Willing but unable: Physicians' referral knowledge as barriers to abortion care

By: Elizabeth M. Anderson, Sarah K. Cowan, Jenny A. Higgins, Nicholas B. Schmuhl, & Cynthie K. Wautlet

Published in: Social Science and Medicine - Population Health 17 (2022)

Abortion care is a crucial part of reproductive healthcare. Nevertheless, its availability is constrained by numerous forces, including care referrals within the larger healthcare system. Using a unique study of physician faculty across multiple specialties, we examine the factors associated with doctors' ability to refer patients for abortion care among those who were willing to consult in the care of a patient seeking an abortion (N = 674). Even though they were willing to refer a patient for an abortion, half (53%) of the physicians did not know how and whom to make those referrals, though they care for patients who may need them. Those with the least referral knowledge had not been taught abortion care during their medical training and were in earlier stages of their career than those who had more knowledge. This research exposes another obstacle for those seeking an abortion, a barrier that would be overcome with a clear and robust referral system within and across medical specialties.

Examining the Effects of a Universal Cash Transfer on Fertility

By: Sarah K. Cowan and Kiara Wyndham Douds*

Published in Social Forces 101 (2), 1003-1030

Childbearing is at once deeply personal and shaped by social structure. It is also a site of profound inequality in the United States. Income inequality is an upstream cause of childbearing inequality, yet the evidence of the effect of income on reproduction is inconclusive. Previously, scholars primarily examined the introduction of means-tested relief to families with children. This limits analysis to families in poverty and provides insight only into the presence or absence of a policy. We analyze the Alaska Permanent Fund Dividend, which has provided all Alaskan residents with a substantial annual cash payment since 1982. The amount of the payment varies annually and is exogenous to individual Alaskans’ behavior and the state’s economy. We examine the effect of the cash transfers on fertility and abortion among a large and diverse population that has received varying amounts of money over time. We find the payments increase short-term fertility rates 1 and 2 years after disbursement, particularly among socioeconomically disadvantaged populations. Standardized to the 2010 household size distribution, two average payments relative to two minimum payments would result in a predicted fertility rate increase from 80.03 to 86.53 per 1,000 women age 15–44. The effect is largest for first births. The payments have no effect on the abortion rate. These results indicate the additional income removes economic constraints to reproductive health and autonomy and reduces reproductive inequality.

This research was covered in New York Times and KCBS.

Discordant benevolence: How and why people help others in the face of conflicting values

By: Sarah K. Cowan, Tricia C. Bruce, Brea L. Perry, Bridget Ritz*, Stuart Perrett* & Elizabeth M. Anderson*

Published in: Science Advances 8 (7), 2022

What happens when a request for help from friends or family members invokes conflicting values? In answering this question, we integrate and extend two literatures: support provision within social networks and moral decision-making. We examine the willingness of Americans who deem abortion immoral to help a close friend or family member seeking one. Using data from the General Social Survey and 74 in-depth interviews from the National Abortion Attitudes Study, we find that a substantial minority of Americans morally opposed to abortion would enact what we call discordant benevolence: providing help when doing so conflicts with personal values. People negotiate discordant benevolence by discriminating among types of help and by exercising commiseration, exemption, or discretion. This endeavor reveals both how personal values affect social support processes and how the nature of interaction shapes outcomes of moral decision-making.