Primary Care Corner with Geoffrey Modest MD: texas abortion law changes and its effects

By Dr. Geoffrey Modest

This blog will not shock you: when Texas closed abortion facilities, decreasing access and making women travel further distances to get an abortion, there was a substantial decrease in the number of abortions done with a small increase in out-of-state abortions (see doi:10.1001/jama.2016.17026).


  • In 2013 Texas enacted a restrictive abortion law which was partially reversed by the Supreme Court in 2016 as being unconstitutional
  • After passage of the law, the number of abortion facilities declined, with the following changes:
    • 2012 (prior to the law): 66,098 abortions done in Texas, 97 done out-of-state. 41 abortion facilities in 17 counties in Texas
    • 2014: 53,882 abortions done in Texas, 254 done out-of-state. 21 abortion facilities in 6 counties in Texas
  • The median distance to a facility increased by 51 miles. There was a clear, consistent trend between the decrease in abortions and the distance to the nearest facility (p<0.001 for trend):
    • 0 distance assoc with 1.3% decline
    • 25-49 miles assoc with 25.3% decline
    • >100 miles assoc with 50.3% decline
  • Even counties with open facilities and minimal distance (within 5 miles)  had a 15.9% decline in abortions [perhaps from less local access, with the number of women seeking abortions being greater than the new capacity]


  • The above does not include abortions done in Mexico, or self-induced abortions
  • Adding together the in-state and out-of-state abortions confirms a 18.2% decline, despite the shift to more being out-of-state
  • None of this is terribly surprising. The concern now is that the new US president and vice-president, their Cabinet appointees, their likely Supreme Court appointees, and the Republican House and Senate are pretty likely to make matters much more difficult for women in the near future. And perhaps decrease funding for/access to birth control, making the situation even more untenable (g. closing Planned Parenthood or not funding abortion/contraceptive services). Especially for poorer women with fewer resources/alternatives.
  • I would just add that in Illinois in the late 1960s/early 1970s, when abortion was illegal, I was told that there were 2 full wards at Cook County Hospital (about 50 people) filled with women having septic abortions (serious uterine infections, in this case after “back-alley” abortions done by coat-hangers, ). And there was a 10% mortality rate….

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