Nearly half of women who have abortions live below the federal poverty level

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A wave of anti-abortion legislation in a handful of states has kept the spotlight on one of the country’s most contentious issues.

Republican Missouri Gov. Mike Parson, for example, signed a bill in May that would ban abortion at eight weeks of pregnancy with no rape or incest exceptions, though a federal judge in August blocked the law from taking effect. Republican Alabama Gov. Kay Ivey signed the nation’s most restrictive abortion law in May, making it a felony to perform abortions in most cases and drawing legal challenges ahead of its implementation.

Meanwhile, Republican Georgia Gov. Brian Kemp signed a law in May banning abortion once fetal cardiac activity can be detected, typically around six weeks — not long, critics say, after a woman might discover she is pregnant. (Supporters of the legislation call it a “heartbeat” bill, a term some doctors have criticized.)

A federal judge temporarily blocked that law on Tuesday from taking effect.

Such restrictions aren’t just about limiting when and under what circumstances women can get abortions — these laws can also affect how much the procedure costs, research suggests. And those who are denied the procedure fare worse economically, some studies have shown.

The average cost of a surgical abortion at 10 weeks hovers at $508

Nine in 10 abortions are performed within the first 13 weeks of pregnancy, according to the Centers for Disease Control and Prevention, and their cost can vary widely.

The average cost of a surgical abortion at 10 weeks was $508 in 2014, according to the Guttmacher Institute, a reproductive-health think tank that supports abortion rights, with the price tag ranging from $75 to $2,500. Early medication abortion (also known as EMA or the abortion pill) at 10 weeks cost $535 on average, with costs ranging from $75 to $1,633.

While the reproductive-health think tank has yet to publish such data beyond 2014, its researchers haven’t observed any steep rise in cost, according to Guttmacher Institute principal research scientist Rachel Jones. “After adjusting for inflation, the cost doesn’t really increase that much,” Jones told MarketWatch.

But how that average cost bears out across states, providers and numerous other variables, Jones said, remains “a big black box.”

A state’s abortion-policy climate can, however, factor into how much a facility charges. For example, 34 states mandate that women receive pre-abortion counseling, and 27 states have instituted a typically 24-hour waiting period between the counseling and the procedure. Fourteen states require in-person counseling.

Laws that require two visits to a clinic are associated with a $107 increase in the price of an abortion, according to a 2015 analysis of two-visit and Targeted Regulation of Abortion Providers laws.

“Restrictive state abortion laws may impose additional expenses on the providers of abortion in order to comply with the laws,” author Marshall Medoff wrote. “As a consequence, restrictive state abortion laws may increase the price of an abortion as abortion providers pass the additional costs of complying with the laws on women seeking an abortion.”

Abortions in the second trimester of pregnancy costs substantially more

The price doesn’t always seem to track with the restrictiveness of a state’s laws, according to 2017 research co-authored by Jones.

• The average cost of a first-trimester surgical abortion in states with few abortion restrictions like California, New Jersey and New York was $402 after adjusting for the cost of living.

• In states like Alabama, Arkansas and Mississippi — which researchers described as “hostile” to abortion because of their relatively restrictive laws — that average cost was $442.

• In “middle-ground” states like Alaska and New Hampshire, it was $470. “There’s no clear-cut pattern or understanding,” Jones said.

• Prices tend to rise after the first trimester, said Jones, due in part to procedures taking more time and requiring more skill on the provider’s part. Women who obtained second-trimester abortions with out-of-pocket costs paid an average of $854 versus $397, 2013 research published co-authored by Jones found.

Missouri, Georgia and Alabama don’t allow Medicaid to be used for abortions

Insurance coverage for abortion varies. Many states have restricted coverage through private insurance or insurance-exchange plans, and several also restrict abortion coverage in public employees’ health-insurance plans.

The 1977 Hyde Amendment prohibits using federal funds to pay for abortion except in cases of rape, incest or a life-threatening condition, but about 16 states allow state Medicaid funds to be used for other medically necessary abortions. (Missouri, Georgia and Alabama are not among the states that extend abortion coverage to Medicaid recipients.)

A majority of abortion patients pay out of pocket for the cost — even those with private insurance, Jones said.

About 35% of abortion patients in 2014 said they had Medicaid coverage, while 31% reported having private health insurance. But more than half of patients (53%) paid out of pocket for their abortions, 24% used Medicaid, 15% used their private insurance to pay, and 14% had financial assistance. Six in 10 women with private health insurance paid out of pocket.

Nearly half of women who have abortions live below the federal poverty level

Researchers also know that 75% of women who obtain abortions are low-income, with nearly half living below the federal poverty level. “It’s likely a substantial expense for a lot of people — and probably enough of an expense that it prevents some women from getting abortions,” Jones said.

Restrictive abortion laws that require an extra trip to a clinic may introduce “logistical challenges and costs” that “act as barriers to care for low-income women,” according to the Guttmacher Institute. Having to travel long distances out of state can also increase costs, Jones added, given potential expenses related to food, overnight lodging, child care and lost wages from taking time off work.

Women who are denied abortions appear to endure far-reaching socioeconomic consequences, and this denial of services “exacerbates” the hardship of those already struggling to make ends meet, according to 2018 research published in the American Journal of Public Health.

Those who weren’t able to obtain an abortion were more likely to be living in poverty four years later; they were also less likely to have a full-time job and were more reliant on public assistance than women who received abortions.

“The net result may have serious adverse economic consequences for women and children,” the study authors wrote. “Laws that impose a gestational limit for abortion or otherwise restrict access to abortion will result in worsened economic outcomes for women.”

Randall K. O’Bannon, the director of education and research at the anti-abortion National Right to Life Committee, disputed the findings in the peer-reviewed research.

“The point is that whatever ‘economic advantage’ there is to aborting, it is minimal if it exists at all,” O’Bannon told MarketWatch in a statement. “Aborting a baby doesn’t lift these women out of poverty. Nothing here indicates abortion is what these women need to climb out of poverty, but pushing abortion as a solution only helps maintain the social and economic status quo.”

Despite the costs and concentration among low-income women, abortion is “probably the least expensive, biggest-bang-for-your buck procedure available in medicine” compared to many other medical procedures, said Sara Imershein, an obstetrician and gynecologist who provides abortions in Falls Church, Va.

“This is not a big money-making endeavor,” said Imershein, who sits on the board of the abortion-rights group NARAL Pro-Choice America Foundation. “Both the Planned Parenthood [clinics] and the independent clinics are here to serve the women who need abortion services, not to line their pockets.”