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Texas abortion clinics closing means more women wait

Unless the Supreme Court steps in to strike down another abortion clinic requirement, more closures are expected.

What happens when more than half a state’s abortion clinics close in two years? Women have to wait. Sometimes as much as 20 days for an appointment.

It’s already happened in Texas, after the state imposed new hurdles on abortion providers. According to a new study from researchers at the Texas Policy Evaluation Project (TxPEP) at the University of Texas, in some parts of the state, wait times have already increased to as much as 20 days.

Unless the Supreme Court steps in to strike down another abortion clinic requirement, more closures are expected, leaving only 10 clinics in a state with 5.4 million women of reproductive age. Judging from TxPEP’s current data, that would mean longer waits in more cities -- and, say the researchers, more later abortions.  

Under the full force of the law, parts of which are temporarily on hold, TxPEP researchers estimate that the number of second-trimester abortions would nearly double, from 6,600 in 2013 to over 12,000 with only 10 clinics.

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“The increase in second-trimester abortion is concerning from a public health perspective, since later abortions, although very safe, are associated with a higher risk of complications compared to early abortions,” said Dr. Daniel Grossman, a co-author of the study and a professor in the Department of Obstetrics, Gynecology and Reproductive Sciences at the University of California, San Francisco. “Later abortion procedures are also significantly more costly to women.”

In 2013, then-Gov. Rick Perry passed a law -- over the filibuster of then-Sen. Wendy Davis -- that included multiple new requirements for abortion providers, touted as protecting women’s health. One provision required all abortion providers to have admitting privileges at local hospitals. Another, which was slated to go into effect later, said abortions had to take place in expensive and cavernous ambulatory surgical centers, or ASCs. The American Medical Association and the American College of Obstetricians and Gynecologists both opposed the law, saying it would jeopardize women’s health.

The Supreme Court allowed the admitting privileges provision to go into effect in November 2013, but has twice prevented the ASC requirement from going into effect. The Court, which begins its new term today, has been asked to hear both provisions. It is also considering whether to take up Mississippi’s admitting privilege requirement, which would shutter that state’s last clinic.

The state of Texas has contended in court that the new requirements don’t place a substantial obstacle in the way of women seeking abortion, pointing out that in Texas’s major cities, clinics have been able to comply both both laws.

To find out if that was true, researchers with TxPEP made monthly “mystery calls” since November 2013, when the admitting privileges requirement first started closing clinics. In Dallas and Fort Worth, for example, where a little less than a third of Texas’s abortions were performed in the study period, waiting times dramatically increased, from 5 to 20 days.

“There were 8 facilities providing abortion care in the Dallas-Ft. Worth metropolitan area in April 2013; now there are only 4,” the researchers wrote. “Wait times have also been as long as 20 days at some clinics in Austin, while wait times have been stable and short in Houston and San Antonio.” (San Antonio has three ambulatory surgical centers whose doctors have been able to comply with the new requirements.)

“These clinics are barely able to serve the needs of women seeking services,” Grossman told MSNBC. “So when one closes, like what happened in Dallas, we see that wait times increase. This is kind of a natural experiment for what is likely to happen if the ASC requirement goes into effect.”

Getting an appointment is just the beginning of the journey for a woman seeking an abortion in Texas. She must make two visits, at least 24 hours apart, and receive a compulsory ultrasound with a doctor’s description of fetal development. And if wait times push her pregnancy past 20 weeks, she is barred from an abortion in Texas and many of its neighbors. The Supreme Court has repeatedly held that abortion is legal until fetal viability, roughly 4-6 weeks later.

TxPEP’s research has been key to the Texas abortion clinics challenging Texas’s law, as they argue that it unconstitutionally burdens women’s rights. “These findings underscore the urgency of the case now sitting at the doorstep of the nation’s highest court,” said Nancy Northup, president of the Center for Reproductive Rights, which is representing the clinics, in a statement. “It is time for the Supreme Court to step in and put an end to the reckless games Texas politicians are playing with women’s lives and livelihoods.”

Roger Rochat, a professor at the Rollins School of Public Health at Emory University, and former Director of the CDC’s Division of Reproductive Health, said of the study, “I think it’s a very good assessment of a potential increase in risk as a result of the policy change.” While Rochat said it was impossible to say for sure how many women would simply give up on having an abortion if they had to wait much longer for an appointment, he said mystery shopping is “the best estimate one can do and that the researchers had opted for a “conservative” estimate.

“Delays in abortion are serious in terms of increased risk of morbidity and mortality,” Rochat said.