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
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to ContraceptionAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Laws affecting reproductive health and rights: 2013 state, policy review.2014 ([cited June 15, 2014])
- The supply-side economics of abortion.N Engl J Med. 2011; 365: 1466-1469
- The impact of state mandatory counseling and waiting period laws on abortion: a literature review.Guttmacher Institute, New York2009
- Regulating abortion: impact on patients and providers in Texas.J Policy Anal Manage. 2011; 30: 775-797
- Brief of amici curiae American College of Obstetricians and Gynecologists and the American Medical Association in support of plaintiffs-appellees and in support of affirmance.([cited June 20, 2014] Available from:)
- First-trimester medical abortion with mifepristone 200 mg and misoprostol: a systematic review.Contraception. 2013; 87: 26-37
- Population estimates.([cited May 15, 2014]; Available from:)
- Houston abortion clinic shut down by state.Chronicle, Houston2014 ([cited May 1, 2014]; Available from:)
- Abortion incidence and service availability in the United States, 2011.Perspect Sex Reprod Health. 2014; 46: 3-14
- Obstacles to the integration of abortion into obstetrics and gynecology practice.Perspect Sex Reprod Health. 2010; 42: 146-151
- Induced terminations of pregnancy by age and county of residence; Texas.([cited July 12, 2014]; Available from:)
- As abortion clinics close, student creates travel fund. Texas Tribune.([cited June 22, 2014]; Available from:)
- Cutting family planning in Texas.N Engl J Med. 2012; 367: 1179-1181
- Births: Final data for 2012.in: National vital statistics reports. vol 62 no 9. National Center for Health Statistics, Hyattsville, MD2013
- Births: Preliminar y data for 2013.in: National vital statistics reports web release. vol 63 no 02. National Center for Health Statistics, Hyattsville, MD2014
- Choice of and satisfaction with methods of medical and surgical abortion among U.S. clinic patients.Fam Plann Perspect. 2001; 33: 212-216
- Determinants of demand: method selection and provider preference among US women seeking abortion services.Contraception. 2008; 77: 397-404
- Self-induction of abortion among women in the United States.Reprod Health Matters. 2010; 18: 136-146
- Risk factors for legal induced abortion-related mortality in the United States.Obstet Gynecol. 2004; 103: 729-737
- Abortion incidence and access to services in the United States, 2008.Perspect Sex Reprod Health. 2011; 43: 41-50
- The public health threat of anti-abortion legislation.Contraception. 2014; 89: 73-74
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.
