Why Texas' abortion rates aren't falling as quickly as everyone expected

In the months since Texas' controversial abortion restrictions began to go into effect, the state's health-care landscape has been transformed.

A new study conducted by researchers at the University of Texas's Policy Evaluation Project found that since state legislators passed HB2 — the raft of restrictions on abortion doctors and facilities made famous last summer by Wendy Davis' marathon filibuster — 19 of Texas's 41 abortion clinics have closed their doors. The closures are thanks to a provision of HB2 that requires abortion providers to receive admitting privileges at local hospitals, a hurdle that has been impossible for many doctors to surmount.

Today, vast swathes of the state have no abortion clinics. The researchers estimate that 290,000 reproductive-age Texas women live more than 200 miles from an abortion facility, up from just 10,000 in April 2013.

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There was no way, given the meteoric decline in the number of providers, that the abortion rate wasn't going to fall. The question was by how much. In the study, which provides a rare and fascinating view into the law's real-time effects, the UT researchers found that the state was on track to see 13 percent fewer abortions annually. It's a steeper drop than the national average, but nowhere near the catastrophic levels that the clinic closures might have spurred. "In some ways, we were expecting a bigger decline," Dan Grossman, one of the authors of the report, told the Texas Tribune.

Why isn't the new law working as well as anti-abortion advocates might have hoped? It's not the first time a barrage of such legislation hasn't had the desired effect.

Beginning in the 1990s, anti-abortion legislators began to impose laws designed to convince women not to have abortions. The requirements were tailored to help women understand the gravity of their decision. Twenty-three states required doctors to provide an ultrasound before an abortion, so women could see their embryo or fetus. Thirty-five states mandated pre-abortion counseling, including — in some states — information about the fetus' ability to feel pain and the assertion that life begins at conception. Twenty-six states required a waiting period, usually 24 hours, between the counseling and the procedure. The abortion rate continued to decline slowly — as it has every year since 1992 — but the laws had no discernable effect.

By passing these laws targeted at women, anti-abortion legislators were hoping to decrease demand for abortion. When that didn't work, they turned to laws like HB2, which affect supply. If more clinics close, one might reasonably assume, the demand for abortion will also decline, either because wait times at the existing facilities are too long or because women will decide that an abortion isn't worth the hassle or expense. After all, the cost of an abortion increases exponentially with each passing month; after the first trimester, the price moves into quadruple digits.

HB2 did have a significant impact on one kind of abortion: medication abortion, which allows women to terminate an early pregnancy with a pill. The law limits the use of medication abortion to the first seven weeks of pregnancy (the scientific consensus says that it can be used up to nine weeks) and requires four trips to the clinic. According to the UT study, the use of medication abortion dropped by a staggering 70 percent. Nationally, medication abortion accounts for 23 percent of nonhospital abortions.

But the decline in drug-induced abortion means that sizable numbers of women are just waiting later to have a more expensive surgical procedure, sometimes driving twice to a facility that's hundreds of miles away. They've been assisted in the past year by Texas groups who raise money to help subsidize the cost of abortion procedures, especially for low-income women who need to make a long trip. But these groups are small and their resources are limited, leaving much of the financial burden on the women.

All of this reinforces the fact that abortion opponents will have to make the procedure all but illegal before the legal abortion rate will fall dramatically. In economic terms, abortion is inelastic — unaffected by price. Unfortunately, what's about to happen in Texas won't just increase the cost, it will make abortions nearly impossible to obtain.

Beginning in September, clinics will be required to comply with another provision of HB2, which mandates that all abortions take place in ambulatory surgical centers — essentially minihospitals. Only six of the 22 remaining abortion providers qualify as ASCs, and few of the non-ASCs will be able to make the costly renovations to bring their facilities up to code. The UT researchers found that 22 percent of abortions in the state take place at ASCs, raising questions about how much of the demand they'll be able to handle. At the same time, cuts to family-planning funding that went into effect in 2011 are making it difficult for women to access the birth control they want.

As a result, the number of unintended births will almost certainly climb. But Grossman says it's also likely that the number of self-induced abortions, often using off-brand versions of the abortion pill, will increase. That's because cutting off the supply of abortions won't reduce demand — it will force women to take increasingly drastic measures to get the procedure.