The impact of Mississippi's mandatory delay law on abortions and births
T. Joyce, S. K. Henshaw and J. D. Skatrud
Baruch College, City University of New York, NY, USA.
CONTEXT: Beginning August 8, 1992, a woman in the state of Mississippi had
to wait 24 hours after in-person receipt of state-mandated information
regarding abortion and birth complications, fetal development, and
alternatives to abortion before an abortion could be performed. OBJECTIVE:
To analyze the effect of the law on the abortion and birth rates of
Mississippi residents. DESIGN: A retrospective analysis of abortion and
birth rates before and after the law in Mississippi as contrasted with
abortion and birth rates in 2 comparison states, Georgia and South
Carolina. Neither Georgia nor South Carolina enforced a mandatory delay
law, but both states began enforcement of parental notification statutes
during the study period. PATIENTS: Female residents of reproductive age in
Mississippi, Georgia, and South Carolina between 1989 and 1994. MAIN
OUTCOME MEASURES: We compared birth rates, abortion rates, the percentage
of late abortions, and the percentage of abortions performed outside the
state of residence for all women and then by age and race before and after
August 1992 among women of Mississippi, Georgia, and South Carolina.
RESULTS: We found that rate ratios (RRs) of resident abortion rates (rate
after law implementation/rate before law implementation) declined 12% more
in Mississippi than in South Carolina (95% confidence interval [CI],
8%-15%) and 14% more in Mississippi than in Georgia (95% CI, 10%-17%) in
the 12 months after the law went into effect. Rate ratios for white adults
declined 22% more in Mississippi than in South Carolina (95% CI, 17%-27%)
and 20% more in Mississippi than in Georgia (95% CI, 15%-25%). Changes
among nonwhite adults and white teens were more modest but also
statistically significant (P<.05). For all women, RRs of the percentage
of abortions performed after 12 weeks' gestation increased 39% more in
Mississippi than in either South Carolina or Georgia (P<.05); the
increase in the percentage of abortions after 12 weeks' gestation was
observed for white and non-white adults (P<.05). We also show that the
percentage of abortions performed out of state increased 42% more among
women in Mississippi relative to women in South Carolina after the law (95%
CI, 34%-50%). CONCLUSION: The timing of the decline in abortion rates in
Mississippi, the lack of similar declines in comparison states, the rise in
percentage of late abortions and abortions performed out of state and the
apparent completeness of abortion reports suggest that Mississippi's
mandatory delay statute was responsible for a decline in abortion rates and
an increase in abortions performed later in pregnancy among residents of
Mississippi. The effect of delay laws in other states will likely depend on
whether statutes require 2 separate visits to the abortion provider (ie,
clinics, hospitals, or physicians' offices where abortions are performed)
and the availability of abortion services.
