How Texas' New Abortion Restrictions Have Actually Impacted Access to the Procedure

The number of abortions being performed in Texas has dropped moderately, clinics offering abortions are vanishing rapidly and women seeking abortions must travel much farther to get an abortion, according to almost 18 months of data compiled by researchers looking at the effects of Texas' passage of some of the most restrictive abortion regulations in the country.

A group made up primarily of researchers from the Texas Policy Evaluation Project and Ibis Reproductive Health document the law's impact in a report to be published in an upcoming issue of Contraception, an academic journal. Over the course of the team's study, which concluded in April, almost half of the state's women's health clinics that provided abortions closed.

The researchers looked at three time periods, the first beginning in November 2012 and ending April 30, 2013, before new restrictions passed the Legislature and 41 abortion providers were open. By October 31, 2013, the day before the first portion of House Bill 2 went into effect, 33 clinics remained open. At the study's conclusion, Texas had 22 abortion providers.

Despite the slew of closures stemming mostly from HB2's requirement that any doctors performing abortions have admitting privileges at a hospital with 30 miles of their practice, the number of abortions performed in the state only decreased by about 13 percent from the first period of the study to the third.

"The decline is a little bit less than we anticipated going into this, given that about half the clinics have closed," Dr. Daniel Grossman, the study's lead author, said. "I think that speaks to the fact that women have made the sometimes difficult decision that they need to have an abortion and they will do whatever it takes and jump through whatever hoops are required."

Those requirements can be stiff. There are know no providers in the Rio Grande Valley and just one in West Texas -- abortions that are performed within the bounds of the law have become concentrated in Texas' major metro areas; Austin, DFW, Houston and San Antonio. When the study began, 10,000 Texas women of reproductive age lived more than 200 miles from the nearest abortion provider. Now that number is 290,000. The travel burden faced by those women is compounded by the state's office visit requirements -- which were in place before HB2 became law -- which can require as many as four trips to a provider before actually having an abortion.

Groups like Planned Parenthood are doing what they can help women seeking the healthcare services HB2 has made so hard for them to get.

"Starting about a year ago, Planned Parenthood, with some of our key long-time donors and board members, put together a three-part investment in what we felt like we needed to do for our patients," Sarah Wheat, Planned Parenthood of Greater Texas' vice president for community affairs, said. "Part of that includes increasing our patient assisistance fund, which makes sure there are funds available if a patient can't access contraception or needs additional funds to travel to our health centers."

Much of the rest of the investment, as we reported last week, is dedicated to compliance with the most onerous part of HB2, that all facilities that provide abortions be certified ambulatory surgery centers as of September 1, 2014.

See also: Planned Parenthood Will Open a New Dallas Abortion Clinic to Clear Texas' New Hurdles

"We were tracking in this study the percent of all abortions that were currently being done in ASCs and that number has stayed pretty constant at around 22 percent," Grossman said. "Come September, when all of the other clinics disappear they're going to have to go from providing 22 percent of the abortions to providing a hundred percent of the abortions."

Depending on the status of the new Dallas clinic and another potential ASC slated for San Antonio, there are expected to be either six or seven Texas clinics that can legally provide abortions once the full law is in effect.

Beyond the effect of the law on clinics that provide surgical abortions, the study also reports on the 70 percent drop in the number of non-surgical, medical abortions over the research period.

"The restrictions in HB2 force doctors to offer a protocol that was approved by the FDA in 2000," Grossman said. "That's really outdated, there are much easier ways to provide the method. The law made it much more complicated for doctors to provide it and it made more expensive."

Given that woman outside of Texas are choosing the prescription drug-based method at a higher rate, the drop can be seen as especially precipitous, Grossman said.

To understand the full impact of the law, Grossman says, years worth of data will have to be examined. A few things, however, are clear:

"There's nothing in this law that is going to [make abortion safer]," Grossman said. "It's just making it much harder for women to access care."