Women's experiences seeking abortion care shortly after the closure of clinics due to a restrictive law in Texas

Abstract

Objective In 2013, Texas passed legislation restricting abortion services. Almost half of the state’s clinics had closed by April 2014, and there was a 13% decline in abortions in the 6 months after the first portions of the law went into effect, compared to the same period 1 year prior. We aimed to describe women’s experiences seeking abortion care shortly after clinics closed and document pregnancy outcomes of women affected by these closures. Study design Between November 2013 and November 2014, we recruited women who sought abortion care at Texas clinics that were no longer providing services. Some participants had appointments scheduled at clinics that stopped offering care when the law went into effect; others called seeking care at clinics that had closed. Texas resident women seeking abortion in Albuquerque, New Mexico, were also recruited. Results We conducted 23 in-depth interviews and performed a thematic analysis. As a result of clinic closures, women experienced confusion about where to go for abortion services, and most reported increased cost and travel time to obtain care. Having to travel farther for care also compromised their privacy. Eight women were delayed more than 1 week, two did not receive care until they were more than 12 weeks pregnant and two did not obtain their desired abortion at all. Five women considered self-inducing the abortion, but none attempted this. Conclusions The clinic closures resulted in multiple barriers to care, leading to delayed abortion care for some and preventing others from having the abortion they wanted. Implications The restrictions on abortion facilities that resulted in the closure of clinics in Texas created significant burdens on women that prevented them from having desired abortions. These laws may also adversely affect public health by moving women who would have had abortions in the first trimester to having second-trimester procedures.

Women’s Experience Obtaining Abortion Care in Texas after Implementation of Restrictive Abortion Laws: A Qualitative Study

“…Previous research has demonstrated that immediately after HB 2 was enforced, women were confused about which clinics were open and some faced longer travel distances to reach clinics, which created obstacles to care [12]. The results from this study demonstrate that such barriers persisted more than six months after HB 2 was first enforced.…”

“…This led some to consider not having the abortion, and one woman ultimately decided to continue her pregnancy at least in part because of the obstacles she encountered. This adds to other documented cases of women in Texas who have been prevented from having a desired abortion because their nearest clinic closed after HB 2 was enforced [12]. …”

“…Taken together these results provide further insight into the burdens imposed by HB 2 and the ways that the Texas abortion law has limited women’s access to abortion [4, 12, 13]. Abortion is a component of comprehensive reproductive health care, and denying women access to this service is increasing recognized as a breach of human rights [4].…”

“…Given the challenges to provision, some facilities stopped offering medication abortion altogether after HB 2 went into effect. The more limited availability of the method at clinics, compounded by clinic closures, the prospect of four visits, and higher costs for the procedure made it harder for women seeking medication abortion to obtain one [12, 13]. Of note, in March 2016, the FDA updated the mifepristone label to allow for use up to 10 weeks’ gestation using a reduced dosage of the medication and home administration of misoprostol [14], which has allowed Texas providers to once again use this evidence-based protocol.…”

Exploring prenatal genetic counselors' perceptions of abortion laws in restrictive states

“…More than half of the respondents in that study reported that they experienced delays in obtaining an abortion due to raising money for the procedure (Roberts et al, ). Another recent study conducted after the closure of almost half of the clinics in Texas due to legislative restrictions found that women experienced increased cost and travel, delays in obtaining an abortion, and some of the women did not obtain their desired abortion at all (Fuentes et al, ).…”