Two-visit counseling law delays timing of abortions, Mississippi data show
Mississippi’s mandatory abortion delay law, under which a woman must receive counseling information at one visit and the procedure at a second visit, has led to an increase in second-trimester abortions, according to new research using Mississ- i ppi data.
The later abortions were performed more often on women who lived relatively far from an out-of-state provider not subject to the two-visit requirement than on residents who lived near a border with another state without the two- visit mandate, says lead researcher Ted Joyce, PhD, a professor of economics at Baruch College in New York City. His research is published in the January/February issue of the Alan Guttmacher Institute’s Family Planning Perspectives.
Delay laws generally mandate that a woman seeking an abortion first receive information about the gestational age of the fetus, risks associated with induced abortion, and alternatives to the procedure. She then must wait at least 24 hours before having the procedure. Some laws require that the information be provided in person, a condition that often means a second clinical visit is needed.
State interest in delay laws was spurred by a 1992 U.S. Supreme Court decision that let stand a Pennsylvania law mandating that women wait at least 24 hours after receiving state-provided information on abortion before they can terminate their pregnancy.
Are two visits necessary?
The court said the mandatory waiting period did not impose an "undue burden" on a woman’s right to an abortion. Since the decision, 19 states have passed waiting period legislation. Advocates for the bills say they help ensure that women make more informed choices about their decision to terminate a pregnancy.
"No one objects to the idea that women receive information so there can be informed consent," Mr. Joyce tells State Health Watch. "The problem is with requiring two visits."
Many states require delay
Fourteen states (Idaho, Indiana, Kansas, Louisiana, Michigan, Miss iss ippi, Nebraska, North Dakota, Ohio, Pennsylvania, South Carolina, South Dakota, Utah, and Wiscon sin) require a delay following state-directed counseling before a woman can receive an abortion, according to the Guttmacher Institute.
The procedure delay requirement has been enjoined in Delaware, Kentucky, Massachu setts, Montana, and Tennessee. In eight states (Alaska, California, Connecticut, Maine, Minnesota, Nevada, Rhode Island, and Vir ginia), state-directed counseling is required without a delay.
Mr. Joyce, who testified as an expert witness at a March court hearing on an American Civil Liberties Union suit against the Kentucky law, says the impact on later-term abortions in Mississippi would have been greater still if more of its neighboring states had laws that required two visits.
"As the borders start to close, women are forced to travel greater distances to avoid the delay," he says, "and often they can’t afford to do that. So as these laws spread, their impact will be greater."
Increased cost means delay
After enactment of the Mississ ippi law, the review of state health depart ment records found, the proportion of second-trimester procedures increased by 53% (from 7.5% of abortions to 11.5%) among women whose closest provider was in-state, but it increased by only 8% (from 10.5% to 11.3%) among women whose closest provider was out-of-state.
The additional required informational visit increases the cost of an abortion in travel time, lost work time, and possible overnight stays, the research report says. For women with children, there also may be additional child-care expenses. Surveys of women who obtain abortions indicate that financial and logistical considerations are significant reasons for any delay.
The Mississippi law seemed to have an impact, separate from other factors, in delay in seeking an abortion, the researchers say. Except for being young — age 18 or 19 — no other risk factor, including race, has a larger impact on the timing of abortion than does enactment of the mandatory delay law, says Mr. Joyce.
The Guttmacher Institute’s Stanley Henshaw, PhD, said he found it surprising that requiring women to make two trips to a clinic would have a big impact, but the statistics indicate that it does. "Another study showed that 10% of women can’t have an abortion if they have to make two trips," he reported.
The abortion rate declined during the study period for Mississippi women whose closest provider was in-state, but it increased among women whose closest provider was out-of-state.
The latest Mississippi research followed 1997 research conducted by Mr. Joyce and Mr. Henshaw that was published in the Journal of the American Medical Association. That study found that Mississippi’s delay statute was responsible for a substantial and statistically significant decline in abortion rates among state residents 12 months after the law took effect. It also found corroborating increases in the percentage of abortions performed out of state and the percentage of abortions performed after 12 weeks’ gestation. No similar changes were found in two comparison states, Georgia and South Carolina.
An increase in out-migration
In his testimony in the Ken tucky lawsuit against a mandatory delay law, Mr. Joyce said the Mississippi experience included an increase in out-migration for abortions, a decrease in in-migration, and an increase in the proportion of second-trimester procedures.
"It seems that abortion policy is being fought out in the state legislatures," he said. "There is an attempt by those who are opposed to abortion to use mandatory delay and parental notification to make it more difficult."
The impact of the laws will vary somewhat by geographic location, he says. A mandatory delay law probably would have very little effect on the timing of abortion in small Eastern states such as Massachusetts, Rhode Island, and Connecticut, Dr. Joyce says, where women can easily cross state lines for abortions.
The same would be true for women in much of New Jersey, Maryland, and northern Virginia, as long as providers in New York City and Washington, DC, do not require two visits.
Two-visit requirements in large Western states, where relatively few women can easily travel out of state for an abortion, would have a greater impact on the timing of abortion, and that effect might even exceed the changes observed in Mississippi, he says.
"The Impact of Mississippi’s Man datory Delay Law on the Timing of Abortion" appeared in the January/ February 2000 issue of Family Planning Perspectives, which is published by the Alan Guttmacher Institute.
Contact Mr. Joyce at (212) 802-5962 and Mr. Henshaw (212) 248-1111, ext. 2280.
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