The Geography of Abortion
Few issues divide Americans more severely than abortion. Even accounting for changes in the nation's political climate over time, polling numbers consistently show a close to even split in the percent of the population who identify as pro-life or pro-choice. And given the variation in abortion laws across the 50 states, that divide has a definite geographic dimension as well.
With the help of my Martin Prosperity Institute (MPI) colleagues Charlotta Mellander and Zara Matheson, I took a detailed look at abortion rates across the 50 states and the District of Columbia as well as the economic, cultural, and political factors that bear on them. We used two systematic data sets, one from a report released in late 2011 by the Centers for Disease Control and Prevention and another from a 2011 paper from the Guttmacher Institute, the pro-choice women's reproductive health advocacy organization. These data cover both where abortions occurred and the states of residence of the women who obtained them.
The first map above shows the geography of abortions by the states in which they occurred, based on data from the Guttmacher Institute. Thirty-seven states are below the national average of 19.1 abortions per 1,000 women. The lowest rates are in the Plains, Sun Belt, and Rocky Mountain states. Fourteen states have rates of less than 10 per 1000: Wyoming, Mississippi, Kentucky, South Dakota, Idaho, Missouri, West Virginia, Utah, Wisconsin, Nebraska, Indiana, Arkansas, Louisiana, and Oklahoma. Thirteen states plus the District of Columbia, mainly on the East and West Coasts, have rates above the national average.
The second map, based on data from the CDC, charts the incidence of abortion by the state of residence for the women who obtained them. While overall the lowest rates remain in the Plains, Rocky Mountain, and Sun Belt states and the highest rates in states on the East and West coasts, the detailed picture changes somewhat. The District of Columbia, for example, has a much lower rate of 9.8 per 1,000 compared to South Dakota, Iowa, and Kansas. Virginia numbers among the top 10 states, with a rate comparable to New Jersey. Georgia and Texas number among the top dozen or so, with rates comparable to Illinois and Pennsylvania.
A 2005 study in the Annual Review of Public Health found that “nearly one-quarter (24 percent) of women seeking an abortion travel 50 miles or more to find a capable physician." The third map, above, also based on CDC data, shows the percent of abortions obtained by out-of-state residents, a clear indicator of the states to which women are traveling to obtain abortion services. Here, the pattern is more mixed. The District of Columbia, not surprisingly since it is the only 100 percent urban jurisdiction, has the highest rate of abortions obtained by out-of-state residents. But Kansas and North Dakota have the next two highest rates, with nearly half and more than a third of abortions respectively obtained by women from out of state. Tennessee, Alabama, South Dakota, North Carolina, Arkansas, Iowa, Kentucky, Georgia and Utah also rank among the top 20 states on this measure.
A detailed 1994 NBER study found that restrictions on Medicaid funding for abortion result in “lower aggregate abortion rates in-state and higher abortion rates among nearby states," suggesting one of the main effects of these policies is to induce cross-state migration for abortion services. A 1997 study found that the variation of abortion rates turns on such issues as "whether there are abortion services nearby, whether state laws restrict access for minors, whether the community supports and tolerates abortion as a reproductive option, whether hospitals offer abortion services, and whether physicians perform abortions and provide referrals."
Access to abortion services is stunningly unequal. Nearly nine in 10 (87 percent) of U.S. counties, home to more than one-third of women of reproductive age, lacked any abortion providers, according to a 2011 study. Nearly all non-metropolitan counties (97 percent), and roughly seven in 10 metropolitan counties lacked a provider. There are 26 states where 90 percent of counties lack an abortion provider. Conversely, there are only seven states where abortion providers are available in more than half of all counties.The map below depicts the percent of counties without an abortion provider
Mellander and I looked at the key economic, cultural, and demographic factors that might also be associated with the state-by-state variation in abortion rates, running correlations for both the states where abortions occurred and the states where the women who obtained them resided. As always, I hasten to add that correlation is not at all the same thing as causation, and point only to association between variables.
First and foremost, the geography of abortion follows the red and blue political patterning of the states. It is positively associated with the share of state voters who voted for Obama in 2008 (.60 to .65) and negatively associated with McCain votes (-.58 to -.63). This is a dramatic change from 1974-1988, the period covered by the 1994 NBER study, which found that “extensive Republican or Democratic control in a state is uncorrelated with abortion rates." It is however in line with a 2011 study which found that:.
“Geographically speaking, the states that adopt unrestricted policies tend to be located in the Northeast and on the West Coast. The restricted funding states, on the other hand, call the Midwest and the South home. This regional breakdown generally does reflect the predictable red state, blue state divide.”
The geography of abortion also tracks that of religion. A state's abortion rate is negatively associated with the share of residents who say religion is a very important part of their daily lives (roughly -.4 across the board).
Some social conservatives contend that abortion is associated with declining moral standards; that restricting access to abortion serves somehow to strengthen marriages and families. But we found that abortion rates are somewhat negatively associated with divorce rates (with correlations of roughly -.30) and even more so with the rate of serial marriages (individuals who have been married more than three times), with correlations ranging from -.43 to -.49. In other words, the higher a state's abortion rate, the stronger its marriages appear to be.
The geography of abortion reflects that of openness and diversity. Abortion rates are positively associated with the percentage of residents who are foreign-born (with correlations ranging from .52 to .75) and the percent that identify as gay or lesbian (from .45 to .57). Race, however, does not appear to play a role in abortion rates, with most correlations being insignificant and just a few weakly significant.
Abortion is most strongly associated with the fault-line of socio-economic class, across three key dimensions—income, education, and occupation. Abortion rates track closely with the wealth and affluence of states: the richer the location, the higher the rate of abortions (the correlations between the two range from .53 to .65). This effect is in line with previous studies and thus appears to be of long standing. This is in line with the findings of the 1994 NBER study which found a correlation of roughly .50 between state abortion rates and per capita income, and also a strong positive correlation between abortion rates and increases in per capita income over more than a decade.
The abortion rate is positively associated with the share of adults who are college graduates (with correlations ranging from .37 to .54). It's also positively associated with the share of the workforce doing professional, technical, and creative work. (Two of the three correlations, .33 and .44, are statistically significant, but the third, .21, is insignificant.) And abortion rates are negatively associated with the share of the labor force in blue-collar working class jobs (with correlations ranging from -.36 to -.64)
While the issue of abortion is typically posed in political or moral terms, its geography reflects the stark reality of class in America. Abortion and reproductive health services are more readily available in more affluent, more educated, more knowledge-based states, while women in poorer states with more traditional blue-collar economies face fewer, if any, choices for reproductive health services and must contend with far greater restrictions on their reproductive rights.
Top image: Reuters/Jim Young