Texas Policy Evaluation Project (TxPEP)
In 2011, the Texas Legislature enacted HB15, cutting family planning funding by two-thirds and requiring women to come in-person at least 24 hours before an abortion for an ultrasound and description of the image. From 2011-2020, Ibis worked with colleagues at the University of Texas at Austin and the University of Alabama at Birmingham, to help evaluate the impact of these legislative changes on Texas women and family planning and abortion providers.
In July 2013, the Texas Legislature passed House Bill 2 (HB2), one of the most restrictive abortion laws of any state. HB2 has four main components. First, it requires abortion providers to have admitting privileges within 30 miles of the clinic where the abortion is performed. Second, the law bans terminations at or after 20 weeks post-fertilization, except in severe cases. Third, abortion providers are required to use an outdated protocol for medication abortion. Fourth, all abortion facilities are required to meet the standards of ambulatory surgical centers.
HB15 had a demonstrable impact on family planning in the state. We found that 59 clinics closed and 37 reduced their hours after the law took effect. We also observed a large unmet need for the IUD, implant, and sterilization due to high costs and lack of insurance coverage, as well as poor provider counseling. Results were used to oppose a new abortion restrictions bill and by advocates and policymakers who successfully pushed to restore family planning funding in the 2013 legislative session. We continue to examine the effects of HB15 through a prospective cohort study of postpartum contraception in El Paso and Austin.
We also studied the influence of HB15’s abortion restrictions. Women reported a wide range of responses to the forced ultrasound viewing, including increased confidence in their decision, feelings of sadness, or no influence at all. A quarter of abortion clients found it difficult to get the clinic for the required extra visit, and low-income women and those traveling more than 20 miles to the clinic were significantly more likely to report difficulty. Results and analyses from this study have been mentioned in several media pieces.
To evaluate the effects of HB2, we measured whether the number and kinds of abortions provided in Texas changed after these provisions were implemented. In May 2013, there were 41 facilities providing abortion in Texas; this decreased to 22 in November 2013, when the admitting privileges law and restrictions on medication abortion went into effect. We found that compared to the same time period one year before, the abortion rate declined 13% in the period from November 1, 2013 - April 1, 2014. We also found that the number of medication abortions provided declined by 70%.
We conducted qualitative interviews with women who had their appointment cancelled or were turned away when clinics closed to understand their experiences with abortion care under the new restrictions; preliminary analyses will be presented at the 2014 American Public Health Association conference. We also fielded a survey among more than 400 women seeking abortion care in Texas to get detailed information about how they navigated the changes in access to abortion care; data analyses are ongoing.
Considering the impacts our research has already demonstrated, we expect the new restrictions to have profound and exponential effects on both the clinics that provide these services and on the women seeking care. We hope our results can also be a useful tool in other states where similar restrictions are in place or proposed.