Report: HB 2 Raises Barriers

During arguments before the U.S. Supreme Court earlier this month, an attorney representing a group of Texas abortion providers claimed the clinic regulations found in House Bill 2 pose an undue burden on women, as they are now being forced to travel much further for abortion care.

In challenging the law, providers have made that claim since day one. Unfortunately for the state – which, with meager evidence, denies the law unduly burdens women – research backing up the providers keeps rolling in.

The latest findings from the UT-Austin based Texas Policy Evaluation Project (TxPEP) show women are now facing a combination of substantial barriers, including increased travel distances, higher out-of-pocket costs, and decreased access to medication abortion. TxPEP also reports that some people are being forced to stay overnight in the cities where they've traveled to receive care. HB 2 led to the closure of more than half of the state’s abortion clinics – today 19 clinics remain. If the final part of HB 2 is enacted, only 10 clinics are expected to stay open.

Published online in the American Journal of Public Health, the study surveyed 398 women seeking abortions at 10 abortion facilities between May and Aug. 2014. When nearby clinics shut down, the average distance to the closest provider increased fourfold, researchers found. These women now live an average of 70 miles one-way for care, instead of the 17-mile distance before HB 2 was made law in 2013. But when researchers looked closer at the distance women on the ground are actually traveling, they discovered patients are making an even longer drive – the group of women without a close provider trekked 85 miles one-way for abortion care, while women whose nearest clinic stayed open traveled an average of 22 miles. Other women were placed even further out of reach; 25% of women surveyed need to travel 139 miles from the nearest clinic and 10% live 256 miles away from abortion care. Researchers note the national average for a one-way trip to an abortion facility is 30 miles.

The study also revealed that 32% of women without a nearby clinic lost more than $100 out-of-pocket while traveling to get abortion care, due to costs such as child care, transportation, and overnight lodging, and to lost wages from taking time off work. Women far from abortion care (versus women who still had a nearby clinic) were three times more likely to make an overnight trip, and nearly 40% of those women had to schedule a surgical procedure instead of their preferred method, a medication abortion. The four-part law is not all clinic regulation – it also bans an updated protocol for medication abortion, forcing women to pay more and take the second dosage (misoprostol) at a doctor’s office instead of at home. This is on top of the extra trip women must make for their state-mandated 24-hour pre-abortion sonogram; the regulations taken together can cause some women to make up to four trips to a clinic. Study author Liza Fuentes tells the Chronicle the results aren’t surprising when factoring in previous TxPEP research showing medication abortion dropped by 70% post-HB 2. “It is concerning since we measure high quality heath care based on if patient preferences are being honored and whether or not patients are getting care in a timely manner,” said Fuentes.

Health researchers continue to warn that an increased number of women are facing nearly insurmountable barriers to abortion – 36% of women without a close provider reported that obtaining an abortion was difficult, compared with 18% of women who still have a clinic in their community.

“This study is unusual in its ability to assess multiple burdens imposed on women as a result of clinic closures, but it is important to note that the burdens documented here are not the only hardships that women experienced as a result of HB 2,” said Fuentes. Indeed, TxPEP research has shown women are experiencing longer wait times for the procedure (some waiting up to 20 days) and more than half report at least one barrier to accessing reproductive health care in Texas. The latest findings are yet another alarming indication of HB 2’s impact on abortion access for millions of Texas women, which should factor into the Supreme Court's decision.