October 21, 2015

By Alexandra Kilpatrick

Passed in October 2013, Texas House Bill 2 (HB2) changed the way Texas women were able to access reproductive health care. The law required doctors providing abortions to have admitting privileges at hospitals within 30 miles of the abortion clinic, a new provision that shut down many Texas clinics. It also prohibited abortions after 20 weeks post-fertilization except in cases of several fetal abnormality or instances in which post-20-week abortion was necessary to prevent the woman’s death or a substantial physical impairment.

The bill also required three doctor’s appointments each for women receiving abortion-inducing drugs, one for each of two doses of the abortion pill and a follow-up within 14 days. In addition, section 245 of the Texas Health and Safety Code was amended in January 2014 to require all new abortion clinics to be ambulatory surgical centers (ASCs) and existing clinics to comply with ASC requirements by September 2014, an expensive upgrade that shut down most clinics in Texas. The Center for Reproductive rights, on behalf of Whole Woman’s Health and others, filed a lawsuit.

In April 2014, a federal district court struck down the ASC and admitting-privileges requirements, but the U.S. Court of Appeals for the Fifth Circuit then stayed the decision. As a result, the requirements went into effect.

Since the law’s enactment, the number of facilities providing abortions in Texas has dropped from 40 to 18. This scarcity lengthens wait times and, by consequence, leads to more second-trimester abortions. The Texas Policy Evaluation Project compiled data on increased wait times and predicted that if the Supreme Court upholds the requirement that all abortion clinics meet the same building codes as ASCs, more clinics will close and the number of second-trimester abortions will double from 6600 in 2013 to about 12400 annually. An OB/GYN and professor who worked on this study, Dr. Daniel Grossman, pointed out that the influx of second-trimester abortions was actually less safe and more expensive.

“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,” Dr. Grossman commented. “Later abortion procedures are also significantly more costly to women.”

Dr. Grossman also predicted a sharp decline in the availability of abortion services in Texas, should the Supreme Court decide not to reverse HB2’s provisions.

“If the non-ASC clinics close, it seems unlikely that the remaining ASCs—especially the ones that already have long wait times—could increase their capacity to meet the demand for services across the state,” Dr. Grossman explained.

If the Supreme Court decides not to hear the challenges to the law, or hears the case and allows the law to stand as-is, young women in Texas would be disproportionately impacted. Statistics show the majority of the approximately 700,000 women in the United States who seek abortion care each year are under 30. Furthermore, women in their twenties make up 57 percent of all women having abortions. Overall, one in three women will have an abortion in her lifetime.

The Supreme Court distributed the petition for conference on November 6, meaning it could decide whether to hear the case as early as November 9. Another case concerning abortion rights out of Mississippi is also pending.

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