Most women who were denied abortions by Texas law got them some other way

In the months since Texas banned all but the first abortions in September, the number of legal abortions in the state fell by about half. But two new studies suggest that the total number of Texan women has fallen by far – about 10% – due to the sharp increase in the number of Texans who visited a clinic in a neighboring state or ordered abortion pills in line.

Two groups of researchers from the University of Texas at Austin counted the number of women using these alternative options. They found that while Texas law – which prohibits abortion after detection of fetal heart activity, about six weeks – reduced the number of abortions, it did so much more modestly than previous measures. didn’t suggest it.

Combined, the data indicates what could happen to abortion access if the Supreme Court decides to overturn Roe v. Wade when she rules on another abortion law this summer. The data show the limits of laws restricting abortion. Yet it also shows how the restrictions erect significant barriers, which will push some women to carry unwanted pregnancies to term.

“The law has done nothing to change people’s needs for abortion care; it’s moved to where people are getting abortions,” said Kari White, principal investigator of the university’s Texas Policy Evaluation Project and principal investigator of the new out-of-state abortion study. She said she was surprised at the low number of abortions prevented by such a sweeping set of restrictions: “The numbers are much larger than we expected. It’s quite amazing.

But for the architects of Texas law, even a modest reduction in abortions is a success.

“There is no hesitation on our part to declare this a victory for protecting unborn children from elective abortion,” said John Seago, legislative director of Texas Right to Life, who participated in the creation of the law. “We are realistic here, so the best we can do is to encourage women to have their children.”

Governor Greg Abbott, a Republican who said the bill “ensures that the life of every unborn child who has a heartbeat will be saved from the ravages of abortion” when he signed it, declined to comment on the new numbers.

As state legislatures await a Supreme Court ruling and take stock of the Texas experience this year, several have passed new abortion restrictions, even though they conflict with Roe. On Thursday evening, the Florida legislature voted to ban most abortions after 15 weeks. somewhere between 21 and 26 states are expected to ban or severely restrict abortion if the Supreme Court allows it. On Monday, an effort by Senate Democrats to codify abortion rights into federal law failed to draw enough votes.

Every month between September 2021, when the Texas law takes effect, and the end of the year, an average of 1,400 women traveled to one of the seven neighboring states, according to one of the new studies, published on Sunday. That was 12 times the number of abortions sought out of state before the law.

The study included seven neighboring states: New Mexico, Oklahoma, Louisiana, Arkansas, Kansas, Mississippi and Colorado. Nearly half of the Texans who traveled went to Oklahoma and a quarter to New Mexico. He counted Texans who visited 34 of the 44 clinics, so the total was likely higher.

An average of 1,100 of women ordered abortion pills online each month from Aid Access, a foreign service that mails pills while circumventing US abortion restrictions, connecting women with European doctors and Indian pharmacies. That’s more than triple the number of people who ordered pills in an average month before the law, according to the second study, published last week in JAMA Network Open.

Before, there were an average of 11 requests per day. Immediately thereafter, that number spiked to 138 requests per day and stabilized at around 30. The study could not determine whether all drug requests resulted in abortions.

“The law is semi-effective; it won’t stop all abortions,” said study author Abigail RA Aiken, who teaches public affairs and directs a research group studies self-directed abortion at the University of Texas at Austin.

According to various researches, those who have not been able to have an abortion are more likely to be poor. It is expensive to travel to another state and pay for transportation, childcare and accommodation on top of the procedure.

The new data covers the most common alternative methods at state clinics, but does not include all Texans who have had abortions. An unknown number of women most likely used other means, such as ordering pills from online pharmacies that did not publish their sales figures; crossing the border into Mexico to buy over-the-counter pills; travel to other states to have an abortion; or the use of herbs or other methods to self-manage abortions.

If Roe is overturned, the same patterns may not apply nationwide, as abortion access would be even more difficult than it has been for Texans.

Recent research has shown that abortion pills outside of formal health care settings are accessible, reliable and effective – and that information about accessing help is increasingly shared online. But some women don’t know it’s an option. “This is the question that has been on my mind for 10 years: how do you reach those who can’t find you?” said Rebecca Gomperts, the doctor who runs Aid Access.

Also, it is technically illegal to sell prescription drugs to American patients in another country without a prescription from a licensed physician in the United States. However, the application is difficult, even if Texas and some other states have explicitly restricted medical abortion.

Without Roe, clinics would close across large swaths of the South and Midwest. The closures would increase average driving distances to the nearest clinic to around 280 miles, compared to 35 miles, for women in states that don’t have one, according to a study by Caitlin Knowles Myers, an economist at Middlebury College. , and his colleagues.

Research on past abortion laws has shown that longer distances tend to reduce abortions, as travel challenges increase. Groups providing financial and logistical support to women in Texas said donations dwindled after a jolt when the law took effect.

The groups added that they would not have enough resources to help women in so many states. The remaining clinics would likely be overwhelmed with patients. Trust Women, which owns an abortion clinic in Oklahoma, sees 10 times more Texans there than before. This causes a ripple effect. Many Oklahomans cannot get local care and must seek it elsewhere, said Rebecca Tong, executive director of the clinics.

Clinics have tried to expand to keep up with demand, but especially in Oklahoma, where abortion would be banned if Roe were canceled, it’s hard to recruit doctors, she said: “Some would leave a full-time job with benefits, and for what?”

At Hope Medical in Shreveport, Louisiana, two-thirds of patients now come from Texas, up from one-fifth before the Texas law took effect. The clinic used to perform the majority of abortions before nine weeks, but now most patients are in their late first or early second trimester due to longer wait times for appointments.

“What ultimately happens is because we’re so busy and can’t work any faster, we’re seeing women whose pregnancies were further along,” said clinic administrator Kathaleen Pittman. “It doesn’t just happen to women in Texas, it also happens to women in Louisiana because they have to wait too.”

Still, clinics are bracing for an even bigger increase if Roe is overthrown, planning to expand capacity if abortion remains legal in their state — or, if not, to open across state lines where it is legal; offer more advice through telemedicine; or offer pre-abortion care.

Kristina Tocce, medical director of Planned Parenthood of the Rocky Mountains, said the influx of Texas patients gave a glimpse of a possible future, in which Colorado, which should keep abortion fully legal, could become a center post-Roe abortion. .

“What will happen when this happens to more and more states? ” she says. “I don’t know, but we can’t absorb 26 dark states.”

Note: Our calculated decline in the total number of abortions compares recent numbers to a baseline of abortion numbers prior to the legal change. For legal abortions in the state and requests for abortion pills, we compared the period from March to July in 2021 with the period from September to December in 2021.

For out-of-state abortions, we compared March through July in 2021 with a monthly average for 2019. (Figures from early 2021 were not available.)

Because the number of abortions in Texas increased in August 2021, in anticipation of the new restrictions, we did not include this figure when compiling historical numbers.