Waiting Periods and the Rising Price of Abortion

Several states have recently enacted laws that require a delay between abortion counseling and the procedure itself. In some cases, this can drive up the cost by hundreds of dollars.

William Philpott / Reuters

There’s a new type of abortion roadblock that’s swiftly gaining popularity: a state-imposed wait between the day a woman decides to have the procedure and the day she can actually get one.

In recent weeks, Oklahoma tripled the length of its waiting period, becoming the fourth state with a 72-hour (three-day) delay. Florida enacted a 24-hour waiting period between two different appointments—one for an ultrasound and another for the procedure. Arkansas Governor Asa Hutchinson signed a two-day waiting-period bill last month—and simultaneously made the state the record-holder for the number of abortion restrictions passed in 2015 so far, advocates say. Tennessee passed a 48-hour wait just last week. Twenty-six states in all now impose these mandatory delays.

Proponents of these measures say they are simply injecting more time into the process so that women can fully consider their choices. “This legislation will help women get the information they need before making a decision they can’t take back,” Oklahoma Governor Mary Fallin said after she signed that state’s bill. “It will allow for more time to consider medical risks as well as explore alternatives to abortion, such as adoption.”

But opponents say waiting periods represent another attempt by pro-lifers to bring about the end of abortion by a thousand restrictions—from legislating the widths of clinic hallways, to requiring doctors to (wrongly) tell their patients that there’s a way to reverse abortions, and now this. Pro-choice advocates point out that most women don’t reconsider having an abortion once they’ve already resolved to have one. A 2008 study of 49 women published in Social Work in Health Care found that most patients had already made up their minds by the time they called the clinic.

The waiting periods’ most egregious toll, pro-choice advocates argue, is the amount of hassle and cost that comes with them, especially in the 11 states that require counseling before the wait begins. Abortions are already too expensive for some women to easily afford, they say.

“The forced delay would create needless and burdensome logistical and financial barriers,” said Jessica González-Rojas, the executive director at the National Latina Institute for Reproductive Health, in a statement opposing the Florida bill. “Furthermore, these policies would have a disproportionately negative impact on Latinas, immigrant women, young women, and women of color across the state, who already struggle to get the care they need.”

Take Missouri, which passed its 72-hour waiting period last fall. Under that state’s law, according to the Guttmacher Institute, a woman seeking an abortion must receive in-person counseling, then wait three days, then return to the clinic for the procedure. During counseling, the women are handed materials declaring that life begins at conception and, if they are 22 weeks along or further, that a fetus can feel pain.

As of February, there was only one abortion facility in Missouri, the Planned Parenthood in St. Louis. Colleen McNicholas, the doctor who provides abortions there, told Think Progress, “From the perspective of the women we care for, the biggest issue is economic. In Missouri, insurance, both private and public, are prohibited from covering the cost. That leaves women scraping by to find the cash to get the care.”

But that was last January, when the wait was still 24 hours. What is it like to get an abortion in Missouri now?

There are very few modern studies on just how much waiting periods ratchet up the price of an abortion. In a 2014 study, researchers asked women who sought abortions at 30 different clinics in the U.S., “Did anything slow you down and prevent you from getting to the [clinic] earlier in your pregnancy?” Costs and the travel involved were the top reason the women gave. (A similarly important reason was not realizing they were pregnant, but only among women in their first trimester.) “It was probably travel costs, procedure costs, not knowing who I would have to come with me on the four-day adventure,” one of the participants said.

‘Why Didn’t You Come to the Clinic Earlier?’

History also provides one strangely fitting example: In 1981, researchers for one study interviewed Tennessee women after the state enacted a counseling and waiting-period law two years prior (the waiting period was struck down in the state in 2000, then re-imposed recently). The study found that 62 percent of women said the second visit increased the cost of the abortion because of lost wages, transportation, and childcare expenses. The requirement made the abortion more expensive by 48 percent for poor women and by 14 percent for richer ones (possibly because it was more costly for employed women and those in rural areas to take time off work and travel to the clinic). Three-quarters of the women said they couldn’t name a single benefit of the waiting period, but more than half of them said the delay caused problems for them. The median additional costs of the abortion added up to $24—but this was back when the procedure cost just $50 to $175. Today, the price is between $470 and $1,320.

More recently, the Texas Policy Evaluation Project surveyed about 300 women who sought an abortion in Texas a year after the state passed a series of abortion restrictions in 2011. Nearly half of the respondents said they faced additional expenses because of the 24-hour waiting period, and they spent an extra $146 on average. But again, this was only for a 24-hour pause. In Missouri, meanwhile, women now have three days to ruminate on their decision. Women who were raped are not exempted.

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I thought it would be interesting to see what a woman in Jefferson City, a town roughly equidistant from Kansas City and St. Louis, would face if she wanted an abortion today.

At the Planned Parenthood in St. Louis, an abortion costs $545 before 12 weeks of gestation. (I’ll assume our person made an appointment almost as soon as she missed a period). Financial assistance is available, but not for everyone. The clinic doesn’t perform either counseling or abortions on Sundays, so the woman must arrive on a Monday or later. Once there, she would undergo counseling, sign a form, and begin her wait.

Jefferson City is two hours and 10 minutes away from St. Louis, or 133 miles. It’s even farther from the abortion clinics in Illinois, Iowa, or Arkansas, which supporters have suggested as alternatives to a Missouri abortion under the new law. Unless the woman opts to commute 4.5 hours on both days, she’ll need lodging in St. Louis and, if she has children, childcare. The cheapest hotel room in St. Louis in June, when I checked Kayak.com a few days ago, is at America’s Best Value Inn and Suites and goes for $38 a night. After taxes and fees, the hotel comes to $138.45 for all three nights. At a gas price of $2.59, Gas Buddy says the round-trip fuel expenses would total $22.88. (Let’s say this woman, like me, drives a 2008 Nissan Versa that gets about 30 miles to the gallon with regular maintenance.) Some of the cheapest childcare offerings in the Jefferson City area on Craigslist run about $100 per week, or about $60 for three days.

This is only a back-of-the-envelope calculation, of course, but already, the hypothetical Missourian is running a $221 tab—not including the cost of the procedure. This tally also doesn’t include the cost of lost wages, fast food, and other sundry needs, since those are too variable to predict. In other words, if she chooses to stay in St. Louis for the wait, the non-abortion costs of her abortion add up to nearly half the cost of the abortion itself.

Jefferson City has 43,000 residents. About a third of them are of reproductive age, not including minors (who face additional abortion hurdles in the state), so about 6,000 women in this city alone could be affected. There is another abortion clinic across the river from St. Louis—in Granite City, Illinois, a state that does not have a waiting period—but to go there Missouri women would have to know about it, understand the difference in the states’ laws, and, for anyone near the center of the state, still drive for hours.

Granted, the state’s lawmakers have argued that this is a perfectly reasonable framework to impose on a woman who, as some believe, is extinguishing a human life. When the Missouri law was enacted, its sponsor, the Missouri state Senator David Sater, said, “I’m sure the unborn child probably would like to see an extra 48 hours for the mother to decide on whether or not to have the abortion done.”

Even if that’s true, medically speaking, the fetus in question would not be able to appreciate the difference. The brain structure that supports consciousness only begins to take shape between 24 and 28 weeks of gestation, but Missouri has also outlawed abortion after 21 weeks and six days.