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Change to method of calculating Texas abortion statistics obscured effect of HB 2 on abortion access

July 18, 2016 — A change to Texas' methodology for calculating the length of pregnancy concealed a 27 percent increase in the number of abortions that were provided later in pregnancy following the implementation of the state's 2013 omnibus antiabortion-rights law (HB 2), the Houston Chronicle reports.

Restrictions in HB 2

HB 2 imposes several restrictions on abortion care access (Zelinski, Houston Chronicle, 7/15).

Last month, the Supreme Court struck down two contested provisions in the law. One provision required abortion clinics in the state to meet the same building standards as ambulatory surgical centers (ASCs), and the other required abortion providers to have admitting privileges at local hospitals. In a 5-3 decision, the court held that both contested provisions violated the U.S. Constitution by imposing an undue burden on a woman seeking abortion care (Women's Health Policy Report, 7/5).

According to the Chronicle, other provisions in the law not challenged in the case remain in effect, including a ban on abortion after 20 weeks of pregnancy (Houston Chronicle, 7/15).

Texas abortion statistics

Prior to the Supreme Court ruling, some advocates had accused the Texas Department of State Health Services (DSHS) of withholding 2014 data on abortion provision in the state.

State officials released finalized data in July just days after the Supreme Court's ruling. The data show an annual decline in the number of abortions obtained in Texas since 2008, with the biggest one-year drop -- 14.2 percent -- occurring between 2013 and 2014, after Texas' antiabortion-rights law took effect.

According to the American Civil Liberties Union (ACLU) of Texas, the finalized 2014 abortion data are important because that was the first full year during which the state implemented provisions under HB 2. However, according to a DSHS insider, the data had been "in limbo" since they were submitted to DSHS' legal office for final approval. DSHS staffers reportedly were told to stop discussing the data in emails and to tell the public that the data were not yet finalized (Women's Health Policy Report, 7/5).

Definition change

In 2014, Texas officials changed the methodology for calculating the length of pregnancy as part of the implementation of HB 2's 20-week ban.

Previously, Texas measured the length of a woman's pregnancy from the first day of a woman's last menstrual period, which is referred to as the point of "gestation." However, following implementation of the 20-week ban, the state revised its methodology to calculate the length of pregnancy as "post-fertilization," effectively shifting the trimesters of pregnancy back two weeks from its previous calculations.

According to the Chronicle, health providers have expressed concerns about the change, calling it unscientific. Abby Cutler -- chief resident of the Department of Obstetrics, Gynecology and Reproductive Sciences at the Yale School of Medicine and a junior fellow at the American Congress of Obstetricians and Gynecologists -- said, "The problem with pegging the dating on 'post-fertilization' is that it's not how medicine is practiced; regardless of the shift in certain legislation toward this term, it's not used by obstetricians."

Implications

Under the new definition, state officials recorded more than 3,000 abortions provided in 2014 as first-trimester abortions that would have been considered second-trimester abortions under the original methodology, the Chronicle reports.

Trisha Trigilio, staff attorney for ACLU of Texas, stated, "That 27 percent increase meant additional cost, discomfort and medical risk for thousands of Texas women. This is the reason we need to continue to push back against Texas's transparent efforts to block access to abortion."

Separately, Daniel Grossman, an investigator with the Texas Policy Evaluation Project and a professor at the University of California, said, "The fact that there was a big jump in second-trimester abortion is really important evidence of this law, and it's really something me and others should really study and learn from." He added that the state's lack of transparency regarding the definition change "hides the very, quite dramatic, impact the law has had in the state" (Houston Chronicle, 7/15).