Most women have been denied abortions by Texas law and received them by other means

In the months after 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 overall number of women in Texas fell much less — about 10 percent — because of the large increase in the number of Texans traveling to a clinic in a nearby state or ordering abortion pills online.

Two groups of researchers from the University of Texas at Austin counted the number of women who took advantage of these alternative options. They found that while Texas law — which prohibits abortion after fetal cardiac activity can be detected, or about six weeks — lowered the number of abortions, it did so much more modestly than previous measurements suggested.

Combined, the data points to what could happen to abortion access if the Supreme Court decides to overturn Roe v. Wade when it rules on another abortion law this summer. The data shows the limitations of laws restricting abortion. But it also shows how restrictions create significant barriers that may prevent some women from carrying out unwanted pregnancies.

“The law has done nothing to change people’s need for abortion care; it’s shifted where people get their 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 expressed surprise at how few abortions were prevented by such a sweeping set of restrictions: “The numbers are much greater than we expected. It’s pretty amazing.”

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

“There is no hesitation on our part in calling this a victory for actually protecting pre-born children from elective abortion,” said John Seago, the Texas Right to Life legislative director who was involved in the drafting of the law. . “We’re realists here, so the best thing we can do is encourage women to have their children.”

Gov. Greg Abbott, a Republican who said the bill “will ensure every unborn child’s life will be saved with a heartbeat from the ravages of abortion,” declined to comment on the new numbers.

While state lawmakers await a Supreme Court ruling and take stock of this year’s Texas experience, several have passed new abortion restrictions, even if they conflict with Roe. On Thursday evening, the Florida legislature voted to ban most abortions after 15 weeks. Between 21 and 26 states are expected to ban or significantly restrict abortion if the Supreme Court allows. An attempt by Senate Democrats to enshrine abortion rights in federal law failed to generate enough votes Monday.

Each month, between September 2021, when the Texas law went into effect, and the end of the year, an average of 1,400 women went to one of seven nearby states, according to one of the new surveys released Sunday. That was 12 times the usual rate before the law sought out-of-state abortions.

The study included seven nearby 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. It counted Texans attending 34 of the 44 clinics, so the total was probably higher.

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

Previously, there were an average of 11 requests per day. Immediately thereafter, that peaked to 138 requests per day and stabilized at about 30. The study was unable to determine whether all drug requests resulted in abortions.

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

Those who couldn’t get an abortion are most likely poor, according to several studies. It is expensive to travel to another state and pay for transportation, childcare and housing in addition to the procedure.

The new data covers the most common alternative methods to the state’s clinics, but doesn’t 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 have not published their sales numbers; cross the border into Mexico to buy over-the-counter pills; travel to other states to have abortions; or the use of herbs or other methods of self-management of abortions.

If Roe is destroyed, the same patterns may not apply across the country, as access to abortion would be even more difficult than for Texans.

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

Also, it is technically illegal to sell prescription drugs to U.S. patients from another country without a prescription from a licensed physician in the United States. Enforcement is difficult, however, even now that Texas and some other states have explicitly restricted drug abortion.

Understand Texas Abortion Law

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The most restrictive in the country. The Texas abortion law, known as Senate Bill 8, amounts to an almost complete ban on abortion in the state. It bans most abortions after about six weeks and makes no exceptions for pregnancies resulting from incest or rape. The law has been in effect since September 1.

Without Roe, clinics in much of the South and Midwest would close. The closures would increase the average driving distance to the nearest clinic to about 280 miles, up from 35 miles, for women in states without one, research found by Caitlin Knowles Myers, an economist at Middlebury College, and colleagues.

Research into past abortion laws has shown that greater distances tend to reduce abortions as the challenges of travel increase. Groups providing financial and logistical support to Texas women said donations had dwindled after a bump as the law went into effect.

The groups added that they would not have enough resources to help women in so many states. The remaining clinics would most likely be overrun with patients. Trust Women, which has an abortion clinic in Oklahoma, sees ten times as many Texans there as it used to. This creates a ripple effect. Many Oklahomans can’t get local care and must seek it elsewhere, said Rebecca Tong, director of the clinics.

The clinics have tried to expand to meet demand, but especially in Oklahoma, where abortion would be outlawed if Roe were reversed, recruiting doctors is difficult, she said: “Some would leave full-time jobs with benefits, and for what?”

At Hope Medical in Shreveport, La., two-thirds of patients now come from Texas, compared to one-fifth before the Texas law went into effect. The clinic used to do most 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 that because we’re so busy and we can’t work faster, we see women whose pregnancies were further along,” said Kathaleen Pittman, the clinic’s administrator. “It’s not only happening to women from Texas, but also to women from Louisiana because they also have to wait.”

Still, clinics are gearing up for an even bigger wave if Roe is overthrown, and plan to expand capacity if abortion remains legal in their state — or, if not, open across state lines where it’s legal. ; provide more guidance through telemedicine; or provide pre-abortion care.

Kristina Tocce, medical director of Planned Parenthood of the Rocky Mountains, said the influx of Texas patients was a preview of a possible future in which Colorado, which is expected to keep abortion completely legal, could become a post-Roe abortion center. †

“What’s going to happen if this happens in more and more states?” she said. “I don’t know, but we can’t absorb 26 states going dark.”

Note: Our calculated decline in total abortions compares recent numbers to a baseline of pre-legislative abortions. For legal in-state abortions and abortion pill requests, 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 the period from March to July in 2021 with a monthly average from 2019. (Figures from early 2021 were not available.)

Because the number of abortions in Texas increased in August 2021, we have not factored that figure into the historical figures in anticipation of the new restrictions.

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