Study: Getting an Abortion in Texas Is Expensive and Complicated Thanks to Clinic Closures

In two months, when the U.S. Supreme Court hears arguments on whether the omnibus anti-abortion law Texas passed in 2013 goes too far, the justices will likely be asked to consider the practical impact of the law.

Hence the latest study from the Texas Policy Evaluation Project at the University of Texas at Austin, a group of researchers who have been examining the on-the-ground effects of an onslaught of laws passed by the Texas Legislature in 2011 and 2013 that either curtailed reproductive rights or slashed funding to family planning programs.

A study from TxPEP, as it's known, published this month in Contraception (a peer-reviewed “international reproductive health journal”) documents the experiences of 23 women who were turned away from clinics that shuttered due to provisions of House Bill 2 that have already been allowed to take effect (the U.S. Supreme Court has been asked to decide whether the state can enforce the last and strictest provision, that all abortion clinics meet the hospital-like standards of so-called ambulatory surgical centers). According to researchers, many of the women who had to find another abortion clinic, sometimes hundreds of miles away, faced a confusing, lengthy and expensive process. For two of the women interviewed, abortion had actually become inaccessible; they followed through with unwanted pregnancies.

The study builds on a body of research that could be important as the Supreme Court hears arguments that HB2 constitutes an “undue burden” on a woman's right to choose, rendering the law unconstitutional. It's expected HB2, if fully implemented, would shutter, at least for a while, all clinics outside of the state's major metro hubs of Houston, San Antonio, Austin and Dallas-Fort Worth. That means nearly 1 million Texas women would live more than 150 miles away from the nearest abortion provider, or about one in six women of reproductive age in the state.

Daniel Grossman, a TxPEP investigator and professor of obstetrics, gynecology and reproductive sciences at the University of California, San Francisco, summarized the new study and its impact this way:
“This study adds to our previous research documenting the negative impact of HB2 on women in Texas and demonstrates that the sudden closure of clinics created significant obstacles to obtain care, forcing some women to obtain abortion later than they wanted, which increases the risks and cost — and forcing others to continue with an unwanted pregnancy. Other research has documented serious health and social problems for women forced to continue an unwanted pregnancy, including medical complications of pregnancy and intimate partner violence.”
All 23 women interviewed by researchers sought abortion at a clinic that was closed after another provision of HB2 requiring physicians to have admitting privileges at nearby hospitals went into effect in late 2013. Some of the women already had appointments for the procedure. Many of the women were from the Rio Grande Valley and had to drive nearly four hours each way to San Antonio to reach a clinic that was still open.

Some tried to cut down on hotel costs by starting their trips at 3 a.m. and driving home immediately after the procedure. Others had to pay for hotel costs. “Six women reported spending between $60 and $200 on hotel stays because the trip was too far to make it in one day,” according to the study. “Women also described being uncomfortable, lonely and feeling sick while traveling far from home.”

The new study also underscores TxPEP's earlier findings that as clinics closed, the state saw an increase in second-trimester abortions, which are associated with a higher risk of complications compared to early abortions. Many of the women interviewed for the study waited a week or more past their initial appointment because of cost and arranging travel plans. Two women who had sought early care couldn't get an abortion until the second trimester, according to the study.

Two women, one from Waco and the other from the Valley, told researchers they simply couldn't work out the logistics and felt forced to follow through with a pregnancy they didn't want. One of the women, a 23-year-old mother of two, told researchers, “I was pretty upset, but I just decided that I guess I'll have to ride it out. I didn't know what else to do, who else to call.”

The researchers say that women for whom abortion services are difficult, if not impossible, to access are often forced to rely on others, meaning they have to tell more people about a sensitive decision they might not have otherwise. Many of the women interviewed talked about having to borrow a car or ask someone to drive them to appointments, despite wanting to keep their pregnancy a secret. One 18-year-old from the Valley lived with her parents and didn't want to tell them because they were against abortion.

But it's hard to be discreet when you're suddenly planning a days-long trip across the state. Researchers say the girl ultimately had to tell her father, who agreed to drive her; "what if something happens to you on the bus or something?” the father told the girl.

At least someone was worried about her safety. 
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Michael Barajas
Contact: Michael Barajas