Association of Texas' 2021 Ban on Abortion in Early Pregnancy With the Number of Facility-Based Abortions in Texas and Surrounding States

Abstract

Importance: Texas' 2021 ban on abortion in early pregnancy may demonstrate how patterns of abortion might change following the US Supreme Court's June 2022 decision overturning Roe v Wade.

Objective: To assess changes in the number of abortions and changes in the percentage of out-of-state abortions among Texas residents performed at 12 or more weeks of gestation in the first 6 months following implementation of Texas Senate Bill 8 (SB 8), which prohibited abortions after detection of embryonic cardiac activity.

Design, setting, and participants: Retrospective study of a sample of 50 Texas and out-of-state abortion facilities using an interrupted time series analysis to assess changes in the number of abortions, and Poisson regression to assess changes in abortions at 12 or more weeks of gestation. Data included 68 820 Texas facility-based abortions and 11 287 out-of-state abortions among Texas residents during the study period from September 1, 2020, to February 28, 2022.

Exposures: Abortion care obtained after (September 2021-February 2022) vs before (September 2020-August 2021) implementation of SB 8.

Main outcomes and measures: Primary outcomes were changes in the number of facility-based abortions for Texas residents, in Texas and out of state, in the month after implementation of SB 8 compared with the month before. The secondary outcome was the change in the percentage of out-of-state abortions among Texas residents obtained at 12 or more weeks of gestation during the 6-month period after the law's implementation.

Results: Between September 2020 and August 2021, there were 55 018 abortions in Texas and 2547 out-of-state abortions among Texas residents. During the 6 months after SB 8, there were 13 802 abortions in Texas and 8740 out-of-state abortions among Texas residents. Compared with the month before implementation of SB 8, the number of Texas facility-based abortions significantly decreased from 5451 to 2169 (difference, -3282 [95% CI, -3171 to -3396]; incidence rate ratio [IRR], 0.43 [95% CI, 0.36-0.51]) in the month after SB 8 was implemented. The number of out-of-state abortions among Texas residents significantly increased from 222 to 1332 (difference, 1110 [95% CI, 1047-1177]; IRR, 5.38 [95% CI, 4.19-6.91]). Overall, the total documented number of Texas facility-based and out-of-state abortions among Texas residents significantly decreased from 5673 to 3501 (absolute change, -2172 [95% CI, -2083 to -2265]; IRR, 0.67 [95% CI, 0.56-0.79]) in the first month after SB 8 was implemented compared with the previous month. Out-of-state abortions among Texas residents obtained at 12 or more weeks of gestation increased from 17.1% (221/1291) to 31.0% (399/1289) (difference, 178 [95% CI, 153-206]) during the period between September 2021 and February 2022 (P < .001 for trend).

Conclusions and relevance: Among a sample of abortion facilities, the 2021 Texas law banning abortion in early pregnancy (SB 8) was significantly associated with a decrease in the documented total of facility-based abortions in Texas and obtained by Texas residents in surrounding states in the first month after implementation compared with the previous month. Over the 6 months following SB 8 implementation, the percentage of out-of-state abortions among Texas residents obtained at 12 or more weeks of gestation significantly increased.

Figure 1.. Location of Abortion Facilities in Texas and Surrounding States After Implementation of Texas Senate Bill 8, September 2021–February 2022

The squares represent facilities where abortions were only available before detection of embryonic cardiac activity; the circles represent facilities where abortions at later gestational durations were provided. The number within the squares and circles indicates the total number of abortion facilities in locations in which there is more than 1 facility. States in dark yellow imposed mandatory waiting periods of 24 to 72 hours for people seeking abortion; states in beige did not require a waiting period before abortion.

Figure 2.. Actual and Predicted Monthly Number of Facility-Based Abortions in Texas and Texas Resident Out-of-State Abortions Before and After Implementation of Texas Senate Bill 8, September 2020–February 2022

^aIn February 2021, there was a winter storm that caused power outages across Texas that disrupted abortion care at in-state abortion facilities. ^bPredicted monthly abortion volume for reporting facilities was estimated from negative binomial regression models that adjusted for the month Texas Senate Bill 8 was implemented and linear time trends before and after the law’s implementation, respectively. The shaded regions represent 95% CIs.

Figure 3.. Percentage and Number of Abortions at 6 or Fewer Weeks and 12 or More Weeks of Gestation Among Texas Residents Obtaining Out-of-State Care After Implementation of Texas Senate Bill 8, September 2021–February 2022

There was a statistically significant decrease in abortions at 6 or fewer weeks of gestation and a statistically significant increase in abortions at 12 or more weeks of gestation, between September 2021 and February 2022; P < .001 for monthly trends. The shaded regions represent 95% CIs.