A recently released study from the Texas Policy Evaluation Project, or TxPEP, found that 7% of patients seeking abortions at Texas clinics had tried to end their own pregnancies before asking for the procedure. The national number is just 2.2%.
Researchers behind the new investigation, published in the journal BMC Women’s Health, point out there are methodological differences between the Texas and national data. Even so, the wide difference makes it clear the Lone Star State is out of step with much of the rest of the country.
“What we know from the study is that how far away the Texas clinics are and how much it costs to travel to them played a significant role in these women’s decisions,” said head researcher Liza Fuentes, a scientist at Guttmacher Institute. “The takeaway is that cost and distance really matter, and that’s something that’s been shown with many other types of healthcare.”
Fuentes and her team surveyed and interviewed more than 700 patients seeking abortions at Texas clinics between 2012 and 2015. In a series of qualitative interviews, they found that many of the women felt they had no other option but to self-administer the procedure, often with the use of drugs obtained over the counter in Mexico.
That timing of TxPEP’s research is important. Its data collection came as Texas enacted some of the nation’s most stringent rules limiting access to abortion care.
In 2013, the Legislature passed a law requiring all abortion doctors have admitting privileges at hospitals within 30 miles of the clinics where they conduct the procedure. The rules also mandated that clinics be outfitted like hospital surgical suites — an expense many simply couldn’t afford.
The U.S. Supreme Court threw out the Texas law in 2016, but by then the damage was already done. A National Public Radio investigation last year revealed that the number of Texas clinics plummeted from 40 to 22 in the wake of the regulations.
Most of the remaining clinics are now clustered in big cities, meaning women in less-populous areas must to travel long distances to obtain abortions. For example, there’s now just one clinic, Whole Woman’s Health in McAllen, serving the entire Rio Grande Valley. Many South Texas women drive to San Antonio, a trek of up to 250 miles, to obtain the procedure.
What’s more, health insurance companies also don’t cover abortion in Texas except in cases where a patient’s health is endangered. That means poor or middle-income women choose self-induced abortion when they worry a medical care at a clinic will be too expensive, Fuentes points out.
Many of the women TxPEP surveyed reported taking misoprostol, an abortion-inducing drug that’s also sold under the brand name Cytotec. While available with a prescription, it can also be purchased over the counter in Mexico and on the black or gray market.
Other women reported that they used herbs, teas or vitamins, often at the advice of relatives.
Almost none of the women in the study appeared to have contemplated inherently risky means such as a blow to the stomach to terminate their pregnancies. Even so, Fuentes said their clinic visits indicate they may not have used the drugs properly or chosen ineffective methods.
Further, some of the women said that without medical supervision they were unsure what effect their attempted self-abortion might have on their future fertility or how to know if the procedure had put their health at risk.
“Patients didn’t always have the information they needed on how to use the method or what to expect,” Fuentes said. “They were often ineffective, leading to a delay of many days or weeks before they sought an abortion at a clinic.”
Mara Posada, director of public affairs for Planned Parenthood of South Texas, said the study’s findings should come as little surprise given state lawmakers’ repeated efforts to close access to the procedure.
Indeed, the Trump administration last week reinstated federal funding for a Texas health program that excludes Planned Parenthood and other groups that provide abortions — a move some worry will embolden the state to continue erecting barriers to access.
Posada said she’d like to see more research from emergency rooms showing whether some women who self-administer end up choosing dangerous methods that result in injury.
“When you create barrier after barrier to obtaining safe and legal abortions, people are going to seek alternative methods,” she said. “And depending on where they get their information on those methods, they could be effective, or maybe not.”
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