The Impact of Women's Health Clinic Closures on Preventive Care

Abstract

M any women rely on publicly funded family planning and women's health clinics as their only recent source of care, including preventive care (Frost, Gold, and Bucek 2012; Guttmacher Institute 2016). Some of these organizations provide abortion services in addition to family planning and other reproductive health services. Consequently, such organizations may face politically motivated funding cuts, which may also impact important non-abortion outcomes and related services.One primary cause of women's health facility closures is the loss of public funding. In the past few years, several states have attempted and in some cases succeeded in cutting public funding for women's health organizations that provide (or are affiliated with provision of) abortion services. These policies are exogenous to our outcomes of interest: women's cancer screenings and routine checkups. This is clearly stated by one of the state legislators responsible for recent funding changes in Texas,

The Impact of Women's Health Clinic Closures on Fertility

“…Our paper contributes to and draws on a well-established literature that investigates the impact of proximity to health care providers (or other entities) on health and health care outcomes (e.g., Goodman et al 1997;Buchmueller et al 2006;Currie et al 2010;Anderson and Matsa 2011;Currie and Walker 2011;Hill 2013;Rossin-Slater 2013;Hill 2014;and Lu and Slusky 2016). This literature validates our methodological approach of estimating the impact of geographic access to a women's health care provider on local behavior, while controlling for time-invariant differences across granular regions.…”

“…The methodology in this paper is analogous to that of Lu and Slusky (2016), which studies the relationship between relative changes in the driving distance to the nearest clinic and the incidence of preventive care.…”

“…They are discussed here briefly. In Table A1, we add the driving distance to the nearest clinic funded by the Texas Department of State Health Services (DSHS)'s Family Planning Program (as in Lu and Slusky 2016) to allay the concern that clinics from the network we study are closing and then reopening as part of a different network. We find, however, that adding this control makes no difference in the results.…”

“…These cuts and the resulting clinic closures allow us to test the impact of ease of access on birth rates. We follow the approach of our previous work (Lu and Slusky 2016) by using health center addresses from a network of women's health centers to calculate the driving distance to the nearest clinic for each ZIP-code. This measure is merged with birth rates by ZIPcode, and, using a within-estimator, we estimate the impact of a relative change in driving distance on the relative birth rate.…”

How Far Is Too Far? New Evidence on Abortion Clinic Closures, Access, and Abortions

“…Also related, Colman and Joyce (2011) estimate the reduced-form effects of Texas' 2004 Woman's Right to Know Act, which substantially increased the distance women had to travel in order to obtain abortions at or after sixteen weeks gestation in addition to requiring that women receive information about the abortion procedure and alternatives to abortion at least 24 hours before an abortion. In other related studies, Lu and Slusky (2016a) and Lu and Slusky (2016b) examine closures of "women's health clinics from a specific network of providers"-which includes both family planning and abortion clinics. Because their study uses data from an earlier time in Texas when family planning clinics-and not abortion clinics-closed en masse, their estimates likely reflect the effects of family planning clinic closures.…”