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. 2016 Oct 26;11(10):e0165048.
doi: 10.1371/journal.pone.0165048. eCollection 2016.

Women's Experience Obtaining Abortion Care in Texas after Implementation of Restrictive Abortion Laws: A Qualitative Study

Sarah E Baum  1   2 , Kari White  1   3 , Kristine Hopkins  1   4 , Joseph E Potter  1   4 , Daniel Grossman  1   5
Affiliations

Women's Experience Obtaining Abortion Care in Texas after Implementation of Restrictive Abortion Laws: A Qualitative Study

Sarah E Baum et al. PLoS One. .

Abstract

Background: In 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.

Methods: In 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.

Results: Women 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.

Conclusions: Medication abortion restrictions and clinic closures following HB 2 created substantial barriers for women seeking abortion in Texas.

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Conflict of interest statement

Dr. Daniel Grossman and Dr. Kristine Hopkins served as expert witnesses in the case Whole Woman’s Health v. Hellerstedt. Dr. Grossman was not compensated for his testimony; Dr. Hopkins was compensated. Lead author Sarah Baum is affiliated with Ibis Reproductive Health which is “an international nonprofit organization with a mission to improve women’s reproductive autonomy, choices, and health worldwide”. All authors are affiliated with the Texas Policy Evaluation Project (TxPEP), whose purpose is to document and evaluate the impact of reproductive health legislation passed by the Texas Legislature. Both Ibis Reproductive Health and TxPEP conduct rigorous research to assess the impact of reproductive health policies. This does not alter our adherence to PLOS ONE policies on sharing data and materials.

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