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.
Keywords
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Article info
Publication history
Published online: July 22, 2014
Accepted:
July 16,
2014
Received in revised form:
July 15,
2014
Received:
July 12,
2014
Identification
Copyright
© 2014 Elsevier Inc. Published by Elsevier Inc. All rights reserved.