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Effects of Mandatory Waiting Periods for Abortions:

In light of the prominence of abortion regulation issues in Judge Alito's nomination, it is somewhat of an coincidence to see this important new paper by Jonathan Klick, "Mandatory Waiting Periods for Abortions and Female Mental Health."

Here's the abstract:

Proponents of laws requiring a waiting period before a woman can receive an abortion argue that these cooling off periods protect against rash decisions on the part of women in the event of unplanned pregnancies. Opponents claim, at best, waiting periods have no effect on decision-making and, at worst, they subject women to additional mental anguish and stress. In this article, I examine these competing claims using adult female suicide rates at the state level as a proxy for mental health. Panel data analyses suggest that the adoption of mandatory waiting periods reduce suicide rates by about 10 percent, and this effect is statistically significant. The result is robust to various attempts to control for unobservable heterogeneity and simultaneity.

Medis:
I'm looking forward to the libertarians around here tearing this sort of paternalistic reasoning apart.
10.31.2005 3:56pm
Assistant Village Idiot (mail):
Wow. That's an enormous difference. I would like to see that replicated.
10.31.2005 4:00pm
nobody (mail):
Clearly, unless women are actually killing themselves, effects on their mental health are not worth considering.
10.31.2005 4:05pm
TL:
Ode to the time when the legal community was less reactionary than the rest of society! I finished reading Alito's Casey dissent (in my bathroom break, no less). Though the blogosphere has been filled today with hand-wringing (formulated into words) regarding how Alito will ride onto the Hill in order to eviscerate demolish all women's freedoms for all of time, his dissent stops considerably short of what most people are saying.

The Casey dissent embodies above all else a careful analysis and exposition of scrutiny levels (the Court has had problems coming to a majority on this point also, Fundamental right, quasi-fundamental, or imaginary right?). Clearly the dissent reveals a Circuit Court author who is following stare decisis and other neato latin words as well.

Alito may or may not be eternal enemy of Roe. But I would be greatly edified if I hear further constructive discussion of the judgment that Alito actually articulated if we are going to once again delve into the depths of society's feelings about abortion.
10.31.2005 4:05pm
PersonFromPorlock:
I'm looking forward to the libertarians around here tearing this sort of paternalistic reasoning apart.

A woman has a right to choose an abortion.

A woman has a right to commit suicide.

Therefore, a woman has a right to commit suicide over having exercised her right to have an abortion, and a waiting period justified by reducing suicides interferes with both these rights.
10.31.2005 4:10pm
TL:
PS-As the lone dissent on the three-judge panel, one would expect the Casey opinion to be as intellectually honest a piece of judicial writing as the Senate Judiciary Committee could ever hope to possess. This is no Miers or Robertsonian piece of administration "lapdog" writing. This is a pure revelation of what the Judge's judgment on the matter is (or at least was in 1992). If the Senate and everyone else will give this dissent the attention it deserves, it should prove an extremely important document to the process.
10.31.2005 4:10pm
Frank Drackmann (mail):
I know hard cases make bad law..but consider the following thought experiment..Your're a young Mary Jo Kopechne and while at a party with Edward Kennedy, The Reverends Al Sharpton and Jessie Jackson, and Bill Clinton, one of them slips the date rape drug in your drink and you wake up pregnant. Would you need any sort of waiting period to make your decision?
10.31.2005 4:15pm
TL:
Frank-Querry: When and if Mary above decides to keep the child, should any of said clowns above get notice before their paternity duty of support is triggered?
10.31.2005 4:21pm
Frank Drackmann (mail):
To keep it non partisan..I should add the late Senator Strom Thurmond into the mix of possible date rapists. I wouldn't count on getting any support from either of the Reverends, or Clinton or Kennedy given their history. With it being Halloween I just thought it was horrible to consider the image of any of those monsters having sex with a beautiful young woman.
10.31.2005 4:35pm
Joe Socher (mail):
On a three judge panel you can only have "lone dissents." :)
10.31.2005 4:41pm
frankcross (mail):
This study shows an effect on the overall female suicide rate. That seems pretty dubious. What you want is rates for women who have abortions without a waiting period, women who have abortions with a waiting period, and women who don't have abortions, due to the waiting period.

The research design here is only very remotely connected to what it purports to show. The entire difference might be entirely unrelated to women having abortions. You can find all sorts of spurious correlations. The study does reference a Finnish study that seems somewhat better.
10.31.2005 4:46pm
Gump:
I wonder if the reduction in suicide rates is similar to that of those for handgun waiting periods.

/would hate to be waiting for handgun and an abortion in the same week.

//didn't read the article.
10.31.2005 4:49pm
Mr. Mandias (mail) (www):
"As the lone dissent on the three-judge panel"

Ah, Joe Socher beat me to it. On three judge panels, we call two-judge dissents 'majority opinions.'


Still, point taken. Couldn't resist, that's all.
10.31.2005 5:01pm
TL:
I fall into the same trap as sportscasters who say "grand-slam homerun." Unnecessarily duplicative; however, double emphasis often serves to highlight yet valid points. Thanks for all the careful attention to my posts.
10.31.2005 5:10pm
B. B.:
For most cases, there is probably little harm done with waiting periods, other than that whole liberty thing (yeah, I don't really like the waiting periods). The laws arise from a paternalistic view that "abortion is wrong" but we have waiting periods in other areas such as guns (I'd argue the reason for a gun waiting period is a bit more persuasive, but the pro-life side would see them as essentially equal). The waiting period would probably not make much of a difference in the abortion context. I assume it's why they aren't unconstitutional under the "undue burden" standard.

I do have an issue with making a raped woman wait though. If said woman wants the pregnancy terminated, I see no reason to make her carry yet one more reminder of her attack for even another day. I'm no shrink, but I do know a bit about rape victims and I can't imagine making her continue the pregnancy in that case if the woman does not wish to do so could possibly be good for her mental health.
10.31.2005 5:12pm
TL:
Also dreaded is the deceptive 1-1-1 wishbone formation of panel opinions. In SDOC's day nobody knew which way the option would run. (After all, a 9-Justice Sup.Ct. is really just Three 3-judge panels, as we learned when we studied all those plurality opinions in Con Law I.)

But now we know what plays the Court will be calling + Alito. Brown, Lawrence, and Roe will most assuredly be over-powered with the Nebraska-style offense. Coming at 'ya.
10.31.2005 5:13pm
Ken Arromdee (mail):
Therefore, a woman has a right to commit suicide over having exercised her right to have an abortion, and a waiting period justified by reducing suicides interferes with both these rights.

The waiting period doesn't reduce suicides because it forcibly prevents the women from committing suicide or makes it physically difficult to obtain the tools. Presumably, it prevents suicide by giving them less of a *motivation* to commit suicide (i.e. reduce anguish that leads to suicide).

That isn't an interference with rights at all. It's like pointing out that people crippled in car accidents might commit suicide, and then claiming that reducing the number of car accidents is unlibertarian because it interferes with suicide.
10.31.2005 5:14pm
TL:
BB: And the PA law at issue most definitively and unequivocally, crystal-clearly never required any responsibility of an abortor to her rapist.
10.31.2005 5:15pm
uh clem (mail):
For most cases, there is probably little harm done with waiting periods, other than that whole liberty thing


For the affluent, or urban dwellers, you're probably right.

But, tell that to a woman who lives 6 hours away from the nearest clinic, doesn't have a car, and can't take time off of work without getting fired. The point is to put as many barriers up as possible. i.e. if you can't outlaw it, regulate it to death.
10.31.2005 5:25pm
elliottg (mail):
BS study with numberous independent variables for which he finds several correlations with his main result being significant to the 6% level (p < 0.06). This was a throw it at the wall and see what sticks study and the abstract fails to disclose the poor design.
10.31.2005 5:28pm
Ciarand Denlane (mail) (www):
Um, if there are multiple issues can there not, in effect, be multiple dissents even on three-judge panels? For example, Judges A and B, but not C, think there is subject matter jurisdiction to decide a case, and Judges A and C, but not B, would rule for plaintiffs if the merits are reached. Even if there is a single issue, if there is a range of possible results, rather than just two, is it not possible to have, in effect, two dissents? For example, verdict below for plaintiff after trial, Judge A would affirm, Judge B would remand for new trial, Judge C would reverse denial of defendant's motion for judgment as a matter of law. I suppose in these kinds of instances one of the opinions might be labeled as "concurring in the result," but I could also easily see those situations as giving rise to two dissenting opinions, or at least two opinions "dissenting in part."
10.31.2005 5:35pm
Ciarand Denlane (mail) (www):
Nevermind. Even in the situations I cited, there may be a dissent that isn't the "only" dissent, but Mandias and Socher are right that each dissenter would be "[a]lone."
10.31.2005 5:40pm
DrewSil (mail):
Ken,

I don't think the libertarian argument would hinge on the fact that government has no buisness preventing suicide. Rather the main point would be they have no buisness interfering with abortions to prevent suicide. That is they have no right to tell a woman to wait.
10.31.2005 5:51pm
Bisch:
uh clem: A less cynical person might consider the possibility that a waiting period for actually terminating a preganancy is at least reasonable in light of the profound impact that it will likely have on her life. But I see you've tossed caution to the wind and gone for the jugular. Nice one. If you like, we can turn it around and postulate that since this hypothetical woman may possibly experience severe mental anxiety following the abortion, that clearly that is the precise goal of the waiting-period opposers who are thus woman-hating hate-mongers.

Ooh ooh, or we could base our legislation on the machinations found in the hit movie Saw II. "Obviously if my head is in an Iron Maiden, it's a violation of basic civil liberties to deny me the right to dig the key out of another man's occular cavity with a spoon. Think about the children."

How 'bout a ten day waiting period for posts like mine?
10.31.2005 5:56pm
TL:
Et. Al on the "lone dissent":

Hate to get medieval on you like this. But concurring opinions nonetheless at their essence are dissents. See The Dissenting opinion. Antonin Scalia. Journal of Supreme Court History 33, 34 (1994). So indeed, lone dissent does have meaning. Although I almost retreated earlier, being in doubt myself. But we can put the whole thing to rest now.
10.31.2005 6:15pm
Luis (mail) (www):
I admit to being a bit of a dogmatist liberal on most abortion issues.

That admission being made, a glance at this paper suggests it's ... flimsy. Suicide as a proxy for mental health is easy to use, but it is not really a good proxy. (I would rather see suicide compared against, e.g., hospitalization rates, or even prescriptions of psychiatric drugs.)
In this paper it is justified more or less by the author's bald assertion that it's a good proxy for mental health.

I also notice that the author "controls for" a bunch of pointless crap. ("Number of psychiatrists" -- huh? Most people who have mental health needs get therapy from MFTs and psychologists and drugs from GPs. Psychiatrists don't figure into it as much as you might think.)

If he assumes that waiting periods for abortion have an effect on suicide rates (as opposed to actually measuring mental health somehow), he needs to control for NOT HAVING HAD ABORTIONS. This does not seem to have been done.

And don't get me started about confounding variables.

Actually, come to think of it, there seems to have been no actual research performed -- just a review of records. Pretty thin stuff, if you ask me. Poring over documents may answer for historians and lawyers, but not so much for actual questions relating to mental health that are intended to have an effect on policy. This won't do at all.

Finally, it is always a little weird to see a scholar in one field (law) make a foray into research in another area (mental health). I like cross-pollination, but this sort of thing reminds me of Joseph Campbell, the English scholar, magically becoming an authority on World Religion, which he was not, and it showed.

FWIW, I am nearly finished with a Master's in Psychology. These are my thoughts; YMMV.
10.31.2005 6:45pm
jonah gelbach (mail) (www):
Having quickly read through it, I think the biggest research design problem with this paper involves its choice of age groups:

1. it doesn't include any data at all on girls and women aged younger than 25, among whom i imagine suicide rates are generally higher than those among older women

2. it includes lots of data on those who are very likely infertile or typically not getting pregnant even though they are fertile. suppose you assume a uniform age distribution. then only about 1/4 of the population reflected by Klick's sample is likely at real statistical risk of pregnancy, and thus abortion. so his dependent variable involves 1/4 signal and 3/4 noise.

now you might say that the second point only makes the paper's result more impressive, since he finds a strong result where one would expect mush given all the noise. and that raises a further problem: if you scale his estimated impacts by 4 to reflect the fact that only 1/4 of the population is likely at risk, you get the result that among those who can be affected, suicide rates decline by about 40% as a result of waiting periods.

and then you have to ask yourself why the apparent reduction
in suicide rates happens: is it because some women don't have abortions once they ponder (as, i assume, the laws' supporters are hoping)? or is it because (as Klick suggests in part) women who do have abortions are mentally more prepared for them given time to ponder?

given that most waiting periods are relatively short, and given that (i'm guessing) the waiting periods most likely are shorter than the time between the date a woman realizes she is pregnant and actually can get an abortion performed, i seriously doubt that the explanation for Klick's result is the latter suggestion above.

if it's the former -- fewer abortions, so fewer distraught women who later kill themselves -- then you have to ask yourself if the waiting periods have a large enough effect on abortion rates to have that big an effect on suicide rates. my understanding from talking to a friend who is an expert on the empirical literature on this topic is that the answer is probably no---even if you assume that every woman deterred from abortion by these laws would have killed herself, the effect would be too large. and she made that comment thinking the effect was 10%, not 40% as i'm arguing Klick's results actually suggest.

i can think of other potential issues here, as well as some approaches to assessing whether Klick's results are spurious, but this post is already quite long....
10.31.2005 6:59pm
R. Gould-Saltman (mail):
Mmm, good demolition job, Luis; I might have stated the "not a really very good proxy" argument a little more strongly (like "stupendous and unsupportable leap of inference", maybe)but otherwise, you've got Prof. Klick by the statistics; and his resume does NOT indicate he's got substantial experience in statistical analysis in med/psych cases.

Also one must wonder, to the extent that women lived in parts of states with waiting periods which closely adjoined metropolitan ares in states without waiting periods, how thre study controlled for those who could afford it simply crossing the border?

All in all, while it was even less statistically supportable than this one, I liked the academic study of the relationship betwen the average income of male heads of households as depicted in fiction television shows and those of male heads of households in reality, compared over time, more than I like this one. What was it Twain said, I think, about getting a huge payoff in speculation from a miniscule investment of fact?


RFGS
10.31.2005 7:03pm
elliottg (mail):
Recipe for an interesting result:

1. Take one controversial subject (abortion)
2. Choose a large number of independent variables (16 in this case)
3. Run regression analysis until you get a significant result. (desired = p < 0.01)
4. Relax definition of significant result. With many variables, it's very unlikely that you won't get something in your filter. Under no circumstances relax past p < 0.10 . (waiting period = p < 0.06)
5. Write paper.
10.31.2005 11:59pm
therut (mail):
Wonder if the families of these women have ever sued the doctors who performed the procedure. Surely there is a trial lawyer out there who could win big money easily with this. If they can sue the manufactures of Prozac when a depressed person commits suicide that is taking Prozac that is maybe, kinda, sorta got something to do with the suicide surely a lawyer can win big on this and put Planned Parenthood out of business. This is alot better than suing firearms manufactures for crimes done with firearms. I know for a fact there is not a consent form signed that states depression could develop after abortion that could lead to suicide.
11.1.2005 1:53am
Tristan Phillips (mail):
It's studies like this that give science a bad name.

First, and this can never be said enough: "Correlation is not causation".

Second: How do you know that the suicides were a result of either having or not having an abortion?

Third: How do you measure accurately and without bias determine those lives saved from suicide because they did or did not have an abortion?

This isn't research. It's a conclusion looking for support. Mr. Zywicki really needs to stop using junk science to support his beliefs.
11.1.2005 12:52pm
corngrower:
We all know that rights enumerated in the constitution are not without 'regulation'. Like the right to keep and bear arms, (2 cnd ammendment), or the right to an abortion, (its in there someplace) so regulation is a legal foundation firmly grounded in precedendt.
11.1.2005 2:19pm
corneater:
The right to an abortion is not in the constitution (I read it!)
11.2.2005 2:05am
Jeremy Pierce (mail) (www):
The libertarian argument fails for a number of reasons, but the most notable is that this isn't paternalism in the ordinary sense. Paternalism is usually thought of as government interference in people's decision-making process when someone has legitimately consented to a practice that the government is rejecting as legitimate consent for no reason other than that they consider such consent irrational. Requiring motorcycle helmets would be such a paternalistic law. We don't, however, consider it paternalistic to restrict a four-year-old from doing things that it takes an adult understanding to consent to. By the same reasoning, we don't consider someone to have consented to sex if under the influence of a mind-altering drug. Waiting period laws are a simple step further in the same direction. Someone who has just found out she is pregnant will not be thinking as rationally as someone forced to wait 24 hours before making an irrevocable decision. For the same reason that euthanasia advocates insist that some time be taken before considering someone to have consented rationally to being killed, those who favor waiting periods for abortion think rational consent requires taking some time before having an abortion. This seems eminently reasonable to me and perfectly consistent with a libertarian view of the purpose of law.
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