The Profits of Pro-Choice: How Abortion Makes Some People Rich

While millions of Americans wrangle over the moral and philosophical questions surrounding the abortion debate, the abortion industry continues to grow and thrive. The economic aspects of abortion may seem far removed from the larger debate. Yet our current laws on abortion are what make the industry so lucrative. In other words, as long as abortion on demand is the standard, those who provide this service will prosper.

What is the problem with this, some might ask. The problem is that with abortion, reality does not square with the public’s perception. While a majority of Americans may tell pollsters they support a right to abortion under unspecified circumstances, more careful public opinion polls reveal that most people do not approve of abortion on demand, late-term abortion, abortion with­out parental consent, or abortion as a form of birth con­trol. What many Americans do not realize is that today’s “free choice” permits all of these things.

At the same time, representatives of the abortion industry are engaged in a constant effort to protect these options because any restrictions on the provision of abor­tion could seriously undermine the profit margins of the industry.

Ever since the Supreme Court’s 1973 landmark ruling in Roe v. Wade, abortion has been a legal option throughout the United States. The net effect of the Court’s rulings in Roe and in Doe v. Bolton was to sanc­tion abortion on demand through the entire nine months of pregnancy. Although Roe did restrict late-term abor­tions to cases where the health of the mother was at risk, Doe defined health as “all factors relevant to the well-being of the patient,” including emotional and psychological factors. So, in essence, abortion could be justified for any reason at any time during a woman’s pregnancy.

Since 1973, nearly 25 million legal abortions have been performed in the United States. In 1975, 22 out of every 1,000 American women had an abortion. The rate had increased to 27 out of 1,000 by 1988, for a total of about 1.6 million abortions that year. The U.S. has one of the highest abortion rates among the developed nations of the world.

Who gets abortions today? Statistics reveal that over the last ten years the average age of abortion patients has increased. In 1980, nearly 70 percent of abortion patients at Planned Parenthood affiliates were under the age of 25, while a little over 30 percent were 25 or older. In 1989, the percentage of women under 25 had fallen close to 60 percent, and nearly 40 percent of abortions were being performed on women 25 and older.

In addition, there has been a significant increase in the number of women over the age of 30 seeking abortions. Some point to this trend as evidence that as abortion has become safer and more accessible, older women, who are more likely to have the resources to support a new baby, are choosing not to. Increasingly, women in this age bracket are choosing career over family, limiting the size of their families, or using abortion as a form of birth control.

According to the Alan Guttmacher Institute, over 90 percent of abortions are performed for reasons not re­lated to the health of the mother. One estimate places the actual percentage of abortions performed to protect the health of the mother or as a result of rape or incest at less than two percent. Of the approximately 1.6 million abortions performed in the U.S. in 1988, more than 40 percent were repeat abortions.

The abortion procedure itself is relatively inexpensive. In 1986 the average cost of a first-trimester abortion performed out of the hospital was $213. Today abortions are said to cost between $250 and $500. Usually the procedure is relatively quick and requires little follow-up care. As a result a doctor can perform several abortions per day. One doctor claims to have performed 32,000 abortions over the course of 10 years. Unlike most other medical procedures, cash payment is usually required. People are required to pay for an abortion up front, in part because most insurance plans do not provide coverage for the procedure.

A Lucrative Business

While abortion has become a lucrative business, the money trail has many twists and turns. Federal funds are no longer directly provided for almost any abortions because of the Hyde Amendment, passed by Congress and upheld by the Supreme Court, which prohibits the use of federal Medicaid funds for abortions except in cases where the life of the mother is in danger. Abortion advocates have argued that the Hyde Amendment has had a disparate impact on poor women who do not have the resources to afford an abortion, and so some states have continued to provide public funding for abortions to welfare recipients. Nine states voluntarily opted to use state funds for abortions; four additional states have been mandated to do so by state courts. In 1987, 12 percent of all abortions performed in this country were paid for with public funds.

Although federal funds are not available for the provision of abortions, clinics and other facilities performing abortions receive significant amounts of federal aid for the other contraceptive and reproductive health services they provide. Under Title X of the Public Service Health Act and Titles V, XX, and XIX (Medicaid) of the Social Security Act, reproductive care facilities receive tens of millions of dollars in government aid each year. According to a survey done by the Alan Guttmacher Institute (an abortion industry ally), in 1990 $500 million in federal and state funds went toward contraceptive services and supplies. At facilities that perform abortions, that money helps to keep the entire operation running; with lights, heating, rent, and salaries subsidized by the government, the cost of abortions can be kept low enough to encourage demand.

The majority of abortions performed in this country take place not in hospitals but in spe­cialized clinics. While Roe v. Wade ensured a woman’s right to obtain an abortion, it could not take away a doctor’s right not to perform one. As a result, a system has evolved where a small minority of physicians perform the vast majority of abortions. As Jonathan Imber, an expert on abortion issues, points out, although the abortion procedure itself has become technically routinized, “abortion has not been morally routinized within the profession of medicine.” Many doctors simply won’t perform one, the New York Times reports, and there is some stigma against physicians who do. The situation is reminiscent of the antebellum South, where even the most forceful advocates of the right to own slaves avoided shaking hands with professional slave-traders.

Because of the nature of the abortion procedure—fast, grimly efficient, and relatively inexpensive—the large demand for abortions can be met by specialized clinics and doctors around the country. In 1988, 86 percent of all abortions were performed in clinics; only 10 percent were performed in hospitals. Planned Parenthood of America operates the largest chain of abortion facilities in the U.S., and the number of abortions performed by its affili­ates has increased steadily over the years. According to a 1990 Planned Parenthood Federation of American service report, the number of abortions performed at these affiliates increased from 77,880 in 1980 to 122,191 in 1989. The number of affiliates performing abortions increased from 36 to 53 during that same time period.

Planned Parenthood’s Coffers

According to its 1990 annual report, Planned Parent­hood’s mission is to secure greater access to contraceptive and abortion services for all Americans, regardless of in­come or socio-economic status. Therefore, the organiza­tion lobbies intensely for increased government funding for contraceptive and reproductive supplies and services. Planned Parenthood has its own political action commit­tee, the Planned Parenthood Action Fund, a financially independent organization which lobbies the federal gov­ernment and contributes money to political campaigns. The ‘money raised by the PAC comes primarily from private contributions; in 1990, total revenues were nearly $600,000.

The scope of Planned Parenthood’s activities extends beyond the U.S. borders. Through Family Planning International Assistance, Planned Parenthood’s international arm, family planning information and services are provided to citizens in developing nations around the world.

Despite general approval among Americans for the information and services provided by Planned Parenthood, serious charges concerning its motives and methods have been leveled against the organization. There have been numerous accounts by young women who claim that when they found themselves pregnant and sought advice and counsel at Planned Parenthood, they were railroaded into getting an abortion. Many pro-life advocates argue that Planned Parenthood does not adequately present other options, such as adoption, to pregnant women, and that information on fetal development is often withheld from clients. Instead, taking advantage of the inexperience and fear of these young women, Planned Parenthood counselors strongly advocate abortion as the best option.

Some critics have alleged that Planned Parenthood en­courages pregnant women to seek abortions rather than other options because abortions are such a significant source of revenue for the organization. An audit carried out by the General Accounting Office in the early 1980s lends support to this theory. The audit revealed that Planned Parenthood clinics referred pregnant women to abortion providers at a much higher rate (roughly 35 percent) than other clinics and family planning facilities, which made these referrals at a rate of about 5.7 percent. Furthermore, at one affiliate, Planned Parenthood of Metropolitan Washington, there is a striking parallel between the number of patients who were tested in 1989 for pregnancy—7,363—and the number who received abortions—7,104. (One wonders how the proportion of blacks and Hispanics aborted compared to their proportion of the general Washington population.)

These charges against Planned Parenthood have implications for the abortion industry as a whole. Abortion clinics may be acting as agents of the industry, an industry driven, like so many others, primarily by the profit motive.

It is not possible to obtain exact revenue data on all the independent abortion providers around the county. Still, we can estimate that in 1988 the 1.6 million abortions performed in this country yielded somewhere between $32 million and $80 million. More precise data is available for Planned Parenthood and its affili­ate groups, and these revenue levels can be taken as an indication of what occurs in the in­dustry as a whole.

Planned Parenthood is estimated to have as­sets of $167 million; a large percentage of these comes from direct revenue supplied by abortions. According to data from the National Right to Life Committee, in 1988 Planned Parenthood affiliates took in nearly $24 million from performing 111,189 abortions. This represents 9.1 percent of the affiliates’ total revenue for that year. Over­all, the organization had an income of $303.1 million; 35 percent of which consisted of federal, state, and local government funds. This indicates that a good deal of tax­payer money does go to the organization itself, regardless of whether or not it is going to fund abortion per se.

More specifically, if we look at the revenues for Planned Parenthood affiliates in 1990, we see that the largest component of total revenue is clinic income; the next largest chunk comes from government grants and re­imbursements. Total revenue for Planned Parenthood and its affiliates was $383.7 million—$135.9 million came from clinic income, $124.6 million from grants and reim­bursements. We can assume that revenues derived directly from the provision of abortion services could fall into either of these categories, depending on whether the abor­tion was paid for by the individual or by state or federal funds. Finally, it is safe to assume that those revenues would diminish significantly if restrictions were to be placed on the provision of abortion or if public funds were to be further curtailed.

Now that we have seen how the abortion industry operates and the extent to which it prospers, it is important to take a look at where the public stands on the complex issues surrounding the abortion debate.

Americans generally support abortion as a right, under certain circumstances. In a 1990 National Opinion Research Center survey, 78 percent of those polled said it should be possible for a pregnant woman to obtain a le­gal abortion if there is a strong chance of a serious defect in the baby. Similarly, 81 percent agreed that abortion should be available to a woman who becomes pregnant as a result of rape.

Opinion is much more divided when the circumstances are altered. The same survey showed that less than half (43 percent) supported a woman’s right to a legal abortion if she is married and does not want any more children. Only 42 percent said a woman should be able to obtain a legal abortion for any reason at all.

When it comes to “abortion on demand,” polls reveal that an overwhelming percentage of Americans are op­posed. A 1991 Wirthlin Group poll showed 83 percent opposed abortion as a form of birth control. A 1989 New York Times poll showed 79 percent rejected abortion on demand. In a Boston Globe poll also from 1989, 89 percent said abortion on demand should be illegal.

As a Los Angeles Times poll reveals, there is a definite moral component involved here. Sixty-one percent of those surveyed said they considered abortion to be “morally wrong.” Fifty-seven percent agreed with the statement that “abortion is murder.” These majorities have shown that they will only support the legal right to abor­tion under narrowly defined circumstances.

The most interesting and revealing aspect of public opinion on abortion is the very real dichotomy which exists between people’s personal opinion on the is­sue and the attitude they adopt toward abortion as a matter of public policy. In the same Los Angeles Times poll cited above, while 57 percent agreed that “abortion is murder,” an almost equal percentage (51 percent) en­dorsed the statement, “I am in favor of abortion because every woman has the right to control her own body.” Along those same lines, a Time magazine poll conducted in 1990 revealed that although 50 percent of respondents said they personally believe having an abortion is wrong, 71 percent said they favor leaving the decision to a woman and her physician.

These discrepancies are puzzling—and they suggest that stronger moral leadership might well succeed in convincing the public to bring their moral attitudes to bear on legislation—but what is quite obvious is that what the public seems willing to accept in terms of the legal boundaries of the abortion “right” differ significantly from what has become the norm in the abortion industry. Abortion on demand is the current standard, in spite of the large majorities that consistently oppose it. The extent to which this standard is maintained directly affects the industry’s revenues and profits. It is clearly in the finan­cial interest of the industry to insure that the legal right of abortion remains an option for all women throughout the entire course of their pregnancy. The question remains as to whether it is in the best interest of the American public at large, and whether that standard will con­tinue if and when the public is made aware of the actual practices of the abortion industry.

This examination into the nature of the abortion industry is both important and timely. It is important because, as public opinion polls indicate, popular standards and values are inconsistent with the day-to-day practices of the industry. It is timely because, for the first time in nearly 20 years, the unequivocal right to an abortion is being seriously challenged, in the courts as well as in the legislative arena.

It is clear that the abortion industry has prospered under the current legal structure. It is not clear whether or not representatives of the industry have attempted to per­petuate the current system in order to protect and even enhance the industry’s revenue base. It would certainly be unfair to link all pro-choice advocates to operatives within the industry. Yet the possibility does remain that industry representatives have capitalized on pro-choice sentiments for their own personal gain.

There is clearly a sense among the public that although abortion may be wrong, individual autonomy must be protected. These contradictory instincts have most likely prevented many individuals from engaging in the abortion debate at any substantial level. That may be changing, however, as the debate shifts from an either/or proposition to a question of curtailing particular, now-available options. The public may indeed be ready for measured change, including restrictions on abortion. Cur­rent realities of the abortion industry must be articulated to the public so that any changes that occur are based on a common understanding of the facts.


  • Kimberly Coursen

    At the time this article was published, Kimberly Coursen was a research assistant at the American Enterprise Institute.

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