title: Change in abortion services after implementation of a restrictive law in Texas.
abstract: OBJECTIVE
  In 2013, Texas passed omnibus legislation restricting abortion services. Provisions restricting medical abortion, banning most procedures after 20 weeks and requiring physicians to have hospital-admitting privileges were enforced in November 2013; by September 2014, abortion facilities must meet the requirements of ambulatory surgical centers (ASCs). We aimed to rapidly assess the change in abortion services after the first three provisions went into effect.
  
  
  METHODS
  We requested information from all licensed Texas abortion facilities on abortions performed between November 2012 and April 2014, including the abortion method and gestational age (< 12 weeks vs. ≥ 12 weeks).
  
  
  RESULTS
  In May 2013, there were 41 facilities providing abortion in Texas; this decreased to 22 in November 2013. Both clinics closed in the Rio Grande Valley, and all but one closed in West Texas. Comparing November 2012-April 2013 to November 2013-April 2014, there was a 13% decrease in the abortion rate (from 12.9 to 11.2 abortions/1000 women age 15-44). Medical abortion decreased by 70%, from 28.1% of all abortions in the earlier period to 9.7% after November 2013 (p<0.001). Second-trimester abortion increased from 13.5% to 13.9% of all abortions (p<0.001). Only 22% of abortions were performed in the state's six ASCs.
  
  
  CONCLUSIONS
  The closure of clinics and restrictions on medical abortion in Texas appear to be associated with a decline in the in-state abortion rate and a marked decrease in the number of medical abortions.
  
  
  CONCLUSIONS
  Supply-side restrictions on abortion - especially restrictions on medical abortion - can have a profound impact on access to services. Access to abortion care will become even further restricted in Texas when the ASC requirement goes into effect in 2014.
authors.affiliation: Texas Policy Evaluation Project, Austin, TX; Ibis Reproductive Health, Oakland, CA; Bixby Center for Global Reproductive Health, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, CA. Electronic address: DGrossman@ibisreproductivehealth.org.
authors.forename: Daniel
authors.initials: D
authors.lastname: Grossman
authors.affiliation: Texas Policy Evaluation Project, Austin, TX; Ibis Reproductive Health, Oakland, CA.
authors.forename: Sarah
authors.initials: S
authors.lastname: Baum
authors.affiliation: Texas Policy Evaluation Project, Austin, TX; Ibis Reproductive Health, Oakland, CA.
authors.forename: Liza
authors.initials: L
authors.lastname: Fuentes
authors.affiliation: Texas Policy Evaluation Project, Austin, TX; Department of Health Care Organization and Policy, School of Public Health, University of Alabama at Birmingham, Birmingham, AL.
authors.forename: Kari
authors.initials: K
authors.lastname: White
authors.affiliation: Texas Policy Evaluation Project, Austin, TX; Population Research Center, University of Texas at Austin, Austin, TX.
authors.forename: Kristine
authors.initials: K
authors.lastname: Hopkins
authors.affiliation: Texas Policy Evaluation Project, Austin, TX; Population Research Center, University of Texas at Austin, Austin, TX.
authors.forename: Amanda
authors.initials: A
authors.lastname: Stevenson
authors.affiliation: Texas Policy Evaluation Project, Austin, TX; Population Research Center, University of Texas at Austin, Austin, TX.
authors.forename: Joseph E
authors.initials: JE
authors.lastname: Potter
mesh_terms: D000028:Abortion, Induced / Q000331:legislation & jurisprudence* / Q000706:statistics & numerical data*; D000554:Ambulatory Care Facilities / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D013781:Texas
keywords: Abortion; Access; Law; Restriction; Texas