摘要：Objectives. To determine the socioeconomic consequences of receipt versus denial of abortion. Methods. Women who presented for abortion just before or after the gestational age limit of 30 abortion facilities across the United States between 2008 and 2010 were recruited and followed for 5 years via semiannual telephone interviews. Using mixed effects models, we evaluated socioeconomic outcomes for 813 women by receipt or denial of abortion care. Results. In analyses that adjusted for the few baseline differences, women denied abortions who gave birth had higher odds of poverty 6 months after denial (adjusted odds ratio [AOR] = 3.77; P < .001) than did women who received abortions; women denied abortions were also more likely to be in poverty for 4 years after denial of abortion. Six months after denial of abortion, women were less likely to be employed full time (AOR = 0.37; P = .001) and were more likely to receive public assistance (AOR = 6.26; P < .001) than were women who obtained abortions, differences that remained significant for 4 years. Conclusions. Women denied an abortion were more likely than were women who received an abortion to experience economic hardship and insecurity lasting years. Laws that restrict access to abortion may result in worsened economic outcomes for women. Since 2011, hundreds of state-level restrictions on abortion have been implemented in the United States. Little is known about the socioeconomic consequences for women and families if women are not able to obtain a wanted abortion. When women are asked why they want to end a pregnancy, the most common reasons are financial—in particular, not having enough money to raise a child or support another child. 1–3 Yet no research has evaluated the economic consequences for US women of being unable to terminate an unwanted pregnancy and carrying the pregnancy to term. The lack of evidence about the socioeconomic consequences of barriers to abortion services is largely the result of methodological challenges related to study design and the identification of appropriate comparison groups. 4–6 Given that preexisting economic difficulties contribute to a woman’s decision to terminate a pregnancy, studies that compare socioeconomic outcomes of women who receive abortion services to women who do not choose to terminate a pregnancy may not identify the effects of abortion, but instead may reflect the characteristics that lead women either to seek abortions or carry a pregnancy to term, such as poverty, lack of education, and younger age. 7,8 We aimed to examine the effects of receiving versus being denied a wanted abortion on women’s socioeconomic well-being by following a group of women who all sought abortions, some of whom were denied services. Facility and state-imposed gestational age limits restrict abortion for women whose pregnancies are past the limit. Women who request services immediately before a facility’s gestational limit are potentially similar to women who seek services immediately after the limit, but women in the former group receive the abortion whereas the latter do not. Gestational limit thresholds provide a quasi-experiment that can reveal the consequences of denial of abortion services on household structure, employment, income, use of public assistance, and poverty in the 5 years after seeking abortion.
