Analysis highlights effects of Texas' HB 2, noting 'disproportionate' effect on Hispanic women

July 22, 2016 — Texas' 2013 omnibus antiabortion-rights law (HB 2) disproportionately affected Hispanic women's access to abortion care, according to a Dallas Morning News analysis of state data, the Dallas Morning News/Sacramento Bee reports (McSwane/Martin, Dallas Morning News/Sacramento Bee, 7/21).

Restrictions in HB 2

HB 2 imposes several restrictions on abortion care access.

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, 7/18).

Before the law took effect, there were about 40 abortion clinics in Texas. The number dropped to about 20 in November 2013, once the admitting privileges provision had taken effect. Under the law, abortion access dwindled dramatically, especially in west Texas, with clinics remaining open in six Texas cities including Austin, Dallas, Fort Worth, El Paso, Houston and McAllen. According to providers, the lack of access spurred long appointment wait times and forced women to travel long distances to reach a clinic. Were the contested provisions upheld, the number of clinics would have fallen to nine (Women's Health Policy Report, 6/30).

Other provisions in the law not challenged in the case remain in effect, including a ban on abortion after 20 weeks of pregnancy (Women's Health Policy Report, 7/18). The law also includes restrictions on medication abortion (Dallas Morning News/Sacramento Bee, 7/21).

Data show decline in recorded number of abortions

According to state data released in late June, the recorded number of abortions in Texas fell by about 14 percent between 2013 and 2014. The 14 percent change marked the largest one-year drop in the period spanning 2008 through 2014. The decline in abortions between 2013 and 2014 appears to be driven in part by a decrease in the number of medication abortions.

The Texas Department of State Health Services released the data just days after the Supreme Court ruling. Some advocates had accused DSHS of withholding 2014 data on abortion provision in the state (Women's Health Policy Report, 7/5).

Racial disparities

An analysis by the Morning News reveals racial disparities in the decline in abortions following the implementation of HB 2.

The Morning News/Bee reports that the highest drop in abortion rates was among Hispanic women (Dallas Morning News/Sacramento Bee, 7/21). The abortion rate among Hispanic women declined 18.3 percent between 2013 and 2014, compared with the state average of 14 percent (Women's Health Policy Report, 7/5). The decline in the abortion rate for Hispanic women is more than three times greater than the decline prior to HB 2's implementation. The Morning News/Bee reports that the decline among Hispanic women largely is tied to abortion clinic closures in the Rio Grande Valley, which has a predominantly Hispanic population.

Jessica Gonzalez-Rojas, executive director of the National Latina Institute for Reproductive Health in New York, said, "The data shows not only that the drop in the number of safe, legal abortions provided was clearly linked to the elimination of access but also, and most especially, that the elimination of clinics disproportionately impacted Latinas." She continued, "The data shows exactly why the Supreme Court struck down the provisions [in the law] ... because they are harmful to women and their families."

According to the analysis, African-American women also experienced a disproportionate decline in the rate of abortion care after HB 2 took effect. Prior to the law's implementation, the rate among African-American women was falling by about 5 percent annually; after the law's implementation, the decline increased to 7.5 percent.

In contrast, among white women, the number of abortions prior to the law's implementation decreased by about 9 percent annually, compared with a 6.7 percent decline after HB 2 took effect.

Geographic variation

The Morning News analysis also found geographic disparities in the provision of abortion care. Overall, about 75 percent of Texas counties reported declines in the number of abortions between 2013 and 2014. According to the analysis, some of the greatest drops in provision of abortion were observed in West Texas, the Texas Panhandle and the Rio Grande Valley -- regions where women experienced the largest increases in distance to the nearest abortion provider.

For instance, Hidalgo County, located in the Rio Grande Valley, saw the number of abortions among Hispanic women drop by 60 percent between 2013 and 2014. When compared with the preceding four years, the change represents a fivefold increase in the rate of decline for Hispanic women in that area. Overall, the county saw the number of abortions fall by 58 percent. The data suggest 97 percent of the decline is attributable to a drop in the number of Hispanic women who obtained abortion care.

When an abortion clinic in McAllen was closed, Hidalgo County residents seeking abortion care had to drive about 140 miles to Corpus Christi to reach a clinic. After the Corpus Christi clinic closed in 2014, women in Hidalgo County had to travel 180 miles to a clinic in San Antonio.

In Cameron County, also in the Rio Grande Valley, the rate of abortion care dropped by around 49 percent after HB 2's implementation, compared with an annual decline of about 20.5 percent in the years prior.

According to the analysis, more than 90 percent of women in Hidalgo County and in Cameron County are non-white, and 36 percent have incomes under the federal poverty level.

The analysis also found an increase in travel distance to abortion clinics for women in West Texas, where the number of abortions provided decreased following clinic closures. For instance, women in Lubbock County currently have to travel 244 miles to reach the nearest clinic, located in Fort Worth, and the number of abortions provided to Lubbock residents in 2014 decreased by 32 percent. Meanwhile, women in Midland County reported a 36 percent decrease in the number of abortions.

Similarly, in the Texas Panhandle, the distance Randall County women had to travel to reach the nearest clinic, located in Fort Worth, increased to 294 miles after HB 2's implementation. The number of abortions provided to women in the county decreased 72 percent. Potter County women saw the travel distance to an abortion clinic increase by 180 miles, while the number of abortions provided to county residents dropped by 80 percent.

Nan Little Kirkpatrick -- executive director of the Texas Equal Access Fund, which helps women in North Texas afford abortion care -- said, "People in the Panhandle were having such a hard time getting together travel, time off, and money that they dropped off communications, and our best guess is that they were forced to carry to term." She noted, "We've heard from some clients that they had considered self-aborting."

Effects of remaining restrictions

The Morning News/Bee reports that, along with the law's provisions that led to clinic closures, other restrictions in the law and longer wait times appear to have curbed access to abortion care. For instance, the number of abortions in El Paso County declined about 40 percent between 2013 and 2014, even though the county had at least one open clinic for most of the past three years. That rate is five times greater than the rate of decline in previous years, according to the analysis.

Moreover, medication abortion dropped 70 percent following the implementation of HB 2, which at the time forced women seeking medication abortion to make four trips to a clinic. Kelly Hart, a spokesperson for Planned Parenthood of Greater Texas, said, "Too many women couldn't find the time away from their jobs and families, nor the money, to get to our health centers for even one visit, much less four."

An update made by FDA earlier this year to the label for a drug used in medication abortion reduces the effects HB 2 has on medication abortion access. Hart said, "Obviously, the rebound in numbers of women choosing medication abortion immediately after the label change underscores just how effective the restrictions were in impeding personal health decisions for women seeking safe, legal abortion" (Dallas Morning News/Sacramento Bee, 7/21).