Health Services/Policy
Is TRAP law enforcement associated with an excess change in abortion providers? Kaya Van Roost* Kaya Van Roost Nichole Austin Sam Harper
Background–The number of abortion-providing facilities in the US decreased over the last two decades. Some of this decline is attributable to a reduced need for abortion services, but it is possible that abortion policies that target providers, or TRAP laws, have also played a role in decreasing provider availability. We quantified the relationship between these policies and clinic and provider availability using clinic data from 2008 to 2020.
Data & methods–We merged data we compiled on the timing of TRAP policies with publicly-available data on state-level counts of both abortion and nonspecialized clinics (“clinics”) and all abortion providers (“providers”) in 2008, 2011, 2014, 2017, and 2020. We estimated changes in the number of clinics and providers post-TRAP enforcement among treated states to the same changes in untreated states using a difference-in-differences method appropriate for staggered treatment designs. To do so, we fit a series of Poisson models saturated with group-time interaction terms and used marginal postestimation to re-express the incidence rate ratios (IRRs) in absolute terms. Standard errors were bootstrapped.
Results–Among treated states, the mean number of clinics and providers was 16.4 and 25.1, respectively, in pre-enforcement years. TRAP enforcement was associated with an excess clinic decline of 18% (IRR: 0.82, 95% CI: 0.77, 0.87) and a smaller decline among providers (IRR: 0.97, 95% CI: 0.92, 1.01). In absolute terms, these findings suggest that TRAP laws resulted in 2.5 fewer clinics (95% CI: -3.8, -1.3) and 0.4 fewer providers (95% CI: -1.2, 0.5), conditional on state and year fixed effects.
Discussion–As abortion restrictions intensify following the Dobbs decision, it is important to understand how abortion policies impact service availability. We found that previous, less restrictive regulation through TRAP laws decreased the number of abortion clinics, where the vast majority of abortions are performed.
