A new analysis by the Guttmacher Institute reveals that women living below the poverty line make up an increasing share of those seeking abortion care in the United States.

In what the authors called the “most striking finding” of the report,  Characteristics of U.S. Abortion Patients, 2008, the share of abortion patients who were poor increased by almost 60 percent over an eight-year period—from 27 percent of all women seeking abortion care in 2000 to 42 percent in 2008.  The analysis is based on a nationally representative survey of women obtaining abortions in the United States. The authors note that “While the data permitted the researchers to calculate the proportion of women obtaining abortions in each socioeconomic category, it did not provide the number or rate of abortions in the United States.”

Aside from the shift in income status relative to choices about unintended or unwanted pregnancies, little changed in the profile of women obtaining abortions between 2000 and 2008.  Women in their twenties, cohabiting, black or poor “remain overrepresented among abortion patients.”

As in 2000, the vast majority of women seeking abortion in 2008 were in their twenties and thirties and already had children. Women 20 years old and younger made up roughly 18 percent of all abortions, while those younger than 18 made up less than 7 percent.

“A broad cross section of U.S. women have abortions,” noted the Institute’s release:

• Fifty-eight (58) percent of abortion patients in 2008 were in their twenties;
• Forty-five (45) percent were never-married and not living with a partner;
• Sixty-one (61) percent were already mothers;
• Forty-two (42) percent were living below the federal poverty line;
• Thirty-six (36) percent were white;
• Fifty-nine (59) percent had at least some college education; and
• Seventy-three (73) percent were religiously affiliated. 

Thirty seven percent of those identified as Protestant while 27 percent identified as Catholic.  One in five identified themselves as evangelical, fundamentalist, charismatic or born-again. The study notes that “[w]hile the Catholic Church has strong proscriptions against abortion, the relative abortion rate for Catholic women was no different from that for all women.”

It is not surprising that a growing share of women seeking abortion care are poor. An increasing number of women and children in the United States are falling below the poverty line.  Indeed, an increasing share of those who are poor are living in what researchers call “severe poverty.” Women, faced with the possibility of giving birth to a child for which they can not provide may make the decision to terminate an unintended pregnancy as early as they can. 

According the National Poverty Center at the University of Michigan, the federal poverty rate increased each year between 2000 and 2004, to reach 12.7 of all Americans in 2004. The poverty rate among women has grown rapidly.  According to a September 2009 Guttmacher report, the proportion of women in the overall population who were poor increased by 25 percent between 2000 and 2008.

Black women and children are most likely to be living in poverty. The National Poverty Center notes that poverty rates for blacks and Hispanics greatly exceeds the national average. In 2008, for example, 24.7 percent of blacks and 23.2 percent of Hispanics were poor, compared to 8.6 percent of non-Hispanic whites and 11.8 percent of Asians.

Poverty rates are highest for families headed by single women, particularly if they are black or Hispanic. In 2008, 28.7 percent of households headed by single women were poor, while 13.8 percent of households headed by single men and 5.5 percent of married-couple households lived in poverty.

Moreover, the share of Americans living in severe poverty–earning less than half of the poverty threshold–also grew by 20 percent between 2000 and 2004, and the proportion of the population in higher income tiers fell. A 2006 study published in the American Journal of Preventive Medicine found that the number of Americans living in severe poverty increased by 3.6 million between 2000 and 2004. Severe poverty is also dramatically worse among African Americans and Hispanics.

Children represent a disproportionate share of the poor in the United States and black children represent a disproportionate share of all children living in poverty. Children make up 25 percent of the total population, but 35 percent of the poor population. Black children make up 34 percent of all children in poverty, the highest share for any sub-group. And, according to Steven H. Woolf, MD, MPH, Professor of Family Medicine, Epidemiology and Community Health, Virginia Commonwealth University, and lead author of the study in Preventive Medicine: “The rise in severe poverty is striking children the hardest.” Children account for 45 percent of all Hispanic and African Americans living in severe poverty.

Woolf states that the likely health consequences of these trends in poverty include “a higher prevalence of chronic illnesses, more frequent and severe disease complications, and increased demands and costs for healthcare services. Adverse effects on children carry long-term implications.”  These realities do not escape mothers or parents-to-be struggling simply to have food on the table each day. 

Economic circumstances are a driving factor in determining how and when people build their families. As the recession has persisted and poverty among already-disadvantaged groups deepened, women make rational decisions about their ability to support a child, or in the case of the vast majority of women seeking abortions who are already mothers, to add another child to an existing and already struggling family.

As Guttmacher’s report on the recession notes:

Decisions that women and their partners make about family planning—when to have a child, how many children to have and even whether to have children at all—take on a special significance and urgency during periods of economic turbulence. The ongoing recession in the United States has altered the economic realities of many families’ lives, and it has dramatically reshaped the environment in which people make, and try to act upon,
decisions about their reproductive lives.

Researchers note that in addition to economic circumstances, long-term and persistent discrepancies in access to pregnancy prevention and other basic reproductive health services are behind the increasing concentration of poor women among those seeking abortion care.

“Gaps in unintended pregnancy and abortion between poor and more affluent women have been increasing since the mid-1990s, so—sadly—none of this comes as a surprise,” says Sharon L. Camp, president and CEO of the Guttmacher Institute.  She continues:

“Reproductive health disparities, and health disparities more generally, are endemic in this country and stem from broader, persistent economic and social inequities. We need to bridge these reproductive health gaps by ensuring that all women, regardless of their economic circumstances, have meaningful access to the full spectrum of information and services—both contraceptive services to reduce levels of unintended pregnancy and abortion services.”

For the first time, the Guttmacher survey used to develop this analysis asked patients about their health insurance status and how they paid for abortion services. Results showed that these women were fairly evenly divided among those with private insurance (30 percent), those with no insurance (33 percent) and those covered by Medicaid (31 percent). Although a majority had some type of public or private health insurance, it is not clear how many of those plans actually included abortion coverage or had a high deductible that discouraged its use for coverage of abortion.  Still, 57 percent of all women obtaining abortions reported that they paid out of pocket for the procedure, while 12 percent used private insurance. Twenty percent of women relied on Medicaid and almost all of the women in the Medicaid group lived in the few states that use their own funds to pay for abortions. Among women on Medicaid who lived in states that use their own funds to pay for abortions, more than nine in 10 relied on this method to pay for their abortion. Some 13 percent of abortion patients relied on financial assistance programs to cover at least some of the cost of the procedure.

The report notes the pressure that demand for abortion care among low-income women have placed on service providers and nonprofit abortion funds across the country, which “have sought to meet the growing need among poor and low-income women by providing services on sliding fee scales and by subsidizing abortion services through charitable donations.”

These services may have allowed some poor women to access services they might not have otherwise been able to afford.