Change in abortion services after implementation of a restrictive law in Texas

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 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.

Abortion Surveillance — United States, 2013

“…Multiple factors influence the incidence of abortion. These factors include access to health care services, including contraception (82)(83)(84); the availability of abortion providers (14,15,(85)(86)(87); state regulations, such as mandatory waiting periods (88), parental involvement laws (89), and legal restrictions on abortion providers (90,91); increasing acceptance of nonmarital childbearing (92,93); shifts in the racial/ethnic composition of the U.S. population (94,95); and changes in the economy and the resulting impact on fertility preferences and use of contraception (96,97). However, because unintended pregnancy precedes nearly all abortions (26), ¶ ¶ ¶ ¶ ¶ efforts to reduce the incidence of abortion need to focus on helping women, men, and couples avoid pregnancies that they do not desire.…”

Incidence of Emergency Department Visits and Complications After Abortion

“…State legislatures have passed regulations such as ambulatory surgical center requirements (23 states), transfer agreement laws (eight states), and hospital admitting privileges requirements (13 states) 26 with the stated intent to increase safety. Given that in practice their ultimate effect often is the closure of abortion facilities, 27 there is a need to consider the public health effect of these policies, weighing any theoretical incremental reduction in patient risk that may occur against any increases in risk that may occur with reduced access to abortion care.…”

Abortion Surveillance — United States, 2014

“…Multiple factors influence the incidence of abortion, including access to health care services and contraception (87)(88)(89); the availability of abortion providers (8,9,50,90-92); state regulations, such as mandatory waiting periods (68), parental involvement laws (93), and legal restrictions on abortion providers (94,95); increasing acceptance of nonmarital childbearing (96,97); shifts in the race/ethnicity composition of the U.S. population (98,99); and changes in the economy and the resulting impact on fertility preferences and use of contraception (100,101). However, despite the multiple influences on abortion, because unintended pregnancy precedes nearly all cases of abortions, ¶ ¶ ¶ ¶ ¶ efforts to reduce the incidence of abortion need to focus on helping women, men, and couples avoid pregnancies that they do not desire.…”