Out-of-State Travel for Abortion among Texas Residents following an Executive Order Suspending In-State Services during the Coronavirus Pandemic

Abstract

During the COVID-19 pandemic, existing and new abortion restrictions constrained people’s access to abortion care. We assessed Texas abortion patients’ out-of-state travel patterns before and during implementation of a state executive order that prohibited most abortions for 30 days in 2020. We received data on Texans who obtained abortions between February and May 2020 at 25 facilities in six nearby states. We estimated weekly trends in the number of out-of-state abortions related to the order using segmented regression models. We compared the distribution of out-of-state abortions by county-level economic deprivation and distance traveled. The number of Texas out-of-state abortions increased 14% the week after (versus before) the order was implemented (incidence rate ratio [IRR] = 1.14; 95% CI: 0.49, 2.63), and increased weekly while the order remained in effect (IRR = 1.64; 95% CI: 1.23, 2.18). Residents of the most economically disadvantaged counties accounted for 52% and 12% of out-of-state abortions before and during the order, respectively (p < 0.001). Before the order, 38% of Texans traveled ≥250 miles one way, whereas during the order 81% traveled ≥250 miles (p < 0.001). Texans’ long-distance travel for out-of-state abortion care and the socioeconomic composition of those less likely to travel reflect potential burdens imposed by future abortion bans.

Abortion patients' decision making about where to obtain out‐of‐state care following Texas' 2021 abortion ban

“…6 People who travel for abortion care may consider multiple locations and do not always obtain their abortion at the nearest facility. 7,8 Studies of abortion patients' travel have largely focused on the financial, logistical, and emotional burdens that people experience. 7,[9][10][11][12][13][14] The few studies about people's decision-making report that cost, referrals, facility name recognition, gestational limits, and distance are important considerations.…”

“…We primarily recruited Texans who obtained out-of-state abortion care after SB8 using flyers that we mailed to 10 independent abortion facilities (i.e., those not affiliated with Planned Parenthood) in Arkansas, Colorado, Kansas, Louisiana, Mississippi, New Mexico, and Oklahoma, which had different abortion policy environments (Table 1). We selected these states based on where Texans were mostly likely to obtain care 8,26 ; in most of these states, independent facilities accounted for 50%-100% of all abortion facilities and provided approximately 70% of all Texas-resident out-of-state abortions immediately after SB8. 19 Between October 2021 and February 2022, facility staff distributed flyers to Texas residents, who then selfreferred to the study.…”

“…People who travel for abortion care may consider multiple locations and do not always obtain their abortion at the nearest facility 7,8 . Studies of abortion patients' travel have largely focused on the financial, logistical, and emotional burdens that people experience 7,9–14 .…”