How Greater Travel Distance Due to Clinic Closures Reduced Access to Abortion in Texas
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In 2013, the Texas legislature passed House Bill (HB) 2, a law that restricted access to medication abortion, banned abortions after 20 weeks “post-fertilization,” required doctors who provided abortions to have admitting privileges at a hospital near the abortion facility, and mandated that abortion facilities meet the standards of ambulatory surgical centers (ASC). In June 2016, the Supreme Court struck down the admitting privileges and ASC requirement as unconstitutional because they imposed undue burdens on a woman’s right to abortion. The admitting privileges requirement had already caused many abortion clinics to close; the majority opinion noted that the ASC provision would cause more clinics to close, requiring even more women seeking abortion to travel long distances to the remaining overcrowded facilities which would unlikely be able to meet statewide demand for abortion. In a Research Letter recently published in the Journal of the American Medical Association (JAMA), the authors assessed whether greater travel distance following clinic closures was associated with a decrease in the number of abortions.1 In 2012, 41 facilities were providing abortions in Texas; by June 2016, this number had fallen to 17. In a previous study, the authors found that women whose nearest abortion clinic closed between 2013 and 2014 traveled farther than those whose nearest abortion clinic stayed open.2 In addition, based on data the researchers collected directly from facilities, the number of abortions declined 14% in the first six months after HB 2 went into effect compared to the same period one year prior.3 Using Department of State Health Services data for the number of abortions by Texas county released several days after the Supreme Court ruling, the authors calculated the distance from the centroid of each county to the nearest US facility providing abortions in 2012 and 2014. Then, the change in distance to the nearest facility for each county was calculated, and counties were aggregated into five groups according to the magnitude of the change in distance to the nearest US facility between 2012 and 2014, with a sixth group encompassing the six counties that still had a facility in 2014. Finally, the percentage change in the number of abortions between 2012 and 2014 in each one of the six groups was calculated.