New Evidence on the Effects of Mandatory Waiting Periods for Abortion

In Tennessee, mandatory waiting periods resulted in higher second-trimester abortions and overall reduction in abortion rates. 


Abortion access and regulations have been topics of significant discourse and controversy in the United States. A particular policy of interest is the Mandatory Waiting Period (MWP) implemented in various states, designed to mandate a waiting period between the initial consultation and the actual abortion procedure. Though some may argue that the motivation behind this policy is to delay abortion procedures and give people more time to make their decision, these laws have also been a part of a broader strategy directed by anti-abortion policy-makers to make it more difficult for people to obtain abortions." Tennessee, with its varied health regions reflecting distinct socioeconomic and racial demographics, offers a unique vantage point for studying the implications of the MWP, specifically regarding abortion access, timing, and associated monetary costs.

To investigate these effects, this study employed a comprehensive examination of data on abortions obtained by Tennessee residents, focusing on the state's distinct "health areas." These regions, consisting of varying numbers of counties, offered an opportunity to explore potential disparities in the effects of the MWP across different socioeconomic backgrounds and racial profiles. Furthermore, by juxtaposing regions with similar average travel distances to abortion clinics but different socioeconomic statuses, the research aimed to disentangle the effects of geography from those of income and ethnicity.


Preliminary findings suggest that while the MWP led to a delay in the timing of abortions, this delay disproportionately affected areas with a higher poverty rate, lower median income, and a greater share of Black women. Additionally, the MWP introduced significant monetary burdens, especially for low-income women, encompassing costs associated with additional consultations, transportation, potential wage losses, and childcare.

  • MWP resulted in a significant increase in the percentage of abortions obtained in the second trimester. Specifically, there was a 53-69% increase in second-trimester abortions, almost closing the pre-existing gap (about 5 percentage points) between Tennessee and comparison states.
  • The impacts of MWP had varying disparities across disadvantaged counties. The effects of MWP appeared to be more pronounced in relatively disadvantaged counties, suggesting a disproportionate impact based on socioeconomic factors.
  • MWP resulted in additional monetary costs imposed on patients. Additional consultation led to an increase in women’s costs by approximately $173-$256, accounting for fees, transportation, lost wages, or childcare. In addition, a delay of one week in obtaining an abortion could increase the total costs by over $502.
  • MWP’s effects on abortion rates vary. While there are indications that the MWP affected abortion rates by increasing second-trimester abortions and possibly decreasing overall abortions due to delays in care and less access to specialized later term abortion procedures), the strength of these findings varies. These estimated effects are not typically significant at conventional levels. 

This study suggests that MWP may be causing delays for women seeking abortion services, which in turn could imply a range of social, economic, and health consequences, especially for those in lower socioeconomic status. While the MWP’s intended purpose may be to give women more time to make an informed decision, the practical effect can be an increased burden on those seeking abortions. 


This study aims to evaluate the effects of Tennessee’s Mandatory Waiting Period (MWP) policy on abortion access and timing. The primary goals of the analysis are to understand impact of abortion timing, compare the rates of second-trimester abortions and overall abortion rates before and after MWP, understand MWP’s varying impact based on demographic and geographic variations, and contrast Tennessee with other states’ abortion practices and regulations.  

Data sources and collection

The study predominantly uses annual abortion data from 2010-2017 acquired from state reports, supplemented by data from the Centers for Disease Control and Prevention (CDC)’s Abortion Surveillance System available from 2010-2016. Two distinct comparison groups emerged. First, Comparison Group 1, defined as data from 2010-2016 from both data sources, and second, Comparison Group 2, defined as data from 2010-2017 from state reports only. Of the 38 states identified as providing abortion information through state reports, the 13 that consistently reported from 2010-2017 were analyzed.

Data variability

The type of abortion data varied across states, which presented a challenge for making direct comparisons. The study identified four types of abortion data categories: 1) Number of abortions occurring within the state 2) Abortions obtained by state residents from providers within the state 3) In-state abortions by residents plus known out-of-state abortions by residents 4) In-state abortions plus known out-of-state abortions by both residents and non-residents. This variability in data types highlights the complexity of accurately capturing abortion patterns, especially in states where a significant number of out-of-state women seek abortion services or where residents seek services outside their home state.  

Outcome measures

The study evaluated the effects of Mandatory Waiting Period (MWP) on three main outcomes:

  • Percentage of second-trimester abortions
  • The rate of second-trimester abortions per 1,000 women (15-44 years old)
  • The rate of overall abortions per 1,000 women aged 15-44

Comparative analysis and “Refined Tennessee” subset

To analyze the effects of the MWP, the study established two comparison groups:

  • "Comparison Group 1" used both state and CDC data for 2010–2016.
  • "Comparison Group 2" relied solely on state reports for 2010–2017.

For Tennessee specifically, a "Refined Tennessee" subset was created to address potential inconsistencies in data reporting. This subset excluded data from certain health areas where out-of-state services might have been more frequently utilized. 

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