The Daily - Ending Roe Was Supposed to Reduce Abortions. It Didn’t.

Episode Date: November 29, 2023

From the moment that Roe v. Wade was overturned, the question was just how much the change would reduce abortions across the United States. Now, more than a year later, the numbers are in.Margot Sanger-Katz, who writes about health care for The Upshot, explains why the results are not what anyone had expected.Guest: Margot Sanger-Katz, a domestic correspondent for The New York Times.Background reading: The first estimate of births since Dobbs found that almost a quarter of women who would have gotten abortions in states that banned it carried their pregnancies to term.The first full-year census of U.S. abortion providers showed significant increases in abortion in states where it’s legal.For more information on today’s episode, visit nytimes.com/thedaily. Transcripts of each episode will be made available by the next workday. 

From The New York Times, I'm Michael Barbaro. This is The Daily. Today, from the moment that Roe v. Wade was overturned, the question was just how much it would reduce abortions across the U.S. Now, more than a year later, the numbers are in. And as my colleague Margo Sanger-Katz explains, they are not what anyone had expected. It's Wednesday, November 29th. Margot, just a few days after Roe v. Wade was overturned by the Supreme Court,

you came on The Daily to describe the new legal landscape of abortion in the U.S., what a new state-by-state post-Roe map of access and restriction was going to look like as a result of that court decision. And the question back then was, what was going to be the impact of that new map on the number of abortions in the U.S.? But of course, we didn't have any data back then. It's true. It was a really an open question. If all of these states banned abortion, what was going to happen to the women who used to have abortions in those states? Would they travel to another state and get an abortion anyway? Would they order pills from overseas through kind of not totally legal methods and have illegal abortions, would they have less sex or use more birth control and become less likely to be pregnant? Or would they end up carrying

pregnancies to term that they would have terminated in the past and there would be more babies? And because it takes a long time for a baby to gestate and be born, we have sort of been waiting for a long time to see what happened. And now, more than a year after Roe was overturned, we finally have the answer. And what is the answer? So the newest data that we have, and we think the best data, actually looked at how many births happened in the aftermath of the Dobbs decision. That was the decision that overturned Roe versus Wade. And what we found out is that in every one of the 13 states that banned abortion immediately after the Supreme Court decision, births increased. Every single one of them.

That's right. They didn't all increase by the same amount. And we can talk more about what I think is driving those differences. But it was a very consistent result across all of these states. And by how much did births increase in those 13 states? So the researchers that did this study estimated that in the first six months of this year, there were about 32,000 more babies born in those states than they would have expected. That's about a 2.3 percent increase. You compare states that banned abortions to the states that didn't ban abortions. And, you know,

that's a small difference. But when you think about how few pregnancies ended in abortion before, But when you think about how few pregnancies ended in abortion before, it's actually a pretty big difference. About 25 percent of women who we might have expected to end their pregnancies ended up carrying their pregnancies to term. rate in these 13 states represents the influence of Roe being overturned and these state abortion bans. Could anything else potentially explain higher birth rates in these states? So obviously, the research that's just looking at the number of births, it can't answer the question for any individual woman, you know, what did she want to do? What would she have done in a different policy environment? But the researchers did a very complicated economics style analysis where they looked at the trends before this policy change in all the states, and then they looked at what happened after the policy changed. And what they saw is that the states that didn't

ban abortion, things kind of looked about the same. You know, births were going down, they kept going down. If births were holding steady, they continued to hold steady. But in the states that banned abortion, there's a huge divergence. Like, there's a chart in the study that is just like, you see it and you're like, oh my goodness, something changed at exactly the time that you would have expected, which is that all of these states suddenly start seeing an increased births about six to seven months after abortion was banned in their state. Got it. So the researchers were able to say with some confidence, you know, they can't be a thousand percent sure.

But there's nothing else that really would explain why you would see this big change in trends in only these states. You had told us back in June of 2022 that when it comes to abortion access, bans in certain states would matter much more than bans in other states. So talk us through the geography of where these birth increases happened, where they were biggest or smallest, and what that tells us about this post-Roe map of abortion access. Yeah, so if you think about the typical patient who seeks an abortion, tends to be a relatively young woman in her 20s, a woman who already has another child, and I think very importantly, also a woman who is poor or close to poor. So these are women for whom long distances are a

really huge hurdle. They're going to have to find a way to get to a clinic in another state. They may have to take time off from work or arrange child care for their existing children. And so what our expectation was is that the further women had to go to get to the nearest abortion clinic, the more likely they were going to be deterred from having an abortion. Because just all of those financial and logistical hurdles were piling up and making it more difficult for them. And essentially what this new study shows is that that intuition was correct. If you look at the states that banned abortion, they are largely clustered in the South, where women have to travel the longest distance to get to an abortion clinic. Those were the places where we saw the largest increases in births. Give us some examples.

So Texas is a huge state with really large distances. And Texas saw the largest increase in births in this period. And the state that had the second largest increase in births is Mississippi. And that's a state that's surrounded by a lot of other states that also banned abortion. You know, Arkansas banned abortion, Tennessee banned abortion, and then heading north, Missouri, Kentucky. So hundreds of miles of travel to get to the nearest abortion clinic. And what we see again is that the births in those states increased by the most of any of the states that had abortion bans. So that makes sense. The impact of these bans is clearly greatest, where it takes the longest to get to a state where it's not banned.

What about in the states where abortion is banned, but neighboring states have not banned it, and therefore the distance to an abortion clinic is smaller? What does the data show there? abortion clinic is smaller. What does the data show there? So the data shows that where the distances are relatively short, there was still an increase in the birth rate, but it was not as large. And I think the best example of this is Missouri. In Missouri, before Roe was overturned, there was only one abortion clinic in the whole state, and it was located right near the Illinois border. So when Missouri banned abortion, that clinic closed. But women seeking an abortion only had to drive two miles further to get to the nearest clinic in Illinois than they did before. And so of all of the states that banned abortion, we see the smallest effect on

the birth rate in Missouri. We're talking about women crossing state lines to get abortions, but of course, that's not the only option. Does this data help us at all understand how many women in the states where abortion is banned are pursuing an abortion through other means? So it tells us a little bit about that. We have known for some time that women are ordering pills through these kind of quasi-legal means where they're getting them from other countries through the mail. So there are websites where you can go and order abortion pills. They come to you usually from India. And the largest provider of those pills has actually been publicly reporting the data on how many orders they've been getting. And we can see that the states

where they have been sending a lot of pills seem to have a smaller increase in the birth rate than we might expect just based on driving distance alone. So that suggests to me and to these researchers that probably those pills are acting as a substitute for travel for some of those women. So an example of that is Arkansas. Arkansas is a state that banned abortion, and the birth rate did go up in Arkansas, but it didn't go up by as much as you would have expected just based on the driving distances alone. And we also know that Arkansas was a state where a lot of women ordered these pills from overseas. But why would women in Arkansas be much more likely to ordered these pills from overseas. Hmm. But why would women in Arkansas be much more likely to order these pills

from overseas through the mail than in any other state where abortion is banned? I don't think that we really know the answer to that question. I think the opportunity to order these pills overseas is kind of new, and so the word about them may be spreading in sort of uneven ways through different parts of the country. I also think that women in different states may think about the legal risk of pursuing this option differently. Texas, for example, is a state where law enforcement and other state officials have

made it really clear that they want to vigorously enforce their abortion ban. So that might be might be a place where on the margin women are a little bit less likely to order pills because they're worried that they could get in trouble. Mm-hmm. So in thinking back to where we started, the effect of overturning Roe on access to abortion, what is this data really revealing? I think it shows us that abortion bans do work. In all of these states that banned abortions, we're seeing births going up, and that's pretty clear. But I think just looking at what happened in those 13 states actually doesn't give us the full picture of what's happened over the last year since Roe v. Wade was overturned. the last year since Roe v. Wade was overturned. If you look at other data and see what's happening nationwide, the total number of abortions actually hasn't gone down. Instead, something

interesting and a little bit surprising has happened. Abortions are going up. We'll be right back. Margot, just before the break, you said that despite these state abortion bans, abortions are somehow up nationwide, which seems very counterintuitive. So just explain that. Yeah, I mean, I have to admit that I was a little bit surprised when I saw these numbers. I should say this is not a huge increase. The estimate is that the number of abortions since the Supreme Court decision only went up by like 0.2 percent. But when you consider that there are all of these states that banned abortion totally, where abortions went to zero, what it's really telling us is that the states where

abortion stayed legal increased by so much that they were able to sort of counterweight that reduction. And I think there are a couple of factors that really explain what's going on here. One is that we know that even though there's women who are prevented from having abortions in the states that banned it, there are a lot of women that are still getting out, who are still traveling to neighboring states. And when you look at data on the number of abortions that are being provided around the country, you can see really large increases in some of these border states that women are tending to go to. Places like Kansas, New Mexico, Illinois, North Carolina. These are states that are neighboring places where abortion is banned. And there's been a big growth in abortion infrastructure to accommodate those

women. And they are traveling there and they are getting abortions. But what's really interesting, and I think more surprising in this data, is that we also see increases in states where they're just not that close to the places that banned abortion. Like California has had a pretty substantial increase in the number of abortions that it's provided. And some of the states in the Northeast have had pretty big increases. And I think that suggests that there's something more going on than just women traveling out of the states with bans, that actually there are more women in some of these states where abortion remained legal who are having abortions in this post-Roe

period than would have had them in the pre-Roe period. And why would that be? Why would there be more women having abortions in states where it was always legal after Roe was overturned and it remained legal? So I think the biggest reason is that right around the same time that the Supreme Court overturned the Roe decision, the Biden administration changed the rules for how women can get abortion pills in the United States. So the abortion pill has been legal for 20 years. But for most of that time, if you wanted to take abortion pills, you had to go to a physical clinic, meet with a doctor in person, and then they would give you the pill in person and you would take the first pill at the visit and then take additional medicine home with you.

And so that meant that medication abortion really wasn't that much easier for women than procedural abortion because they still had to go to a clinic that might be pretty far from their house. And it was still pretty expensive. What the new rules allow is that you can get abortions through telemedicine. new rules allow is that you can get abortions through telemedicine. And with these telemedicine abortions, women could talk to a doctor from their home and then have abortion pills mailed to their home, and then they could take the abortion pills at home. And that change made abortion less expensive in a lot of cases, and it also made it much more convenient for women who didn't live near an abortion clinic. You know, we were talking before about the driving distances. And so, of course, if you live in Texas or Mississippi and there's no abortion clinic within hundreds of miles, driving distance is really important.

But even in states where abortion had always been legal, and again, I think California is a good example. You know, if you lived kind of in central California, you might be pretty far from an abortion clinic before. And so this regulatory change, I think, made it a little easier for some of those women to get abortions. The other thing that happened is that once that policy went into place, there was actually a big kind of startup movement. They almost feel a little bit like tech startups in the abortion space now where they feel like, OK, we can have some doctors who can work remotely and can provide abortions through the Internet to women. And so that's been like an increase in the number of providers that are available for those women. So since Roe, the infrastructure for abortions that don't require going to a clinic expands dramatically from what you're saying.

Yeah, but I think that's not the only thing that happened. I think for a lot of people who had not been paying attention to abortion in the recent years, the overturning of Roe was like a huge activating moment. And we have seen in the last year a lot of fundraising and money being poured into the abortion system and awareness of abortion and the options for abortion growing. And we've also seen a lot of these states that always had legal abortion have started pursuing new policies to make abortion even easier to get and less expensive. States have required insurance companies to cover abortion. They've provided extra legal protections for doctors that provide abortion. They've allowed nurse practitioners and other kinds of people to provide abortions

in their states. And I think all of that is sort of a political reaction to the Supreme Court decision. And those changes might not have happened in the absence of it. And all of those changes probably also helped make abortion a little bit more available to women in those states and also probably raised their awareness that abortion was an option for them. So in these states, and this is counterintuitive, the overturning of Roe leads to greater access to abortions, kind of a mirror image to the 13 states that banned it. And therefore, according to this data, there are more abortions in these states. could reverse, but I actually think it's possible that we're going to see an even larger increase in the number of abortions nationwide because all this data we've been talking about are a little old. The most recent data about the number of abortions comes from this summer, but since then,

there's been a pretty important change, which is that a bunch of these states that kept abortion legal have passed laws that allow doctors there to mail abortion pills into states with bans, and they will protect them from extradition. So if you're a doctor in New York, in the first year in which Roe was overturned, you would not want to treat a patient in Texas, and you would not want to mail abortion pills into Texas because abortion is illegal in Texas and authorities could come and arrest you potentially. And what New York and Massachusetts and a couple of other states have done is they've passed laws where they said, no, no, if you go to Texas, you could get arrested. But as long as you stay here in your home state of New York, we will make sure that you're not going to get in any legal trouble.

And as a result of that, there are doctors who are setting up shop and sending large numbers of pills into these banned states. And because of that, researchers I talked to think that we could see an even larger number of abortions happening this year than we saw last year. I mean, all this, Margo, suggests that while abortion bans have worked and the states were there in place during this first year post-Roe, overall, the strategy of trying to overturn Roe and therefore reduce abortion has kind of backfired, right?

And it may continue to backfire more and more over time. Yeah, I think it has backfired. If you think about the activists that brought this case to the Supreme Court, their goal was not just to reduce abortions in Texas and Mississippi. They really wanted to reduce abortions across the entire country. And I think we've all been really focused on the states that were banning abortion. But there was also this huge change that happened in the states that didn't ban abortion, which is a lot of states. And I think that's why we see abortions going up by so much. I don't know that the anti-abortion activists could have ever predicted that this would be the effect of the end of Roe.

And I don't even think that the abortion rights activists saw this coming. I think everyone assumed that the end of Roe was going to mean a decrease in abortions, not an increase. Well, Margot, thank you very much. We appreciate it. Thank you. We'll be right back. Hamas and Israel. Hamas released 12 more hostages from Gaza, including 10 Israelis and two Thai nationals, while Israel released 30 Palestinians from Israeli prisons. Overall, Hamas has released 85 hostages since the ceasefire began, and Israel has freed 180 imprisoned Palestinians. And the powerful political network led by conservative billionaire Charles Koch has endorsed former South Carolina Governor Nikki Haley for president,

the latest boost to her Republican candidacy, which has steadily risen in the polls. Republican candidacy, which has steadily risen in the polls. The endorsement gives Haley's campaign much-needed organizational muscle and financial might, and cements her place as the favorite candidate of Republican donors seeking to stop Donald Trump from becoming the nominee. the nominee. Today's episode was produced by Will Reed, Alex Stern, and Carlos Prieto.

It was edited by Devin Taylor, fact-checked by Susan Lee, contains original music by Marian Lozano and Dan Powell, and was engineered

by Alyssa Moxley. Our theme music is by Jim Brunberg and Ben Lantiford of Winderly. That's it for The Daily. I'm Michael Bilboro. See you tomorrow.