October 6, 2015 — The wait time for an abortion care appointment in some Texas metropolitan areas increased to about 20 days following the passage of an omnibus antiabortion-rights bill (HB 2) in 2013, according to a new report from the Texas Policy Evaluation Project (TxPEP), the Texas Tribune reports (Ura, Texas Tribune, 10/5).
The number of clinics providing abortion care in Texas has dropped from 41, before HB 2 took effect, to 18 (Garcia-Ditta, Texas Observer, 10/5).
HB 2 prohibits abortion after 20 weeks' gestation, restricts the use of medication abortion, requires abortion clinics to meet the building standards of ambulatory surgical centers and mandates that abortion providers have admitting privileges at nearby hospitals.
The Center for Reproductive Rights filed suit against certain provisions in the law, including the ambulatory surgical center requirements and whether abortion clinics in El Paso and McAllen should be exempt from the law's admitting privileges requirement.
In June, the U.S. Circuit Court of Appeals for the Fifth Circuit upheld the law's ambulatory surgical center provision and admitting privileges requirements except in the case of the McAllen clinic, Whole Woman's Health. CRR then appealed to the Supreme Court, which later that month put a temporary hold on the ambulatory surgical center requirement while weighing whether to hear the case (Women's Health Policy Report, 10/1).
For the report, researchers made "monthly mystery calls" to abortion clinics starting in November 2013 to assess how well clinics were meeting patient demand and whether the capacity of clinics to meet patient demand varied in different areas of the state (TxPEP report, 10/5). They found that after HB 2 took effect, the wait time for abortion care in certain areas of the state -- including Austin, Dallas and Fort Worth -- met or exceeded 20 days, the Tribune reports.
Compared with the other metropolitan areas that were studied, Dallas had the largest increase in wait times during the review period. According to the researchers, wait times in Dallas increased from roughly five days to up to 20 days following the June closure of an area clinic that performed about 350 to 500 procedures monthly.
Meanwhile, women in nearby Fort Worth saw wait times increase to up to 23 days after the high-volume clinic in Dallas closed. Prior to that clinic's closure, wait times had increased from about six days in December 2014 to up to 13 days in February, when a Fort Worth facility temporarily stopped providing abortion care, the Tribune reports.
In Austin, wait times reached 20 days in December 2014, but they since have fallen slowly to an average of more than 10 days. The researchers noted that one of the two clinics in the city does not meet the law's ambulatory surgical center provision, which means that if the requirement takes effect, there could be a large increase in wait times.
In Houston, the report found that wait times have averaged under five days since November 2014, although they reached up to 13 days in March. Researchers said wait times could increase further should HB 2 be allowed to take effect, as only two of the six Houston facilities meet the ambulatory surgical center requirement.
San Antonio, which has three ambulatory surgical centers that provide abortion care, has an average wait time of under five days. The longest wait time there was in January, averaging about nine days.
Conclusions and Implications
The researchers stated, "The long wait time at some of the [abortion clinics that meet ambulatory surgical center standards] suggests that these facilities are not meeting the existing demand for services" (Texas Tribune, 10/5). Daniel Grossman, lead researcher at TxPEP and Ibis Reproductive Health, added, "If the non-[ambulatory surgical center-compliant] clinics close, it seems unlikely that the remaining [ambulatory surgical center-compliant clinics] -- especially the ones that already have long wait times -- could increase their capacity to meet the demand for services across the state" (Texas Observer, 10/5).
Further, the researchers predicted that an increase in wait times could spur an increase in the number of second-trimester abortions (Texas Tribune, 10/5). They said if HB 2's ambulatory surgical center provision takes effect, just 10 clinics would remain in Texas, and the number of second-trimester abortions would increase from about 6,600 in 2013 to more than 12,000. According to MSNBC, Texas imposes a 24-hour mandatory delay on abortion care, in addition to the 20-week abortion ban.
Grossman said, "The increase in second-trimester abortion is concerning from a public health perspective, since later abortions, although very safe, are associated with a higher risk of complications compared to early abortions." He added, "Later abortion procedures are also significantly more costly to women."
Roger Rochat -- a professor at the Rollins School of Public Health at Emory University and former director of the CDC's Division of Reproductive Health -- called the study "a very good assessment of a potential increase in risk as a result of the policy change."
Separately, CRR President Nancy Northup said, "These findings underscore the urgency of the case now sitting at the doorstep of the nation's highest court," adding, "It is time for the Supreme Court to step in and put an end to the reckless games Texas politicians are playing with women's lives and livelihoods" (Carmon, MSNBC, 10/5).