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Texas's legal abortion rate declines in wake of restrictions

Under a conservative legislature, half of Texas's abortion clinics closed in a year. Here's what happened to the abortion rate.
Files and supplies ready for storage in the recovery room on the Whole Women's Health Clinic's last day of seeing patients, in McAllen, Texas, March 4, 2014.
Files and supplies ready for storage in the recovery room on the Whole Women's Health Clinic's last day of seeing patients, in McAllen, Texas, March 4, 2014.

In November 2013, Texas began conducting an experiment of sorts on the women living there. Now the early results are in. 

Despite Wendy Davis's famous filibuster of the legislature's omnibus abortion law, and with the Supreme Court declining to block the law from going into effect, the state implemented several sweeping restrictions on abortion that had never before been in effect all at once. Those restrictions effectively closed nearly half of the state's clinics, made it much harder to get an abortion by taking two pills (known as medication abortion), and banned abortion after 20 weeks, several weeks before the Supreme Court deemed constitutional. 

For the first time, researchers have released data on what the immediate impact of those laws has been. In the first six months of the law going into effect, there was a 13% decrease in the abortion rate in Texas compared to the year before, according to a study to be published in the journal Contraception by public health researchers affiliated with the Texas Policy Evaluation Project.

There was what the researchers termed a "small but significant" increase in the number of abortions conducted after twelve weeks gestation, from 13.5% of all abortions performed in Texas to 13.9% of all abortions. 

Because the data was drawn from the abortion clinics left standing, it did not include women self-inducing abortions using pills obtained in Mexico, a known practice, particularly in border regions, that will be the focus of the authors' future research. 

The law also imposed restrictions on medication abortion, which in effect forced women to make four clinic visits instead of two, and narrowed the window when medication abortion would be available. The study found that in the period the law went into effect, medication abortions decreased by 70%. 

Where these legal hurdles don't exist, an increasing number of abortion patients are choosing medication abortion, which allows them to induce a miscarriage in the privacy of their home. A similar law in Arizona was struck down after a federal appeals court said the law didn't protect women's health in any way, but the more conservative appeals court overseeing Texas disagreed.

The evidence so far suggests that trying to talk women out of having abortions -- mandated "counseling," including forcing a woman to view an ultrasound and listen to a heartbeat, or waiting twenty-four hours between clinic visits, all of which Texas has in place -- does not significantly change the number of women who want the procedure. The Texas data confirms that so-called "supply side" restrictions on abortion have proven the most effective way to limit the number of safe and legal abortions. 

"Given the number of closures, and the size of the population left without a nearby provider, it is surprising that the overall decline in the abortion rate was not greater than the 13% change we observed," write the researchers, who include experts from the University of Texas, Ibis Reproductive Health, and the University of Alabama. It's possible, they say, that Texas's deep cuts to family planning funds raised the demand for abortion overall, offsetting the decline in supply, but there is no good data on it yet. 

The researchers also see their results as evidence that women in Texas remained determined to end their pregnancies, and activists were in place to help them, despite the hurdles lawmakers put in their way: "Our findings suggest that most women desiring an abortion—but not all—overcame the barriers of distance and additional cost to obtain the service they needed. In addition, the public opposition to HB2 galvanized a coordinated response among activists who provided financial and logistical support to women seeking abortions."

The researchers also found that the number of women of reproductive age living more than 200 miles from an abortion clinic increased under the law, from 10,000 to 290,000. At a hearing before the Fifth Circuit Court of Appeals in January, Judge Edith Jones had been skeptical that the law would be much of a burden on women, because they could drive 75 miles an hour on a flat highway. 

As the study points out, "In May 2013, there were 41 facilities providing abortion in Texas; this decreased to 22 in November 2013." But that number is poised to shrink. Unless a federal court agrees to a request to block the next part of the omnibus law, requiring that clinics be mini-hospitals, by September there will be an estimated six clinics in the entire state of Texas.