Impact of distance to provider and state-level abortion restrictions on abortion rate
Awarded 2017
Complex Family Planning Fellowship Research
Benjamin Brown, MD
The University of Chicago

Over the past 10 years, collectively, states have proposed and/or enacted hundreds of restrictions on abortion. Some restrictions are directed at adolescents and women (e.g., parental involvement laws, biased counseling requirements, restrictions on state funding for abortion, mandatory waiting periods) which for many may prevent them from accessing abortion. Other restrictions are directed at abortion providers (e.g., targeted regulations of abortion providers, or TRAP laws).  Complying with such restrictions may be prohibitively expensive or challenging and, as in the case of Texas’ HB2, result in clinic closure. Thus, state-level restrictions may restrict women in seeking abortions (reducing demand) or prevent clinics from providing abortion (affecting supply). State geography is another critical factor that must be added to this complex picture of supply and demand. Even in the absence of restrictions, distance to care may present a barrier to family planning services. In larger, more sparsely-populated states, many women do not live close to an abortion provider and may be required to invest significant time, money, and effort to access abortion care. However, this relationship is difficult to study rigorously as intrinsic demand for abortion care may also contribute to providers’ decisions about where to locate their practices. For example, an observed correlation between distance to provider and abortion rate may be evidence that the further a woman lives from a provider, the harder it is to access abortion. Alternatively, however, this observered correlation may mean that providers choose to establish their practices in areas with higher demand and that those living far from the provider have little demand for abortion. This type of relationship, in which the value of the explanatory variable is partially determined by the outcome variable, is called endogeneity (an econometric term). Robust models are needed to elucidate the interaction between state-level abortion restrictions, state geography, and abortion rates. The proposed study will examine the impact of distance to provider and state-level abortion restrictions on abortion rates and the ratio of abortions to births (abortion ratio). We will use high quality data from the Guttmacher National Abortion Provider Census, supplemented by data from the Centers for Disease Control and Prevention (CDC). Adopting a technique previously validated by one of this study’s mentors, we will use college-enrolled female population as an instrumental variable to adjust for endogeneity in the distance to provider / abortion rate relationship. This study will help to disentangle the relationship between abortion supply and abortion demand and will show whether less availability of abortion prevents women from obtaining abortion and increases the rate of births. This question is an important one as it can help to demonstrate that these myriad abortion restrictions may be associated with an undue burden for women seeking abortion.