Assessing the acute impact of new abortion restrictions in Texas: A qualitative policy evaluation

In 2013, the Texas Legislature enacted one of the most restrictive abortion laws in the US.  The parts of this legislation that went into effect on November 1, 2013 restricted use of medical abortion, banned abortions after 22 weeks gestation, and required physicians performing abortion to have admitting privileges at nearby hospitals.  Twelve of 34 abortion providers immiediately closed because they did not have admitting privileges. To assess the acute effects of these restrictions on provision of and access to abortion care, we conducted qualitative, semi-structured interviews with 14 staff of closed clinics and 12 women who had or sought appointments after the clinic closures. Clinic staff described emotional difficulties notifying women of their cancelled appointments.  Helping women make arrangements to obtain care elsewhere was a challenge because travel to another clinic was an impediment for women, especially for undocumented immigrants in the Rio Grande Valley who could not pass border checkpoints further north. Staff also reported that many women thought abortion was now illegal. Women expressed disappointment and fear after learning the clinic was closed and were frustrated by the additional cost and travel required to go to another provider. Those who obtained an appointment elsewhere reported driving between 4 and 14 hours further, spending between $40 and $800 more, and being seen days or weeks later than their original appointment. Two women reported being unable to overcome these barriers and could not obtain the abortion they wanted. The 2013 Texas abortion restrictions resulted in immediate, costly obstacles to abortion care.