MY TWO CENTS NOV. 20, 2018
The future of your right to choose may be uncertain these days, but its monetary cost may be even more so. Try googling the price of an abortion, and you’ll get a confounding array of numbers that start at zero (if you qualify for funding assistance, or have the rare insurance plan that’ll cover it entirely) and spike well into the thousands. Major factors regarding how much an abortion costs include the state you live in, how far along the pregnancy is, and what type of procedure is available to you — plus, the constantly shifting landscape of health-care policy. “The cost is a bit of a black box,” says Rachel Jones, a principal research scientist at the Guttmacher Institute, an organization that studies reproductive health policy. “Nobody really knows what it costs to provide abortions. The numbers change from facility to facility within the same state or even the same city.”
Most abortion providers are trying to keep their prices as low as possible, Jones explains. The majority of their patients (75 percent, according to the most recent data) qualify as poor or low-income, so many clinics offer a sliding scale price system. Others will refer patients to third-party organizations, like the National Abortion Federation, for funding assistance. Abortions are hardly a profitable business; many facilities are simply trying to afford staff.
In general, it costs more to get an abortion in a “hostile” state (i.e., one with restrictive abortion laws, like Texas and Florida) than a “supportive” one. Still, about half of all abortions in the U.S. happen in areas where they’re hardest to come by. We shouldn’t need data to prove this, but it’s there: Making abortions difficult to obtain does not stop women from going to great lengths to get them, just as making them more accessible does not increase their appeal.
Are abortion prices going up or down? It’s hard to say, says Jones, especially when the legal future of reproductive rights seems so dicey. For example, the abortion pill may be slightly cheaper now than it was ten years ago, but clinics aren’t likely to pass along those savings to their patients if new (or anticipated) legislation make it more expensive to keep their doors open. Dr. Warren Hern, one of the few physicians in the U.S. that performs abortions for patients in their second and third trimesters, says that over 50 percent of his clinic’s income goes to security measures like bulletproof glass, closed-circuit cameras, and real-estate costs (at one point, he had to buy the building next to his office to prevent anti-abortion activists from renting it and harassing his patients). “We are beset by what economists call ‘externalities’ — operational costs that most other physicians don’t have to face, like legal and security fees,” he says.
Moreover, tighter abortion laws saddle patients with higher ancillary costs. They may have to travel longer distances to obtain medical services, pay for child care while they do so (about half of women seeking abortions already have kids), and forgo wages if they have to take time off work to attend appointments.
Below, a look at the costs of current abortion options, according to data from the Guttmacher Institute and abortion providers around the country.
Also known as: The abortion pill, Mifiprex, RU-486, or EMA (Early Medication Abortion).
Price: The mean cost is $535, but it ranges from $75 to $1,633 or higher.
When it’s used: Five to ten weeks into pregnancy.
What it’s like: You’ll take two pills over a period of one to three days. Usually, you’ll take the first pill under supervision at the clinic where it’s prescribed, followed by the second pill 6 to 48 hours later. You may also get antibiotics to prevent infection, as well as pain medication. You’ll experience heavy bleeding and cramping for a few days, although the process itself takes about 1–5 hours. Follow-up calls and/or appointments are required, and spotting lasts for over a week.
Pros: The pill is often faster and easier to obtain than a surgical procedure. Over the past decade, there’s in been an influx of EMA-only facilities, which just offer medication and nothing else. Meanwhile, some people feel that it’s less invasive, as the experience is similar to a common miscarriage.
Cons: The pills can be more expensive than a surgical procedure, take longer, and require multiple appointments. However, the price is slowly inching down, most likely because providers and patients are more aware of what to expect. When the pill was newer to the market, clinics followed an intensive (and pricey) follow-up protocol to make sure the abortion was complete; now that time has shown the pill to be effective and safe, providers are easing up a bit. There’s also a risk of needing an additional procedure if the pill doesn’t work or if there are other complications.
Worth knowing: In some states, you can obtain the pill via telemedicine. One Planned Parenthood clinic in Iowa City doesn’t even have examination rooms; instead, it contains monitors where patients can speak with medical professionals online, as well as cash register–style drawers that pop open with a single dose of medication after it’s been prescribed remotely.
More information on medication abortion: See here.
Also known as: A suction abortion, or MVA (Manual Vacuum Aspiration).
Price: $435 to $955; the mean cost to perform it ten weeks into pregnancy is $508.
When it’s used: Five to 12 weeks into pregnancy, but sometimes earlier or later.
What it’s like: A medical professional uses a tiny hand-held instrument to empty your uterus in five to ten minutes. You’ll usually get the option to receive anesthesia or other pain medication. In most cases, you’ll also get antibiotics, and be asked to rest under supervision at the clinic for a couple of hours after the procedure is over.
Pros: The process is quicker and cheaper than the pill and may only require one appointment. It also has a slightly higher success rate (98 percent) than medication abortions (95 to 97 percent, depending on the length of pregnancy), and some physicians consider it to be safer.
Cons: It can take longer to schedule an appointment and/or find a clinic that offers the procedure.
More information on aspiration abortion: See here.
Also known as: A dilation and evacuation procedure.
How much it costs: $500 to $3,000 or more.
When it’s used: Usually for later first-term or second-term abortions, nine to 20 weeks into pregnancy, or sometimes earlier or later.
What it is: The procedure itself is similar to an aspiration abortion, but when your pregnancy is farther along, your cervix requires extra preparation so tissue can pass through. As a result, you’ll need additional in-clinic treatments to dilate the cervix in advance, which may take up to three days (those 15 to 22 weeks pregnant may require two days, while those at 23 to 24 weeks will probably take three). Once your cervix is dilated, medical professionals use a combination of suction and other instruments to empty your uterus. You will need anesthesia and prescription pain medication, plus antibiotics.
Pros: It’s widely considered to be the safest way to terminate a pregnancy after ten weeks, which is often when women find out about dangerous fetal abnormalities.
Cons: It can be expensive and/or completely inaccessible in certain states. It’s also uncomfortable and time consuming.
More information: See here and here.
How much it costs: $8,000 to $15,000 or more.
When it’s used: If you’re in a later stage of pregnancy, particularly your third trimester.
What it is: After 16 to 24 weeks, abortions require more nuanced protocols. In some cases, a labor induction procedure — which involves a cocktail of medications to terminate the pregnancy and cause contractions to expel the contents of your uterus — is a common method. However, sometimes labor induction doesn’t work or isn’t recommended for certain patients, in which case a modified D&E procedure is better. More often, physicians will combine elements of both D&E and labor induction for patients in this phase of pregnancy, particularly because cases need to be approached on an individual basis. The whole process usually takes several days.
Pros: There’s nothing easy about an abortion after 20 weeks, but it can become suddenly and urgently necessary when the pregnancy is life-threatening or if the fetus has a fatal abnormality (which sometimes isn’t discovered until it’s too late for the abortion pill or a vacuum aspiration procedure). Under proper care, however, there is a low risk of major complications.
Cons: Late abortions are very expensive and hard to access. You may need to go out of state to find medical professionals who will perform one. What’s more, there’s very little data on them. Dr. Hern is one of the few physicians to perform late abortions and regularly publish his work. Most doctors, as well as institutions like Guttmacher, don’t publish or collect data on abortion procedures past the first trimester.