Impacts of Abortion Legalization and Restrictions
Paper Session
Monday, Jan. 5, 2026 8:00 AM - 10:00 AM (EST)
- Chair: Melanie Guldi, University of Central Florida
Response of Private Philanthropy to Holes in the Social Safety Net: The Case of Abortion
Abstract
In the United States, the lack of a national healthcare system has generated a patchwork of healthcare financing, where patients rely on private health insurance, Medicare, or Medicaid, and sometimes fall through the cracks. As a result, patients sometimes rely on philanthropy to access the care they need.In many states, abortion care is not covered under Medicaid, leaving many patients with low incomes unable to afford the care they seek. In response, philanthropic organizations called Abortion Funds (AFs) have, since the 1970s, provided financial assistance for care provision and practical support. Today, AFs play a significant role in abortion provision. In 2022, these organizations commanded more than $284m in revenue and assisted more than 194,000 patients, representing approximately 30% of total abortions reported by the CDC that year. We create the first data set with information on the operation of more than 100 local AFs, including ruling year, annual revenues, allocations to direct assistance vs. salaries, and geographic targeting, from 2009 to 2023. We examine how cuts to public funding for abortion and changes in abortion access policies drive the creation of AFs, their revenue generation, and their operational structure. Future work will examine the role of local AF spending in mitigating policy-induced reductions in abortion access. This work suggests impacts of out-of-pocket costs on abortion access. It also enhances our understanding of the abortion provision market, non-profit operations, and the philanthropic response to public policies more broadly.
The Road Not Taken: How Driving Distance and Appointment Availability Shape the Effects of Abortion Bans
Abstract
We use difference-in-differences research designs to estimate the effects of abortion bans on births at the county level, leveraging data on changes in driving distance and appointment availability at the nearest facility where abortion remains legal. We find that bans alone increase births, but their total impact depends on geographic barriers to access. Even in counties where distance and appointment availability remain unchanged, a total ban leads to a 1.0% increase in births, suggesting a chilling effect---potentially due to legal uncertainty, misinformation, or logistical hurdles---that is independent of measurable barriers. However, the effects grow substantially with travel burdens. In counties where the nearest abortion facility was 50 miles away pre-Dobbs, a total ban increases births by 2.8% when distance rises to 300 miles. Limited appointment availability in destination cities further amplifies these effects, resulting in an additional 0.4 percentage point increase in births. The largest increases occur among Black and Hispanic women, those without a college degree, and unmarried women. We do not observe evidence that the effects have diminished with time despite expanded logistical, financial, and telehealth abortion support, underscoring the persistent role that geographic barriers play in abortion access.Abortion Ballot Measures and Voting Behavior
Abstract
Can abortion ballot measures generate electoral spillover effects, and for whom? We exploit the geography of US media markets to isolate the effects of abortion ballot measures in 2022 and 2024 from related television advertising. We find that abortion ballot measures decreased the Republican vote margin in US House elections by 4.8 percentage points in 2022 but increased the margin by 4 percentage points in 2024. We discuss how these contrasting results can be explained by two mechanisms: a decrease in turnout in ballot states in 2024 and vote switching in 2024 such that voters separated their opinion on abortion from their choice of partisan candidate. We also provide the first evidence on the process via which abortion measures appear on the ballot: counties that have lost access to abortion providers in the prior year contribute more signatures towards ballot measure petitions.Discussant(s)
Melissa Spencer
,
University of Richmond
David Slusky
,
University of Kansas
Kelly Jones
,
American University
Caitlin Myers
,
Middlebury College
JEL Classifications
- I1 - Health