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Change in Second-Trimester Abortion After Implementation of a Restrictive State Law

White, Kari PhD, MPH; Baum, Sarah E. MPH; Hopkins, Kristine PhD; Potter, Joseph E. PhD; Grossman, Daniel MD

doi: 10.1097/AOG.0000000000003183
Contents: Abortion: Original Research
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OBJECTIVE: To assess whether indicators of limited access to services explained changes in rates of second-trimester abortion after implementation of a restrictive abortion law in Texas.

METHODS: We used cross-sectional vital statistics data on abortions performed in Texas before (November 1, 2011–October 31, 2012) and after (November 1, 2013–October 31, 2014) implementation of Texas' abortion law. We conducted monthly mystery client calls for information about abortion facility closures and appointment wait times to calculate distance from women's county of residence to the nearest open Texas facility, the number of open abortion facilities in women's region of residence (facility network size), and days until the next consultation visit. We estimated mixed-effects logistic regression models to assess the association between obtaining abortion care after the law's implementation and having a second-trimester abortion (12 weeks of gestation or more), after adjustment for distance, network size, and wait times.

RESULTS: Overall, 64,902 Texas-resident abortions occurred in the period before the law was introduced and 53,174 occurred after its implementation. After implementation, 14.5% of abortions were performed at 12 weeks of gestation or more, compared with 10.5% before the law (P<.001; unadjusted odds ratio [OR] 1.45; 95% CI 1.40–1.50). Adjusting for distance to the nearest facility and facility network size reduced the odds of having a second-trimester abortion after implementation (OR 1.17; 95% CI 1.10–1.25). Women living 50–99 miles from the nearest facility (vs less than 10 miles) had higher odds of second-trimester abortion (OR 1.24; 95% CI 1.11–1.39), as did women in regions with less than one facility per 250,000 reproductive-aged women compared with women in areas that had 1.5 or more facilities (OR 1.57; 95% CI 1.41–1.75). After implementation, women waited 1 to 14 days for a consultation visit; longer waits were associated with higher odds of second-trimester abortion.

CONCLUSION: Increases in second-trimester abortion after the law's implementation were due to women having more limited access to abortion services.

Second-trimester abortion increased after implementation of a restrictive state law owing to women having more limited access to abortion services.

Department of Health Care Organization and Policy, University of Alabama at Birmingham, Birmingham, Alabama; Ibis Reproductive Health, Oakland, California; Population Research Center, University of Texas at Austin, Austin, Texas; and Advancing New Standards in Reproductive Health (ANSIRH), Bixby Center for Global Reproductive Health, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, California.

Corresponding author: Kari White, PhD, MPH, Health Care Organization and Policy, University of Alabama at Birmingham, 1720 2nd Ave S, RPHB 320, Birmingham, AL 35294; email:

This project was supported by a grant from the Susan Thompson Buffett Foundation and a center grant from the Eunice Kennedy Shriver National Institute of Child Health and Human Development (P2C HD042849) awarded to the Population Research Center at the University of Texas at Austin. The funders played no role in the design and conduct of the study; interpretation of the data; or preparation, review, or approval of this manuscript for publication.

Financial Disclosure The authors did not report any potential conflicts of interest.

Presented on October 14–16, 2017 at the North American Forum on Family Planning in Atlanta, GA.

Each author has confirmed compliance with the journal's requirements for authorship.

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© 2019 by the American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved.