Abstract
BackgroundIn November 2013, Texas implemented three abortion restrictions included in House Bill 2 (HB 2). Within six months, the number of facilities providing abortion decreased by almost half, and the remaining facilities were concentrated in large urban centers. The number of medication abortions decreased by 70% compared to the same period one year prior due to restrictions on this method imposed by HB 2. The purpose of this study was to explore qualitatively the experiences of women who were most affected by the law: those who had to travel farther to reach a facility and those desiring medication abortion.MethodsIn August and September 2014, we conducted 20 in-depth interviews with women recruited from ten abortion clinics across Texas. The purposive sample included women who obtained or strongly preferred medication abortion or traveled ≥50 miles one way to the clinic. The interview guide focused on women’s experiences with obtaining services following implementation of HB 2, and a thematic analysis was performed.ResultsWomen faced informational, cost and logistical barriers seeking abortion services, and these obstacles were often compounded by poverty. Two women found the process of finding or getting to a clinic so onerous that they considered not having the procedure, although they ultimately had an abortion; another woman decided to continue her pregnancy, in part because of challenges in getting to the clinic. For two women, arranging travel required disclosure to more people than desired. Women who strongly preferred medication abortion were frustrated by the difficulty or inability to obtain their desired method, especially among those who were near or just beyond the gestational age limit. The restricted eligibility criteria for medication abortion and difficulty finding clinics offering the method created substantial access barriers.ConclusionsMedication abortion restrictions and clinic closures following HB 2 created substantial barriers for women seeking abortion in Texas.
Highlights
56 million abortions occur worldwide annually, corresponding to a rate of 35 abortions per 1000 women aged 15–44 years [1]
We conducted semi-structured in-depth interviews with women in Texas about their experiences seeking and obtaining abortion services after the first three provisions of House Bill 2 (HB 2) went into effect
We sampled based on these characteristics in order to conduct interviews with women who were most affected by HB 2, including those who were seeking or obtained medication abortion and those who traveled farther than the mean distance (46 miles one way) reported in the survey [13]
Summary
56 million abortions occur worldwide annually, corresponding to a rate of 35 abortions per 1000 women aged 15–44 years [1]. Many countries impose legal restrictions on the procedure. In the United States, despite legalization of abortion in 1972, policy restrictions at the state level have imposed barriers to women’s access to care, including laws that restrict how abortion is provided, known as Targeted Regulations of Abortion Providers (TRAP) laws. Examples of TRAP laws include regulations on the type of facility that can provide abortion care or requirements that providers have a relationship with a nearby hospital, including admitting privileges. The number of medication abortions decreased by 70% compared to the same period one year prior due to restrictions on this method imposed by HB 2. The purpose of this study was to explore qualitatively the experiences of women who were most affected by the law: those who had to travel farther to reach a facility and those desiring medication abortion
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