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The mesoeconomics of abortion: A scoping review and analysis of the economic effects of abortion on health systems

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  • Samantha R Lattof
  • Ernestina Coast
  • Yana van der Meulen Rodgers
  • Brittany Moore
  • Cheri Poss

Abstract

Background: Despite the high incidence of abortion around the globe, we lack synthesis of the known economic consequences of abortion care and abortion policies at the mesoeconomic level (i.e. health systems and communities). This scoping review examines the mesoeconomic costs, benefits, impacts, and values of abortion care and policies. Methods and findings: Searches were conducted in eight electronic databases. We conducted the searches and application of inclusion/exclusion criteria using the PRISMA extension for Scoping Reviews. For inclusion, studies must have examined at least one of the following outcomes: costs, benefits, impacts, and value of abortion care or abortion policies. Quantitative and qualitative data were extracted for descriptive statistics and thematic analysis. Of the 150 included mesoeconomic studies, costs to health systems are the most frequently reported mesoeconomic outcome (n = 116), followed by impacts (n = 40), benefits (n = 17), and values (n = 11). Within health facilities and health systems, the costs of providing abortion services vary greatly, particularly given the range with which researchers identify and cost services. Financial savings can be realized while maintaining or even improving quality of abortion services. Adapting to changing laws and policies is costly for health facilities. American policies on abortion economically impact health systems and facilities both domestically and abroad. Providing post-abortion care requires a disproportionate amount of health facility resources. Conclusions: The evidence base has consolidated around abortion costs to health systems and health facilities in high-income countries more than in low- or middle-income countries. Little is known about the economic impacts of abortion on communities or the mesoeconomics of abortion in the Middle East and North Africa. Methodologically, review papers are the most frequent study type, indicating that researchers rely on evidence from a core set of costing papers. Studies generating new primary data on mesoeconomic outcomes are needed to strengthen the evidence base.

Suggested Citation

  • Samantha R Lattof & Ernestina Coast & Yana van der Meulen Rodgers & Brittany Moore & Cheri Poss, 2020. "The mesoeconomics of abortion: A scoping review and analysis of the economic effects of abortion on health systems," PLOS ONE, Public Library of Science, vol. 15(11), pages 1-25, November.
    • Handle: RePEc:plo:pone00:0237227
    DOI: 10.1371/journal.pone.0237227
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    References listed on IDEAS

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    1. Ernestina Coast & Samantha R Lattof & Yana van der Meulen Rodgers & Brittany Moore & Cheri Poss, 2021. "The microeconomics of abortion: A scoping review and analysis of the economic consequences for abortion care-seekers," PLOS ONE, Public Library of Science, vol. 16(6), pages 1-21, June.
    2. Naomi Lince-Deroche & Deborah Constant & Jane Harries & Judith Kluge & Kelly Blanchard & Edina Sinanovic & Daniel Grossman, 2018. "The costs and cost effectiveness of providing second-trimester medical and surgical safe abortion services in Western Cape Province, South Africa," PLOS ONE, Public Library of Science, vol. 13(6), pages 1-16, June.
    3. Susanne Sjöström & Helena Kopp Kallner & Emilia Simeonova & Andreas Madestam & Kristina Gemzell-Danielsson, 2016. "Medical Abortion Provided by Nurse-Midwives or Physicians in a High Resource Setting: A Cost-Effectiveness Analysis," PLOS ONE, Public Library of Science, vol. 11(6), pages 1-9, June.
    4. Yana van der Meulen Rodgers & Ernestina Coast & Samantha R Lattof & Cheri Poss & Brittany Moore, 2021. "The macroeconomics of abortion: A scoping review and analysis of the costs and outcomes," PLOS ONE, Public Library of Science, vol. 16(5), pages 1-18, May.
    5. Parmar, Divya & Leone, Tiziana & Coast, Ernestina & Murray, Susan Fairley & Hukin, Eleanor & Vwalika, Bellington, 2017. "Cost of abortions in Zambia: a comparison of safe abortion and post abortion care," LSE Research Online Documents on Economics 63643, London School of Economics and Political Science, LSE Library.
    6. Kelly M. Jones, 2015. "Contraceptive Supply and Fertility Outcomes: Evidence from Ghana," Economic Development and Cultural Change, University of Chicago Press, vol. 64(1), pages 31-69.
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    9. Coast, Ernestina & Norris, Alison H. & Moore, Ann M. & Freeman, Emily, 2018. "Trajectories of women's abortion-related care: A conceptual framework," Social Science & Medicine, Elsevier, vol. 200(C), pages 199-210.
    10. Naomi Lince-Deroche & Tamara Fetters & Edina Sinanovic & Jaymala Devjee & Jack Moodley & Kelly Blanchard, 2017. "The costs and cost effectiveness of providing first-trimester, medical and surgical safe abortion services in KwaZulu-Natal Province, South Africa," PLOS ONE, Public Library of Science, vol. 12(4), pages 1-16, April.
    11. Jones, B.S. & Weitz, T.A., 2009. "Legal barriers to second-trimester abortion provision and public health consequences," American Journal of Public Health, American Public Health Association, vol. 99(4), pages 623-630.
    12. Jason M. Lindo & Caitlin Knowles Myers & Andrea Schlosser & Scott Cunningham, 2020. "How Far Is Too Far? New Evidence on Abortion Clinic Closures, Access, and Abortions," Journal of Human Resources, University of Wisconsin Press, vol. 55(4), pages 1137-1160.
    13. Michael Mbithi Mutua & Lenore Manderson & Eustasius Musenge & Thomas Noel Ochieng Achia, 2018. "Policy, law and post-abortion care services in Kenya," PLOS ONE, Public Library of Science, vol. 13(9), pages 1-18, September.
    14. Silvie Colman & Ted Joyce, 2011. "Regulating abortion: Impact on patients and providers in Texas," Journal of Policy Analysis and Management, John Wiley & Sons, Ltd., vol. 30(4), pages 775-797, September.
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    1. Brittany Moore & Yana van der Meulen Rodgers & Ernestina Coast & Samantha R Lattof & Cheri Poss, 2021. "History and scientific background on the economics of abortion," PLOS ONE, Public Library of Science, vol. 16(9), pages 1-9, September.
    2. Ernestina Coast & Samantha R Lattof & Yana van der Meulen Rodgers & Brittany Moore & Cheri Poss, 2021. "The microeconomics of abortion: A scoping review and analysis of the economic consequences for abortion care-seekers," PLOS ONE, Public Library of Science, vol. 16(6), pages 1-21, June.
    3. Bethany G. Everett & Jessica N. Sanders & Jenny A. Higgins, 2023. "Abortion Policy Context in Adolescence and Men’s Future Educational Achievement," Population Research and Policy Review, Springer;Southern Demographic Association (SDA), vol. 42(3), pages 1-20, June.

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