Glimpse of future from Texas example
The experience of abortion restrictions in Texas, described in another original investigation published in JAMA, provides a window into what could happen as access to abortions continues to decrease.
Texas has banned abortions after detectable embryonic cardiac activity since Sept. 1, 2021. Researchers obtained data on 80,107 abortions performed between September 2020 and February 2022.
In the first month following implementation of the Texas law, SB-8, the number of abortions in Texas dropped by 50%, compared with September 2020, and many pregnant Texas residents traveled out of state for abortion care.
But out-of-state abortions didn’t fully offset the overall drop in facility-based abortions.
“This decrease in facility-based abortion care suggests that many Texas residents continued their pregnancies, traveled beyond a neighboring state, or self-managed their abortion,” the authors wrote.
Increased time comes with costs
Sarah W. Prager, MD, professor in obstetrics and gynecology at University of Washington, Seattle, and director of the family planning division, explained that the travel time has to be seen in addition to the time it takes to complete the procedure.
Depending on state law, an abortion may take more than one visit to a clinic, which may mean adding lodging costs and overnight hours, or taking time off work, or finding childcare.
“A typical time to be at a clinic is upwards of 6 hours,” Dr. Prager explained, including paperwork, counseling, consent, the procedure, and recovery. That time is growing as active clinics overbook with others closing, she noted.
“We already know that 75% of people getting abortions are economically burdened at baseline. Gas is super expensive so the farther they have to drive – if they have their own car – that’s going to be expensive,” she noted.
In Washington, she said, abortion access is centralized in the western part of the state and located primarily between Seattle and Olympia. Though Oregon to the south has some of the nation’s most supportive laws for abortion, the other surrounding states have restrictive laws.
People in Alaska, Wyoming, Idaho, and Montana all have restrictive access, she noted, so people seeking abortions from those states have long distances to drive to western Washington and Oregon.
“Even for people living in eastern Washington, they are sometimes driving hours to get abortion care,” she said. “We’re really looking at health care that is dictated by geography, not by evidence, medicine, or science.”
The study by Dr. White and colleagues was supported by grants from the Susan Thompson Buffett Foundation and Collaborative for Gender + Reproductive Equity, as well as a center grant from the Eunice Kennedy Shriver National Institute of Child Health and Human Development awarded to the Population Research Center at the University of Texas at Austin. One coauthor reported receiving compensation from the University of Texas at Austin for providing data during the conduct of the study, as well as grants from Merck and Gynuity Health Projects and personal fees from Merck and Organon outside the submitted work; another reported being named plaintiff in the case Planned Parenthood of Montana v State of Montana, a lawsuit challenging abortion restrictions in that state. No other disclosures were reported. Dr. Cansino and Dr. Prager reported no relevant financial relationships.