Abortions in Texas dropped 38% in early days of COVID-19 pandemic

The number of abortions performed in Texas fell nearly 40% the first full month after the state issued an executive order on March 22 that delayed “surgeries and procedures deemed not medically necessary,” researchers wrote.

“Texas officials interpreted this to prohibit most abortions until the order expired on April 21, 2020,” Kari White, PhD, MPH, an associate professor of social work at the University of Texas at Austin Steve Hicks School of Social Work, and colleagues wrote.

The researchers analyzed monthly data from 18 abortion facilities from 2019 and 2020. Together, the facilities performed 93% of all Texas abortions during the study period. The researchers also examined the number Texas residents who obtained abortions in six other states from February through May 2020, comparing it with 2017 data.

The results, published in JAMA, show there were 4,608 abortions in Texas in April 2019 vs. 2,856 abortions in the state in April 2020 — a 38% decrease (95% CI, 40.8% to 35.1%).

“Stay-at-home orders, facilities’ coronavirus precautions and patients’ reluctance to seek in-person care may also have contributed to the decline,” White and colleagues wrote.

In addition, the number of Texas residents who received abortions in one of the other six states increased from 157 in February 2020 to 947 in April 2020; monthly totals varied from 107 to 165 in 2017.

In Texas, the number of medication abortions performed increased from 1,808 in April 2019 to 2,297 in April 2020, accounting for 39% and 80% of all abortions, respectively. After the researchers adjusted their analysis for time trends and the number of facilities, they found a difference of 17.4% (95% CI, 7.1% to 48.4%) in the number of medication abortions that were conducted in April 2020 had the expected linear trend from January 2019 not been interrupted.

Compared with April 2019, there were fewer procedural abortions at less than 12 weeks’ gestational age (2,318 vs. 317) and at 12 weeks’ gestational age or more (482 vs. 242) in April 2020. In May 2020 — after the executive order had been lifted — there were more procedural abortions conducted after 12 weeks’ gestational age vs. May 2019 (815 vs. 507) — an increase of 82.6% (95% CI, 46.7% to 127.4%) over the number that was “expected based on linear trends,” researchers said.

This “likely reflects delays in care among those who waited for an appointment and facilities’ limited capacity to meet backlogged patient need,” White and colleagues wrote.

Although abortions later in pregnancy are “very safe, they are associated with a higher risk of complications and may require additional visits compared with those provided earlier in pregnancy,” they said.