Change in abortion services after implementation of a restrictive law in Texas
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Fig. 1
Geographic distribution of abortion facilities in Texas, November 2012–April 2014.
For each city, dot charts present number of open (solid circle 
) and closed facilities (open circle 
) on the Y axis at four key time points on X axis:
November 1, 2012–April 30, 2013 
October 31, 2013 
November 1, 2013 
April 30, 2014.
Fig. 2
Number of women age 15–44 living in a county at various distances from the nearest Texas abortion provider on various dates.
The blue line (diamonds) represents the number of women age 15–44 in a county >50 miles from the nearest Texas abortion provider, the red line (squares) represents those living in a county >100 miles from the nearest Texas provider and the green line (triangles) represents those living in a county >200 miles from the nearest Texas provider.
Abstract
Objectives
In 2013, Texas passed omnibus legislation restricting abortion services. Provisions restricting medical abortion, banning most procedures after 20 weeks and requiring physicians to have hospital-admitting privileges were enforced in November 2013; by September 2014, abortion facilities must meet the requirements of ambulatory surgical centers (ASCs). We aimed to rapidly assess the change in abortion services after the first three provisions went into effect.
Study design
We requested information from all licensed Texas abortion facilities on abortions performed between November 2012 and April 2014, including the abortion method and gestational age (<12 weeks vs. ≥12 weeks).
Results
In May 2013, there were 41 facilities providing abortion in Texas; this decreased to 22 in November 2013. Both clinics closed in the Rio Grande Valley, and all but one closed in West Texas. Comparing November 2012–April 2013 to November 2013–April 2014, there was a 13% decrease in the abortion rate (from 12.9 to 11.2 abortions/1000 women age 15–44). Medical abortion decreased by 70%, from 28.1% of all abortions in the earlier period to 9.7% after November 2013 (p<0.001). Second-trimester abortion increased from 13.5% to 13.9% of all abortions (p<0.001). Only 22% of abortions were performed in the state's six ASCs.
Conclusions
The closure of clinics and restrictions on medical abortion in Texas appear to be associated with a decline in the in-state abortion rate and a marked decrease in the number of medical abortions.
Implications
Supply-side restrictions on abortion — especially restrictions on medical abortion — can have a profound impact on access to services. Access to abortion care will become even further restricted in Texas when the ASC requirement goes into effect in 2014.
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