Second trimester abortions became more common following the implementation of Texas House Bill 2, which dramatically restricted abortions in the state, researchers found.
After the law was enacted, 14.5% of abortions were performed later than 12 weeks gestation, compared with 10.5% before (P<0.001), reported Kari White, PhD, of the University of Alabama at Birmingham, on behalf of the Texas Policy Evaluation Project (TxPEP), and colleagues.
Not surprisingly, geographic distance and living in an area with fewer abortion clinics were both associated with higher odds of having a second trimester abortion, the authors wrote in Obstetrics & Gynecology.
They found that following the passage of House Bill 2, the number of facilities in Texas that provided abortions declined from 41 to 19, and the total number of abortions fell by 17% from 2012 to 2014, with larger decreases in counties where women needed to travel farther to an open facility.
“Given the recent national debate over later abortions, it’s important to recognize that restrictive laws are a major obstacle preventing women from obtaining abortions earlier in pregnancy,” study co-author Daniel Grossman, MD, of the University of California, San Francisco, and an investigator at TxPEP, said in a statement. “Those who support reducing the number of later abortions should also support eliminating these unnecessary and burdensome restrictions.”
The researchers examined cross-sectional vital statistics data on abortions performed in Texas prior to the state law (Nov. 2011-Oct. 2012) and after (Nov. 2013-Oct. 2014). They also conducted “mystery calls” to facilities opened when House Bill 2 was passed or that opened subsequently, “to determine whether the facility was providing abortions and the number of days until the next available appointment,” the authors said.
They added that the facility was presumed closed if clinic staff did not answer the phone on 2 consecutive days, the phone number was no longer in service, the call was rerouted to another facility, or a voicemail message confirmed the clinic was closed.
Overall, there were about 118,000 abortions performed in the time periods before and after the implementation of House Bill 2. Mean gestational age at abortion significantly increased during that time (7.3 weeks vs 8.3 weeks, respectively, P<0.001). During this time, there was also a decline in first trimester medication abortions (27.3% to 8.6% of all procedures, respectively).
Younger age (<18), black race, living farther from an open Texas facility at the time of the abortion, and living in a region with a smaller facility network were all associated with a higher likelihood of having a second trimester abortion during both study periods, the authors noted.
Adjusted analyses found higher odds of abortion at >12 weeks after the law (adjusted OR 1.44, 95% CI 1.39-1.50). Compared with women living <10 miles from a facility, women who lived 50-99 miles from the nearest facility were associated with higher odds of second trimester abortion (adjusted OR 1.24, 95% CI 1.11-1.39), as well as women in regions with <1 facility per 250,000 reproductive-age women (vs women in areas with ≥1.5 facilities, adjusted OR 1.57, 95% CI 1.41-1.75).
The authors also noted that following implementation of the law, women waited 1 to 14 days for a consultation visit.
“Women’s health policies should focus on ensuring women have access to timely, evidence-based care, not on creating obstacles that delay it,” White said in a statement.
This study was supported by the Susan Buffett Thompson Foundation and a grant from the Eunice Kennedy Shriver National Institute of Child Health and Human Development.
The authors disclosed no conflicts of interest.