Most women who have abortions have health insurance, but most still pay out-of-pocket for abortion services, according to "At What Cost? Payment for Abortion Care by U.S. Women," by Rachel Jones of the Guttmacher Institute et al., published online in the journal Women's Health Issues. This is true for women with both public and private health insurance. The most common reason women reported not using their insurance was that they believed their plan didn't cover it (46%)—either because they were told abortion was not covered or more often assumed it was not. About one in 10 women indicated that they did not want to use their insurance, presumably because of stigma or concerns about confidentiality.
The average cost of a first-trimester abortion was $470 in 2009, and most women obtaining abortions were poor or low-income. Not surprisingly, more than half of women not using health insurance indicated that it was difficult for them to pay for their abortion procedure. Half of all abortion patients in the study relied on somebody else to help pay some or all of the costs—most commonly the male partner (60% of those obtaining assistance), although substantial proportions relied on one or more of the following: a discount from the clinic, donations provided by an abortion fund or a family member (20% for each).
In addition to the direct cost of the abortion procedure, many abortion patients also incur ancillary expenses. Two-thirds of study participants reported that they also had to cover transportation costs (on average, $44), while one-quarter reported lost wages (on average, $198) and one in 10 had childcare expenses (on average, $57). Given that most abortion patients already have a child and are poor or low-income—and most are paying out-of-pocket—these expenses can pose a sizeable financial burden separate from the procedure itself.
"The findings make clear that abortion can pose a major financial burden for women seeking these services and is not a decision they take lightly," says Rachel Jones, a senior researcher at the Guttmacher Institute. "Many of these women are poor or low-income, and have to come up with several hundred dollars to pay for the procedure. They rely on friends and family, clinics and abortion funds, and often have to not pay their bills or delay payment in order to do so."
Even though it goes against the current political tide, the authors point out that expanded coverage of abortion services under private insurance plans, and the repeal of the Hyde Amendment restricting federal Medicaid coverage of abortion for poor women, would increase access to services earlier in pregnancy and ease the financial strain many women face.
"At What Cost? Payment for Abortion Care by U.S. Women," by Rachel Jones of the Guttmacher Institute and Ushma Upadhyay and Tracy Weitz of Advancing New Standards in Reproductive Health (ANSIRH), is currently available online and will appear in a forthcoming issue of Women's Health Issues. For a full copy of the article, please contact the journal directly.