Texas Legal Abortion Rate Drops Post-HB 2

Newly released data, collected directly from Texas abortion providers, shows what many reproductive health leaders and advocates have anticipated in the post House Bill 2 landscape – a drop in the number of legal abortions.

When comparing November 2012-April 2013 to the same time period in 2013-14, the rate of legal abortions dropped 13% – a reduction of 9,200 procedures annually – researchers with the Texas Policy Evaluation Project (TxPEP), a five-year study examining the impact of Texas legislation on women’s health, found. In an even sharper decline, the number of pharmaceutical abortions fell a stunning 70% within that time frame.

Texas’ abortion-restrictive HB 2 (effective since Nov. 1 of last year) bans abortion after 20 weeks of pregnancy, forces women to follow outdated, expensive protocol and make more trips to the clinic when undergoing pharmaceutical abortion, and requires physicians to have admitting privileges at a hospital no further than 30 miles of where the abortion is performed. While a handful of states have enacted admitting privileges requirements and one has enforced a similar restriction on pharmaceutical abortion, no state has passed both concurrently, the researchers note in the embargoed research paper, made available to the public this morning.

“Some women have a strong preference for medical abortion, but the law has made it much more difficult to obtain,” says OB-GYN and lead author of the study, Dr. Daniel Grossman. “There is no evidence that any of the provisions in this law has improved the safety of abortion in the state – they have just made it harder for women to access the services they want and need.”

While the authors cannot prove causality between the state restrictions and the falling abortion rate, the timing is “suggestive of a link,” they write. They hypothesize that part of the reduction is due to the clinic closures as a result of doctors’ inability to obtain hospital admitting privileges.

Authors say they’re “somewhat surprised” that the dropping abortion rate was not even greater, attributing the reasons to a handful of factors such as HB 2’s larger impact on smaller, less populated cities than metros where most procedures are performed; indications unintended pregnancy may be rising due to hurdles accessing contraceptive services, and a concerted effort among activists to fund and provide logistical support for displaced patients. Among those groups: Fund Texas Women, the Lilith Fund, the Texas Equal Access Fund, Jane’s Due Process and Planned Parenthood’s newly created ‘Patient Assistance Fund.’ In upcoming research, TxPEP plans to explore whether limited access to services forced abortion-seeking women to obtain the procedure later in pregnancy, when both the health risks and costs are higher, and determine if the rate of abortion self-induction has increased.

The final part of HB 2 (to take effect Sept. 1) requires clinics to meet building code compliance that match the standards of ambulatory surgical centers, a costly regulation that is estimated to shut down 14 clinics, leaving the state with less than 10 abortion providers. To date, roughly 50% of Texas abortion clinics have shuttered their doors since HB 2.

For more on the impact of HB 2, read our coverage in the July 25 Chronicle.