Texas Study Proves That Without Access, There Is No Choice

The Texas Policy Evaluation Project (TxPEP) has released the findings of its study on the effects of the increased distance between a patient and abortion provider facilities on the state’s abortion rates. The TxPEP study provides us with valuable information which we may use to further arm ourselves in the war on women that will be undertaken by the Trump administration.

Alex Wolf

Published in the Journal of the American Medical Association (JAMA), the study is the first to closely examine—and offer quantitative evidence of—the definitive role a woman’s geographic location plays in her access to abortion services. “While it may seem intuitive that increasing distance to a facility providing abortions limits access, this is the first study to rigorously demonstrate that association,” Dr. Joseph Potter, TxPEP’s principal investigator and professor at the Population Research Center at the University of Texas at Austin, said in a statement.

Enacted in 2013, Texas’ omnibus anti-abortion HB 2 law was overturned by the Supreme Court in June of 2016, with the Court ruling the law’s requirement that all abortion provider facilities must meet hospital-level standards (including the size of procedure rooms and doorways as well as methods of administering anesthesia), as well as requiring facilities have a doctor with admitting privileges at a hospital within 30 miles of the clinic constituted an “undue burden.”

Nevertheless, in the in the years leading up to the Court’s decision, women were made to contend with tremendous barriers to access reproductive healthcare services. The TxPEP study found that, by 2014, only six out of Texas’ 254 counties still had an abortion provider. Meanwhile, between 2013 and 2016 the number of abortion facilities in the state dropped from 41 to 17 and, according to the Texas Department of State Health Services, there was an 18.5 percent in the number of abortions performed on Texas residents over 2012 to 2014. However, researchers noted that, during an overlapping period, from 2013-2014 the number of second-trimester abortions increased by 27 percent.

Such dramatic increase is no surprise considering the financial constraints presented by the restrictions under HB 2. According to the study, finds that the increases in travel distance to the “nearest” abortion clinic, due to clinic closures under the HB 2 law, closely correlates with a decline in the official number of abortions. Counties where distances to the nearest clinic increased by over 100 miles saw official abortion rates drop by 50 percent, undoubtedly due to the financial pressures of transportation, possible lodging and time away from a job or children, rooted in traveling a significant distance.

A caveat, however, is that the “official” abortion rate decreasing doesn’t mean attempted abortions were decreasing. Another TxPEP study found that at least 100,000 women in Texas have attempted self-induced abortions in their lifetimes.

After the election, Trump told CBS’ 60 Minutes that “if [Roe v. Wade] ever were overturned, it would go back to the states…Women might still be able to get an abortion, but ‘they’ll perhaps have to go, they’ll have to go to another state.'” This study shows that traveling excessive distances for care is no small obstacle—and that requirement will put women’s health and well-being at risk.

“A post-Roe landscape would be a patchwork of blue and red states where abortion would be either legal or not,” TxPEP researcher Daniel Grossman wrote in a recent op-ed for USA Today. “Rather than looking back to 1972 to understand the consequences of such a situation, we can learn a lot by examining recent data from Texas.”

He goes on to explain:

Women we interviewed in our research told us how the closure of nearby clinics created delays in accessing care, since it took time to find an open clinic, get time off work and arrange transportation. Sometimes they were delayed into the second trimester, which is concerning from a public health perspective because later abortion, although very safe, is associated with a higher complication rate and is also more expensive.

In addition to these clinic closures and later abortions, there are other possible repercussions of HB2 that are still being explored, including more women traveling to Mexico to obtain abortions or self-inducing without clinical supervision. Our previous research has documented cases of women who have taken matters into their own hands because their nearest clinic closed, although it is not yet clear that self-induced abortion increased in Texas after HB2.

Pressed by interviewer Leslie Stahl, Trump said: “we’ll see what happens.” Women and our allies do understand, President Trump, and we are prepared to fight you every step of the way.



Lauren Young is a Ms. contributor. She has a Master’s Degree in European and Russian Studies from Yale University and a Bachelor’s Degree in Government and Russian Civilization from Smith College. Follow her on @thatlaurenyoung.