Increase in distance to nearest abortion facility in Texas associated with decline in abortions

January 19, 2017

In Texas counties without an abortion facility in 2014, an increase in distance to the nearest facility was associated with a decline in abortions between 2012 and 2014, according to a study published online by JAMA.

Texas House Bill 2, enacted in 2013, was one of the most restrictive abortion laws in the country before the U.S. Supreme Court ruled in June 2016 that two provisions were unconstitutional. Following introduction and passage of the bill, the number of Texas facilities providing abortions declined, from 41 in 2012 to 17 in June 2016.

Women whose nearest clinic closed traveled farther to access abortion services than those whose nearest clinic remained open. Overall, abortions declined 14 percent in Texas between 2013 and 2014.

Daniel Grossman, M.D., of the University of California-San Francisco, and colleagues examined whether the decline in abortions would be greater as the change in distance to the nearest open facility increased. County-level data on abortions received by Texas residents both in and out of state in 2012 and 2014 were obtained from the website of the Department of State Health Services. The distance from the center of each Texas county to the nearest open facility providing abortions in 2012 and 2014 was calculated.

In 2012, 66,098 abortions were performed among Texas residents (97 out of state). In 2014, 53,882 abortions were performed among Texas residents (754 out of state). Of 254 counties, there were 41 facilities in 17 counties in 2012 and there were 21 facilities in 6 counties in 2014. The average change in distance to a facility was 51 miles and the median change was 13 miles.

Counties that had an open facility in 2014 (all in large metropolitan areas) had minimal distance changes (0-5 miles) and a 16 percent decline in abortions. Among counties without an open facility in 2014, the decline in abortions increased as the distance change to the nearest facility increased. Counties with no facility in 2014 but no change in distance to a facility between 2012 and 2014 had a 1.3 percent decline in abortions. When the change in distance was 100 miles or more, the number of abortions decreased 50 percent.

The authors write that the decline in abortions among women in counties with an open facility in 2014 indicates that there were other factors related to the decrease, such as limited capacity to meet demand for services. "In counties with no facility and no change in distance, the decline in abortion was minimal. Many of these counties were in East Texas where family planning services were disrupted, likely leading to increased demand for abortion that offset the increased capacity barriers women faced."
(doi:10.1001/jama.2016.17026; the study is available pre-embargo at the For the Media website)

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