Change in distance to nearest facility and increase in second-trimester abortion after the implementation of House Bill 2 in Texas

K. White, S. Baum, K. Hopkins, J. E. Potter, D. Grossman

Jan 2018

Objectives: Following passage of Texas’s restrictive abortion law, House Bill 2 (HB2), in 2013, more than half of the state’s abortion facilities closed. We examined changes in second-trimester abortion after passage of HB2, including change in one-way distance to the nearest open facility.

Methods: We obtained individual-level vital statistics data on Texas resident abortions performed 1 year before (November 2012–October 2013; n=63,327) and 1 year after implementation of HB2 (November 2013–October 2014; n=53,174). For each period, we computed the percentage of abortions performed at or after 12 weeks from last menstrual period and estimated the change in one-way distance from women’s county of residence to the nearest U.S. facility providing abortion. Using multivariable-adjusted logistic regression, we assessed the association between receiving abortion care after implementation of HB2, change in one-way distance and having a second-trimester abortion.

Results: The number of second-trimester abortions increased from 6589 (10.4%) in the year before HB2 to 7720 (14.5%) the year after (p<.001). After multivariable adjustment, women obtaining abortion care after HB2 were more likely to have had a second-trimester procedure (OR, 1.47; 95% CI, 1.42–1.52). Compared with women living in counties with an open facility, women living in a county with no facility who had an increase of 50 miles or more in distance to the nearest open facility were more likely to have had a second-trimester procedure (OR, 1.25; 95% CI, 1.13–1.38).

Conclusions: Increases in second-trimester abortion after HB2 may be partially explained by greater geographic barriers to services. Limited capacity of open facilities also may have contributed to delays in accessing care.