to deny Medicaid funding except in cases of rape, incest or life endangerment (abortions that meet
these federal exceptions have to be covered). The Hyde amendment was immediately contested in the
Courts, but in June 1980 the U.S. Supreme Court in Harris v. McRae (448 U.S. 297, 1980) and Williams
v. Zbaraz (448 U.S. 358, 1980) ruled that the federal and state governments have no obligation to provide
funds for the exercise of the right to abortion. Today, thirty-two states prohibit the use of state funds (but
have to meet the federal exceptions). The remaining use their own funds to pay for all or most medically
needed abortions, although most do so as a result of a court order under their individual states
constitutions (Merz et al, 1995, 1996; Alan Guttmacher Institute, 2011). In defiance of federal
requirements, South Dakota limits funding to cases of life endangerment only.
Since Roe, numerous states have also enacted parental notification or consent laws requiring that
minors notify parents or obtain their consent before an abortion can be performed. These laws are known
as Parental Involvement laws (PI laws). Courts have generally upheld laws that incorporate a judicial
bypass mechanism, which allows a minor to petition a court for permission to have an abortion without
involving parents. Much litigation arose challenging these laws and most of them remained unenforced in
the middle and late 1970s/early 1980s. Today, thirty-five states require parental involvement in minors'
abortions (legislation on Parental Involvement laws is reviewed in detail in Chapter three).
In 1992, the Supreme Court's ruling in Planned Parenthood v. Casey (505 U.S. 833, 1992)
retained the essential holding of Roe that women have a right to terminate their pregnancy before fetal
viability, but allowed states to restrict abortion access so long as these restrictions do not impose an
"undue burden" on women seeking to terminate their pregnancy. The Court's decision upholds Parental
Involvement laws, as well provisions requiring information to be offered to women about abortion
procedures and alternatives to abortion, and mandating a waiting period before the procedure can be
performed. In 1992, Mississippi became the first state to enforce such a policy. Currently, twenty-four
states require a woman seeking an abortion to wait a specified period of time, usually twenty-four hours,
between when she receives counseling and the procedure is performed. Six of these states have laws that
require the woman make two separate trips to the clinic to obtain the procedure.


6

The Casey's

decision represented an important change for evaluating the constitutionality of

abortion regulations and leads the way for further enactment of PI laws as well as other regulations.
Furthermore, over time states imposed a series of regulations on abortion facilities governing a range of
operational aspects that are not typically imposed on other types of medical providers (Medoff, 2009).
Some states also restrict private insurance coverage of abortion. More often, states have banned abortion
coverage in public employees' insurance policies or in other cases where public funds are used to insure
employees.
This description suggests that the current environment of abortion availability in the United States
has been shaped by a long series of judicial and legislatives interventions that took place in the past
decades. Knowledge of these aspects will help in interpreting and put into context the results of the
analysis of subsequent chapters. The next section describes the purpose of the study and the contributions
of this research, which are separately analyzed in chapters two and three, respectively. Chapter four
summarizes the contributions and discusses.

1.2

Purpose of the Study and Contributions
As described in the previous section, after Roe v. Wade the main source of changes in abortion

policy have been attempts at the state levels to impose restrictions on abortion access. The court ruling
itself, while legalizing abortion, left states some discretion to regulate the procedure. Furthermore, the
Court's decision did not mandate the provision of abortion services but allowed access to providers to
vary within and across states. 5
The available data suggest that the number of abortions increased dramatically following
legalization (although there is little direct evidence on the number of illegal abortions performed in the
1960s). According to the Alan Guttmacher Institute (AGI) the number of legal abortions (and abortion

4

Today five states have laws in effect restricting insurance coverage of abortion in all private insurance plans
written in the state. Twelve states restrict abortion coverage in insurance plans for public employees and other states
have more than one of the above restrictions.
5

The term abortion provider refers to any facility performing legal abortion services.


7
rates) rose sharply in the wake of Roe, from under 750,000 in 1973 to over 1.6 million in 1980 and then
started to decline, reaching about 1.2 million in 2005 (correspondingly, abortion rates rose from 16
abortions per thousands women in 1973 to about 29 in early 1980s and back to 19 in 2005). Previous
research has not been able to provide satisfying explanations for these patterns and in some cases has
been focused only on the role of government policies like Medicaid abortion funding restrictions or PI
laws. Notably, relatively little attention has been given to explanations focused on the supply side, despite
the data showing patterns in abortion rates and abortion providers being strongly interrelated, as depicted
in Figures 1 and 2.

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Source: Author's elaboration from Henshaw and Kost (2008).
Figure 1. National abortion rate 1973-2005.


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Source: Author's elaboration from AGI provider data.
Figure 2. Number of abortion providers 1973-2005.

From a policy point of view, it is important to know whether and to what extent abortion rates are
sensitive to changes in the legal availability of abortion services. This is relevant because the
constitutional right of a woman to terminate her pregnancy as established in Roe may be undermined if
constraints in access to abortion, which are not related to demand factors, impose an undue burden on the
choice to terminate the pregnancy. In this context, the number and geographic distribution of providers
may be an important determinant of access.
The manner in which abortion availability affects women's behavior is important as the analysis
of this issue allows answering several questions. Does the change in availability of abortion services alter
the frequency of abortions? Does it affect also women's sexual and contraceptive behavior? Does it imply
a differential impact across different groups of women? These issues can be examined in the framework
of economic analysis of fertility. The decision of terminating a pregnancy depends on the net benefit from


9

another child and abortion can be considered as a means of ex-post fertility control. In this context,
abortion decisions are function of cultural and religious values as well of all factors that affect the full
cost of having children and the full cost of obtaining an abortion. Reduced geographical access to
abortion providers has a direct effect on the full cost of services by increasing the distance women have to

travel to get an abortion. Lack of local services makes it harder for women to obtain information about
facilities. Costs increase because of travel expenses; post-abortion complications are more difficult and
costly to be treated; and women have to be away from work and home for a longer period.
While some previous studies did attempt to assess the direct impact of variations in the local
availability of abortion services on abortion demand, they have been limited in their ability of providing
estimates of a causal relationship. Thus, the research question I want to answer in the first part of this
study (chapter two) is whether changes in the supply of abortion services affect abortion rates and thereby
uncover whether there is a causal connection between the seemingly interrelated patterns in abortion rates
and abortion providers observed in the data. In doing this, this chapter complements and extends previous
research in several ways.
First, 1 use a panel of U.S. counties and a fixed effects model design to obtain more robust
estimates of the impact of changes in availability of abortion services on abortion rates. The use of
variation in availability of abortion services within counties over time allows me to more plausibly limit
the influence of potentially confounding factors which greatly vary across geographic areas and may
confound the estimates of the impact of abortion availability (like social and community norms toward
sexual activity or attitudes toward abortion). 1 use counties as geographical reference unit of analysis
because they define a more proximate market for abortion services compared to states or metropolitan
areas employed in most of previous research. To the best of my knowledge, this is the first study to use a
large panel of U.S. counties to analyze the issue of abortion availability.
In addition, the majority of previous research neglects the problem that demand and supply of
abortion services are simultaneously determined. To address this limitation, I implement an instrumental
variable approach to control for the fact that measures of provider availability are potentially endogenous.


10

Finally, overall population abortion rates mask large differences across demographic groups. Thus, I also
stratify the analysis according to women's demographic characteristics which, according to economic
theory, may signal different behavioral responses to changes in availability of services.
The results of the analysis carried out in chapter two shows that reduced availability of abortion

providers is associated with a decline in abortion rates over the sample period considered and results are
robust across a wide range of specifications. I provide evidence that the instrumental variables procedure
is valid and that estimates of the correlation between abortion rates and access to abortion services can be
plausibly interpreted as causal. As described at the beginning of this section, the data document a
substantial decline in both abortion rates and the availability of providers after the early 1980s. My
results, which consistently indicate that decreased access to services leads to lower abortion rates, confirm
the broader direction of these trends.
These findings are important from a public policy point of view. They indicate that provider
availability directly affects women's behavior as policies either expressly or indirectly limiting access to
abortion decrease women's use of the procedure. While, over the years, the U.S. Supreme Court has
generally struck down regulations that place an "undue burden" on women on their path to terminate a
pregnancy, it has usually applied this standard to specific restrictions. The findings of independent effect
of abortion availability in its broader dimension suggest that these standards should probably take into
account a broader range of restrictions and factors affecting abortion services and use across women.
In the second part of the dissertation (chapter three) I analyze the long term effects of abortion
Parental Involvement laws (PI laws) for minors. According to these laws, minors are required to either
notify a parent(s) or obtain their consent before terminating their pregnancy. After several years of battles
in lower court rulings, the United States Supreme Court has held that parental involvement does not
infnn°e on a minor's constitutional rights to terminate a pregnancy if judicial bypass options are
available. To gain a judicial bypass, a pregnant minor must demonstrate either that she is mature enough
to decide to have an abortion or that the procedure would be in her best interest. Today, the majority of
states enforce some form of parental involvement (notification, consent, or both) requirement (Figure 3).


11

H

State with PI law in effect

D

State without PI law in effect

Source: Author's elaboration from AGI (2011).
Figure 3. States with Parental Involvement laws in effect as of February 2011.

These laws have generated great controversy in the past decades in both court rulings and public
opinion. Supporters argue that excluding parents from minors' abortion decisions violate parental rights;
that the laws aid the decision making of immature minors and contribute to resolve family conflicts and
may generate significant increases in sexual abstinence and contraceptive use, thereby reducing
pregnancy rates. Opponents argue that parental involvement imposes an extra cost on minors and
emphasize that the reality of the judicial proceedings represents a biased legal avenue for minors to get an
abortion. The Supreme Court itself acknowledges the difficulty in measuring "maturity," but has
continued to use this as the standard for judges to evaluate minors' petitions. Furthermore, albeit the
Supreme Court has mandated expediency in judicial bypass, some courts are not prepared or willing to
hear bypass cases thereby causing delays. In addition, although approximately one third of states do not
have PI laws in effects, their geographic location de facto limit interstate travel as an option to minors
seeking an abortion. In sum, according to this view, the laws would impose a significant burden on
minors willing to terminate their pregnancy.