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 versus ≥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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Objective To compare the estimated proportion of contraindications to combined oral contraceptives between women who obtained combined oral contraceptives in U.S. public clinics, compared with women who obtained combined oral contraceptives over the counter (OTC) in Mexican pharmacies. Methods We recruited a cohort of 501 women who were residents of El Paso, Texas who obtained combined oral contraceptives over the counter (OTC) in Mexico and 514 women who obtained combined oral contraceptives from family planning clinics in El Paso. Based on self-report of WHO category 3 and 4 contraindications and interviewer-measured blood pressure, we estimated the proportion of contraindications and, using multivariable-adjusted logistic regression, identified possible predictors of contraindications. Results The estimated proportion of any category 3 or 4 contraindication was 18%. Relative contraindications (category 3) were more common among OTC users (13% vs 9% among clinic users, p=0.006). Absolute contraindications (category 4) were not different between the groups (5% for clinic users vs 7% for OTC users, p=0.162). Hypertension was the most prevalent contraindication (5.6% of clinic users and 9.8% of OTC users). After multivariable adjustment, OTC users had higher odds of being contraindicated compared to clinic users (OR 1.59, 95% CI: 1.11–2.29). Women aged 35 years or older (OR 5.30, 95% CI: 3.59–7.81) and those with body mass index 30.0 kg/m2 or greater (OR 2.24, 95% CI: 1.40–3.56) also had higher odds of being contraindicated. Conclusions Relative combined oral contraceptive contraindications are more common among OTC users in this setting. Progestin-only pills might be a better candidate for the first OTC product given their fewer contraindications.

Texas House Bill 2, enacted in 2013, was one of the most restrictive abortion laws in the country before the US Supreme Court ruled in June 2016 that 2 provisions were unconstitutional.Following introduction and passage of the bill, the number of Texas facilities providing abortions declined, 1 from 41 in 2012 to 17 in June 2016. Women whose nearest clinic closed traveled farther to access abortion services than those whose nearest clinic remained open. 2 Overall, abortions declined 14% in Texas between 2013 and 2014. 3 We hypothesized that the decline in abortions would be greater as the change in distance to the nearest open facility increased. County with ≥1 facility in 2014 (6 counties); change in distance, 0-5 mile increase Change in distance to the nearest facility, 2012 to 2014 County with no facility in 2014 (248 counties

We examined the impact of legislation in Texas that dramatically cut and restricted participation in the state's family planning program in 2011 using surveys and interviews with leaders at organizations that received family planning funding. Overall, 25% of family planning clinics in Texas closed. In 2011, 71% of organizations widely offered long-acting reversible contraception; in 2012-2013, only 46% did so. Organizations served 54% fewer clients than they had in the previous period. Specialized family planning providers, which were the targets of the legislation, experienced the largest reductions in services, but other agencies were also adversely affected. The Texas experience provides valuable insight into the potential effects that legislation proposed in other states may have on low-income women's access to family planning services.