New Research Finds Link Between Self-Induction and Abortion Restrictions

(PRESS RELEASE) Today the Texas Policy Evaluation Project (TxPEP) released a groundbreaking report on self-induced abortion among the general population, finding that at least 100,000 Texas women of reproductive age have ever attempted to end a pregnancy without medical assistance.  The findings suggest that self-induction is disproportionately prevalent in Texas, where extreme clinic shutdown laws have drastically limited women’s access to reproductive care.

The report marks the first time statistics on self-induction in the general population have ever been calculated, and suggests that women who reported barriers in accessing reproductive care and Latinas near the U.S.-Mexico border are at especially high risk for self-induction. TxPEP’s findings follow research released by the group last month exposing a substantial increase in wait times at clinics in the state following the passage of Texas’ anti-abortion omnibus bill HB2 in 2013.

The U.S. Supreme Court on Friday agreed to review a challenge brought by the Center for Reproductive Rights to the most restrictive provisions of HB2, which threaten to shut down all but 10 abortion clinics in Texas. TxPEP’s findings suggest that the state is likely to see an increase in self-induction if those provisions are allowed to be fully implemented.

Said Nancy Northup, president and CEO of the Center for Reproductive Rights:

“This new study confirms that women who are denied safe, legal abortion care where they live are more likely to take matters into their own hands—with often devastating consequences.

“If these regulations are allowed to stand others like them will inevitably follow, threatening to drag our country back to the perilous days before Roe and endangering women’s lives.   

“We are counting on the U.S. Supreme Court to overturn these deceptive laws and reject the underhanded tactics of legislators who care more about political gamesmanship than the health, well-being and constitutional rights of women in their state.”

TxPEP researchers conducted a statewide survey that controlled for sociodemographic factors, including age and reported history of abortion, and also performed interviews with women who had attempted to self-induce an abortion in recent years in Texas. Their findings indicate a link between poverty and barriers to access in the decision to self-induce.                                                         

According to the group, the four primary reasons for self-induction are financial constraints to travel to a clinic or to pay for the procedure, local clinic closures, recommendation from a close friend or family member to self-induce, or efforts to avoid the stigma or shame of going to an abortion clinic, especially if they had had prior abortions.

The case now before the Supreme Court, Whole Woman’s Health v. Cole, was brought by the Center for Reproductive Rights on behalf of a coalition of women’s health providers seeking to permanently block two provisions of HB2 that, taken together, would have a devastating impact on women’s health in Texas.

The first provision requires that all abortion providers obtain local hospital admitting privileges, a mandate which has already forced the closure of over half the clinics in the state. The second provision requires every reproductive health care facility offering abortion services to meet the same hospital-like building standards as an ambulatory surgical center (ASC), which can amount to millions of dollars in medically unnecessary facility updates. The law has been denounced by leading national medical experts, including the American Medical Association and the American College of Obstetricians and Gynecologists.

Since Roe v. Wade was decided in 1973, the U.S. Supreme Court has continually maintained women have a constitutional right to decide whether to end or continue a pregnancy— a right that is central to personal dignity, autonomy, and the liberty protected by the 14th Amendment.

Further, the Court’s 1992 decision in Planned Parenthood v. Casey reaffirmed a woman’s constitutional right to abortion and held that states could not enact medically unnecessary regulations meant to create substantial obstacles for a woman seeking to end a pregnancy. Justices Kennedy, O’Connor, and Souter made clear that “these matters, involving the most intimate and personal choices a person may make in a lifetime, choices central to personal dignity and autonomy, are central to the liberty protected by the 14th Amendment.”

Case History: Whole Woman’s Health v. Cole (formerly Whole Woman’s Health v. Lakey)

Following a lawsuit brought by the Center for Reproductive rights on behalf of Whole Woman’s Health and several other Texas health care providers in April 2014, a federal district court blocked two of the most harmful restriction of Texas’ House Bill 2 (HB2) in late August 2014: the ambulatory surgical center requirement and the admitting-privileges requirement.                     

The U.S. Court of Appeals for the Fifth Circuit stayed that decision in large part on October 2, 2014, allowing the requirements to immediately take effect. Because forcing hospital-style surgery center building and staffing requirements on every clinic would amount to a multi-million dollar tax on abortion services, all but 7 reproductive health care facilities in the state were prevented from offering safe and legal abortion services for 12 days. On October 14, 2014, the U.S. Supreme Court reinstated the injunction in large part, allowing many of the previously closed clinics to reopen their doors while the state’s appeal moved forward.

On June 9, 2015, the Fifth Circuit’s final decision in the appeal once again upheld the state restrictions in substantial part, this time threatening to shutter all but 10 abortion providers in the state. Once again, the U.S. Supreme Court stepped in to block the Fifth Circuit’s decision and allow the clinics to remain open while the legal challenge continued. On November 13, 2015, the Supreme Court announced that it would review the Texas law, with oral arguments before the Court anticipated to occur in early 2016.

The clinics and physicians in this challenge are represented by Stephanie Toti, David Brown, Janet Crepps, and Julie Rikelman of the Center for Reproductive Rights, J. Alexander Lawrence of the law firm Morrison &, Foerster, and Austin attorneys Jan Soifer and Patrick O’Connell of the law firm O’Connell &, Soifer.

About TxPEP

The Texas Policy Evaluation Project (TxPEP) is a five-year, comprehensive effort to document and analyze the impact of the measures affecting reproductive health passed by the 82nd and 83rd Texas Legislatures. The project team includes researchers from The University of Texas at Austin’s Population Research Center, Advancing New Standards in Reproductive Health (ANSIRH) at the University of California, San Francisco, Ibis Reproductive Health, and the University of Alabama-Birmingham.