>The last couple of weeks I’ve been getting ready for the American Academy of Family Physicians’ Annual Scientific Assembly and the hearing of several controversial resolutions at our Academy’s Congress of Delegates, held last week in Chicago, Illinois.
One of the resolutions called for the protection of “physician-patient confidentiality” by restricting the information that insurance companies could send to the homes of minor children. It seems that some doctors object to parents being involved in their children’s health care, if it means that the parents will find out about “reproductive health services.” In other words, parents should pay for, but not know that they are paying for, their child’s birth control, treatment for STD’s and, I suppose, abortion.
Another resolution called for “the repeal of the Hyde amendment,” the rider that Congress has passed each year since 1976 to restrict federal funds from being used to pay for abortions except in cases of rape, incest and life of the mother. In other words, a few family docs are convinced that taxpayers should pay for elective abortions – those that are actually birth control.
Fortunately neither of these resolutions was passed and neither will become part of the position statements of the AAFP. However, during the testimony in front of the Reference Committees, there we heard the usual red herring arguments of increased teen Sexually Transmitted Diseases and the threat of increased illegal abortions.
Several of us were able to stand to tell the truth about abortion and abortion restrictions, as well as parental involvement laws and their effects on the abortion rates and health of minors.
Last month, LifeEthics posted a brief review of an article in the Journal of Law, Economics, and Organization Advance Access published online by Jonathan Klick and Thomas Stratmann on September 4, 2007 entitled, “Abortion Access and Risky Sex Among Teens: Parental Involvement Laws and Sexually Transmitted Diseases.”
The statistics show that state parental notification laws result in lower STD rates for teens in those states. The article also reviews some of what we know about laws that restrict abortion and their effects on health, pregnancy rates and abortion rates.
However, it is possible that passage of parental involvement laws will affect the incentives teenagers face, inducing them to engage in less risky sex which would decrease the demand for abortion without increasing the incidence of teen motherhood. That is, if teens implicitly view abortion as a form of birth control, increasing the psychic costs of obtaining an abortion through parental involvement laws may induce teens to substitute toward other forms of birth control such as condoms, birth control pills, or abstaining from sex altogether. For this substitution effect to occur, however, teens must be forward looking in their decision-making process regarding their sexual activities, and parental involvement must represent a nontrivial increase in the total cost faced by a teen when obtaining an abortion.
We examine the effect of parental involvement laws on the decision to engage in risky sex using Centers for Disease Control (CDC) data on the incidence of gonorrhea among teenage girls. Using gonorrhea rates among adult women to control for contemporaneous variation in unobservable characteristics of the state population, we find that parental involvement laws reduce teen gonorrhea rates by 20% for Hispanics and 12% for white teens. The effects are smaller and not statistically significant for young black women.
The results are robust to a wide range of empirical specifications. These results suggest that parental involvement laws reduce risky sexual behavior among teens as predicted by a model in which teens consider costs and benefits when deciding to engage in sexual activities.
When abortion was legal in a few states, those states had higher STD rates than the national average. When Roe v Wade made abortion legal in all states, the STD rates went up all over, to match those found earlier in the states with legal abortion on demand:
Klick and Stratmann (2003) attempt to avoid the data problem illegal abortions represent in examining pregnancy rates by focusing on the incidence of sexually transmitted diseases (STDs) as a proxy for the incidence of risky sex (Klick 2004). That is, since more sex in the aggregate and the substitution toward sex without a condom will both lead to an increase in STDs, increasing abortion access will lead to an increase in STD incidence if individuals are forward looking in their decision to engage in risky sex. Klick and Stratmann (2003)examine the ‘‘double experiment’’ provided by US abortion policy to examine this link. They find that when Alaska, California, Hawaii, New York, and Washington legalized abortion on demand in the period 1969–1970, the gonorrhea and syphilis rates in those states rose significantlycompared to the rest of the country. When the Supreme Court legalized abortion on demand nationwide in 1973, the STD gap between the early legalizers and other states disappeared.
We also know that parental notification laws decrease not only abortion rates for minors, but pregnancy rates as well.
Interestingly, in a more recent article examining the experience of Texas whose parental notification law went into effect in 2000, Joyce et al.(2006) find a significant effect on the abortion rates of those women covered by the law relative to 18-year-old women.
There’s also evidence that restricting funding for legal abortion does not increase illegal abortions. When the Hyde Amendment was first passed in 1976 to forbid federal funding of abortion, abortion rates went down but there were no increased rates of illegal abortion. The results of State restrictions on abortion funding were reviewed in the CDC’s Mortality and Morbidity Weekly in June, 1980 (no link available):
The present study in Texas found more than one-third of the legal abortions expected among Medicaid-eligible women were not obtained in the postfunding restriction period. The data cited from the present study are consistent with those from a previous investigation in Texas, which found approximately 40% of the expected number of subsidized abortions were not being obtained in the interval after the funding restriction . .. In Texas, pregnant, low-income women who do not have federal or state funds for abortions do not appear to be resorting to illegal abortions to terminate unwanted pregnancies . . . These findings are consistent with those from a national monitoring system, which also could not document that the restriction of public funds for abortion caused
a large percentage of Medicaid-eligible women to choose elf-induced or non-physician-induced abortions.
It’s important for each of us to become aware and involved in the making of public policy as much as we are able. We can save the lives of our children of tomorrow and improve the health of our children, today.