Trump is Wrong on Abortion and Roe V. Wade

Many women won't be able to just go somewhere else if their state bans abortion. Distance matters.

By: Daniel Grossman
Featured in USA Today. First published January 22, 2017. 

The 44th anniversary of the Supreme Court’s ruling in Roe v. Wade is surely the most somber I can recall. With hundreds of thousands of women marching in protest in Washington and across the country and a newly installed president promising to name justices who oppose abortion, reproductive rights have never felt so threatened. There is real worry about what would happen if Roe were overturned.
A post-Roe landscape would be a patchwork of blue and red states where abortion would be either legal or not. Rather than looking back to 1972 to understand the consequences of such a situation, we can learn a lot by examining recent data from Texas. Although President Trump might think women can just “go to another state” to obtain an abortion, a new study I led — published in the Journal of the American Medical Association — suggests otherwise. As distance to the nearest abortion clinic grows, at some point the geographic barrier becomes insurmountable.
We analyzed the official Texas abortion statistics and compared county-level data between 2012 and 2014. During that period, the number of clinics in Texas providing abortions declined from 41 to 21, largely because of the restrictive law known as HB2. This law required physicians providing abortion to have admitting privileges at a nearby hospital and forced clinics to extensively modify their facilities, although the latter provision was largely blocked by the courts. Clinics unable to meet the unnecessary standards of HB2 were forced to close. Many of these closures occurred in smaller cities, leaving large areas in the western and southern parts of the state without a provider.
Thankfully, the Supreme Court overturned key provisions of HB2 in its ruling in Whole Woman’s Health v. Hellerstedt last June based on clear evidence of ”undue burdens” on women seeking abortions without any clear health benefit. Unfortunately, however, the damage was already done. There were only 17 clinics providing abortion in Texas at the time of the ruling, as we noted in our study. Now, more than six months later, our latest count shows there are only 18.

For counties that did not have an abortion clinic in 2014, our study found that the change in the number of abortions between 2012 and 2014 directly correlated with the change in distance to the nearest facility. In other words: the greater the change in distance, the greater the fall in abortions.  Counties that had a change of 100 miles or more experienced a 50% drop in abortions. For counties that had no change in distance, there was essentially no change in abortions.

Of course, the goal of the anti-choice movement is to reduce abortions, so some may argue that this research demonstrates the success of their legislative strategy. New data indicate that abortion numbers have reached record lows nationwide, likely due to better contraception access in some states, and restrictions on abortion access in others. But the reduction in abortion was not the only effect of HB2 in Texas; second-trimester abortions increased by 27% between 2013 and 2014.

Women we interviewed in our research told us how the closure of nearby clinics created delays in accessing care, since it took time to find an open clinic, get time off work and arrange transportation. Sometimes they were delayed into the second trimester, which is concerning from a public health perspective because later abortion, although very safe, is associated with a higher complication rate and is also more expensive.
In addition to these clinic closures and later abortions, there are other possible repercussions of HB2 that are still being explored, including more women traveling to Mexico to obtain abortions or self-inducing without clinical supervision. Our previous research has documented cases of women who have taken matters into their own hands because their nearest clinic closed, although it is not yet clear that self-induced abortion increased in Texas after HB2.
If women do not end up traveling for care, what happens to those who want an abortion and are unable to obtain it? The Turnaway Study, led by Dr. Diana Greene Foster at the University of California San Francisco, is beginning to give us an answer. Compared to women who obtain an abortion, those who are forced to continue an unwanted pregnancy are more likely to have negative physical health outcomes.