From the title alone it appears that either the author and his editor know little about sex and gender research or they think that any book with “sex” in the title will sell, or both. Thus, it is fortunate that the subtitle does accurately describe the contents of the book: an economic analysis of the consequences of changes in abortion law and policy on fertility behavior.

Phillip Levine makes it clear at the beginning that he wants to step away from what he terms the “ideological extremes” provoked by the topic and bring in the cool rationality of economic modeling. This coolness is all in the assumptions, most importantly the assumption of the rational actor. Applied to women's behavior relating to conception, pregnancy, childbirth, and abortion, such assumptions, along with the aggregate treatment given to women, may be protested by readers of Politics & Gender. Sticking with the author through the presentation of his research and findings, however, gives a different and useful perspective on a sometimes too-familiar policy conflict. It also helps that the research design and findings are carefully presented and explained for the noneconomist, and that the author takes time and space to summarize the content of various, especially complex sections.

The goal of the research described in this book is to assess the impact of abortion policy changes on fertility, specifically pregnancies both wanted and unwanted, abortions, and births. Models of fertility behavior involve setting out a series of assumptions about human behavior, the predictions that logically follow, and a comparison with empirical findings. Levine offers a model based on a critique and an extension of the standard fertility models used in economic and demographic analysis. Like the standard model, it assumes that individuals choose to reduce the costs of their actions and, when presented with alternatives, will make the rational choice. Thus, as the cost of abortion becomes less than the cost of bearing a child, those who do not want a child will be likely to choose abortion. The standard model would predict that any decrease in the cost of abortion, such as legalization or the providing of financial support, would increase the abortion rate and decrease fertility. Similarly, any increase in the cost of abortion would decrease the rate of abortion and increase the birth rate. Perfect knowledge before pregnancy would lead people to make decisions about contraception accordingly. Those who do not want a child would be likely to increase what Levine terms their “contraceptive intensity,” in other words, actively seek to prevent pregnancy.

Unlike the standard model, however, Levine's approach does not assume perfect information before pregnancy of the costs of birth versus abortion. Since costs include not only financial but also moral, social, and cultural costs, many of these may not be known to women until after they become pregnant. Thus, he adds another variable to the model—the positive information (more likely to lead to birth) and negative information (more likely to lead to an abortion) a pregnant woman receives. The model posits an interaction among intensity of contraceptive behavior, wanted/unwanted pregnancies, types of postpregnancy information, abortion/birth decisions, and changes in abortion policy.

The major predictions of the model are as follows:

1. When costs of abortion are dramatically lowered, such as when abortion is initially legalized, the rate of abortions will increase and the rate of both unwanted births and fertility will decline.
2. When expanded access leads to even further reductions in the cost of abortion, however, it will not result in a further decrease in fertility but may actually increase births. This is because when abortion costs are extremely low, contraceptive intensity declines and more pregnancies result. Many of these may be unwanted, but because of positive postpregnancy information, many women may decide to give birth, thus increasing the birth rate. This outcome is analogous to the safety of sports utility vehicles (the author uses the example of insurance). When SUVs become super safe from accidents, drivers tend to take more risks in driving, leading to more, not fewer, accidents and injuries.
3. When there are limited restrictions on access to legal abortion, such as administrative hurdles and limits on Medicaid funding, there will be a reduction in abortion demand, thus decreasing the number of abortions without increasing the number of births. This comes about because when faced with some increase in abortion costs, people will act to increase their contraceptive use to prevent unwanted pregnancies in the first place.

Using what he terms “quasi-experimental methods,” Levine finds empirical support for the predictions of the expanded model. To support the first and second propositions, he compares fertility rates nationwide before and after legalization of abortion in 1973, as well as rates between states that repealed restrictive abortion laws before 1973 and those that had restrictive laws. He compares states that have adopted restrictions on Medicaid, parental involvement laws, and mandatory waiting periods to test the third proposition.

Subsequent chapters compare these findings with published research on abortion policy changes in Europe, as well as with studies of their effects beyond fertility, specifically on marriage, children, and women's lives and fortunes. These chapters set forth a number of areas where well-designed empirical research is needed, such as an examination of the effect of contraceptive technology on sexual activity and pregnancy outcomes; the ways in which restrictions on abortion affect subgroups of women, especially poor single mothers; and the question of whether the ability to control one's fertility does improve women's educational and employment status.

The findings reported in Sex and Consequences support those in the abortion policy debate who assert that lifting excessive restrictions on abortion relieves women of the burdens of unwanted pregnancies by allowing them to exercise their choice to seek abortion at an affordable cost. These findings weaken arguments by pro-choice advocates, however, that unlimited access to abortion reduces unwanted pregnancy even more. Rather, unlimited access may increase unwanted pregnancies because it increases the relative cost of diligence in practicing contraception vis-à-vis abortion. With more pregnancies, there will also be both more abortion and more births. Placing a few hurdles on the way to abortion is likely to decrease unwanted births through greater contraceptive intensity and, consequently, unwanted pregnancies and abortion.