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Objectives. To describe minors' use of judicial bypass to access abortion and the percentage of bypass petitions denied in Florida and Texas. Methods. Data were derived from official state statistics on judicial bypasses and abortions by age in Texas and Florida; abortions in Texas among minor nonresidents were estimated. In addition, judicial bypass petitions as a percentage of abortions received by minors and judicial bypass denials as a percentage of petitions were calculated. Results. Between 2018 and 2021, minors received 5527 abortions in Florida and an estimated 5220 abortions in Texas. Use of judicial bypass was stable at 14% to 15% in Florida and declined from 14% to 10% in Texas. Among petitions for judicial bypass, denials increased in Florida from 6% to a maximum of 13% and remained stable in Texas at 5% to 7%. Conclusions. Minors' use of judicial bypass in Texas and Florida is substantial. The percentage of denials is higher and increasing in Florida. Public Health Implications. Minors who need confidential abortion care may now be forced to seek judicial bypass far from home. Parental involvement laws in states that do not ban abortion will compound barriers to abortion care. (Am J Public Health. 2023;113(3):316–319. https://doi.org/10.2105/10.2105/AJPH.2022.307173) [ABSTRACT FROM AUTHOR]

Texas counties with greater abortion-rate declines had more publicly funded contraceptive clinics and served more contraceptive clients than counties with lower abortion-rate declines. OBJECTIVE: To evaluate how the availability of contraceptive services was associated with a change in the abortion rate before and after Texas' legislative changes to the family planning budget in 2011 and abortion access in 2013. METHODS: In this cross-sectional study, we obtained 2010 and 2015 data on contraceptive provision (number of publicly funded clinics and number of contraceptive clients served per 1,000 reproductive-aged women) from the Guttmacher Institute and county-level abortion data from the Texas Department of State Health Services. We categorized counties as having an abortion rate that increased or declined less than the national rate between 2010 and 2015 (low-decline counties) compared with those having an abortion rate that declined equal to or greater than the national rate between 2010 and 2015 (high-decline counties). We evaluated differences in contraceptive provision between high-decline and low-decline counties and evaluated county characteristics (racial and ethnic composition, unemployment, poverty, uninsured, education, distance to an abortion clinic, deliveries covered by Medicaid, and Catholic hospital marketplace dominance) as potential confounders. RESULTS: Of 157 counties that had at least one contraceptive clinic in either 2010 or 2015, 49 were low-decline counties and 108 were high-decline counties. Although the total number of publicly funded family planning clinics increased by 10.8%, there was a 4.7% decrease in the total number of contraceptive clients served statewide. Compared with low-decline counties, high-decline counties had a higher median number of contraceptive clients served per 1,000 women aged 18–44 years (31.9 vs 60.7, P <.05) in 2015. Between 2010 and 2015, the abortion rate decreased 19.7% for each 1.0% increase in contraceptive clients served. CONCLUSION: Texas counties with higher abortion-rate declines had more publicly funded contraceptive clinics and served more contraceptive clients than counties with lower declines, which may indicate the importance of greater access to publicly funded contraceptive services. [ABSTRACT FROM AUTHOR]

Objective: To understand the specific ways in which champions lead efforts to obtain and sustain buy-in for immediate postpartum long-acting reversible contraception (LARC) programs.Methods: We conducted a qualitative study with 60 semistructured interviews at 3 teaching hospitals in Texas with physicians, nurses, administrators and other staff who participated in the implementation of immediate postpartum LARC. Physicians self-identified as champions and identified other champion physicians and administrators. Two researchers analyzed and coded interview transcripts for content and themes.Results: We found that champions draw on institutional knowledge and relationships to build awareness and support for immediate postpartum LARC implementation. To obtain buy-in, champions needed to demonstrate financial sustainability, engage key stakeholders from multiple departments, and obtain nurse buy-in. Champions also created buy-in by communicating goals for the service that focused on expanding reproductive autonomy, improving maternal health, and improving access to postpartum contraception. Some staff, especially nurses, identified reasons for the program that run counter to reproductive justice principles: reducing birth rates, poverty, and/or unplanned pregnancy among young women and high-parity women. Respondents at 2 hospitals noted that not all women had equitable access to immediate postpartum LARC.Conclusion: Physician and non-physician champions must secure long-term support across multiple hospital departments to successfully implement an immediate postpartum LARC program. For programs to equitably serve all women in need of postpartum contraceptive care, champions and other program leaders need to implement strategies to address access issues. They should also explicitly focus on reproductive justice principles during program introduction and training.Implications: Successfully implementing immediate postpartum long-acting reversible contraception programs requires champions with institutional networking connections, administrative and nursing support, and clearly communicated goals. Champions need to address access issues and focus on reproductive justice principles during program introduction and training to equitably serve all women in need of postpartum contraceptive care. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the association between a restrictive Texas law, House Bill 2 (HB2), and receipt of in-clinic abortion by patient's race-ethnicity.Study Design: In this retrospective cohort study, we collected Texas state statistics on number of abortions, abortions per county, and abortions per county by race-ethnicity for 2012, before HB2 was enacted, and 2015, after HB2 was in effect. Using female reproductive-aged population estimates, we calculated the abortion rate and percent change in the abortion rate between the two time periods by county, patient residence in a county with an open clinic or HB2-related clinic closure, and change in distance to an open clinic for each race-ethnicity. We also used geospatial analyses to depict the greatest decrease in abortion rate by race-ethnicity and county.Results: In Texas, there were 64,716 reported abortions in 2012 and 54,253 in 2015. Statewide, there was a 20% decrease in the abortion rate affecting all racial-ethnic groups, yet the reduction was greater among Hispanic women compared to White women (-25% vs. -16%, respectively). The abortion rate also decreased more among those living in a county with an HB2-related clinic closure, especially for Hispanic women (-41% Hispanic vs. -29% White vs. -30% Black vs. -3% Other). Hispanic women whose travel distance increased 100+ miles had the greatest reduction in the abortion rate (-43%). Geospatial mapping confirmed our quantitative findings.Conclusion: HB2 led to a disproportionate reduction in the abortion rate among Hispanic women in Texas, including those living in counties with a closed clinic or traveling long distances to obtain in-clinic abortion care.Implications: Restrictive abortion policies in Texas may disproportionately burden Hispanic women and those affected by clinic closures. [ABSTRACT FROM AUTHOR]

Objective: To assess whether indicators of limited access to services explained changes in rates of second-trimester abortion after implementation of a restrictive abortion law in Texas.Methods: We used cross-sectional vital statistics data on abortions performed in Texas before (November 1, 2011-October 31, 2012) and after (November 1, 2013-October 31, 2014) implementation of Texas' abortion law. We conducted monthly mystery client calls for information about abortion facility closures and appointment wait times to calculate distance from women's county of residence to the nearest open Texas facility, the number of open abortion facilities in women's region of residence (facility network size), and days until the next consultation visit. We estimated mixed-effects logistic regression models to assess the association between obtaining abortion care after the law's implementation and having a second-trimester abortion (12 weeks of gestation or more), after adjustment for distance, network size, and wait times.Results: Overall, 64,902 Texas-resident abortions occurred in the period before the law was introduced and 53,174 occurred after its implementation. After implementation, 14.5% of abortions were performed at 12 weeks of gestation or more, compared with 10.5% before the law (P<.001; unadjusted odds ratio [OR] 1.45; 95% CI 1.40-1.50). Adjusting for distance to the nearest facility and facility network size reduced the odds of having a second-trimester abortion after implementation (OR 1.17; 95% CI 1.10-1.25). Women living 50-99 miles from the nearest facility (vs less than 10 miles) had higher odds of second-trimester abortion (OR 1.24; 95% CI 1.11-1.39), as did women in regions with less than one facility per 250,000 reproductive-aged women compared with women in areas that had 1.5 or more facilities (OR 1.57; 95% CI 1.41-1.75). After implementation, women waited 1 to 14 days for a consultation visit; longer waits were associated with higher odds of second-trimester abortion.Conclusion: Increases in second-trimester abortion after the law's implementation were due to women having more limited access to abortion services. [ABSTRACT FROM AUTHOR]

This study describes the perspectives of caregivers of youth in foster care in Texas about the caregiver's role in adolescent contraception decision-making for adolescents in their care, particularly for long-acting reversible contraception. The study also explores how providers and foster care agencies can better support pregnancy prevention for youth in care. Researchers recruited 18 caregivers of youth in care from an academic center in Texas to complete in-person, one-on-one, semistructured interviews from August to December 2019. Two independent coders identified the main concepts with thematic analysis; discrepancies were resolved by consensus. Most caregivers identified as female (88%), Black (59%), and ranged in age from 30 to 69 years old. Half (47%) reported previously caring for an adolescent who was pregnant or parenting. Themes from the interviews included the importance of building relationships before contraception conversations, the balance between adolescent autonomy and strict caregiver oversight in contraceptive decision-making, variation in beliefs about contraception for youth in care, and extreme reactions to long-acting reversible contraception in both directions. Providers and foster care agencies played an important role managing confidential expectations and providing resources or trainings about contraception. In a region of the country with high rates of adolescent pregnancy, strategies that empower adolescent autonomy allow delicate caregiver oversight, provide comprehensive information about all contraceptive options, and respond to extreme long-acting reversible contraception reactions and trainings that focus on the context of contraception that should inform communication-based interventions to address teen pregnancy prevention among youth in care. Few studies address the experiences of caregivers of adolescents in foster care. This study highlights a range of caregiver attitudes about contraception for adolescents in care. Provider training regarding contraception should include strategies to manage caregiver beliefs and extreme reactions to contraception use among youth in care. [ABSTRACT FROM AUTHOR]

Objective: Over the past 5 years, Texas has become a hotbed of debate on abortion rights and restrictions. Legislation in 2011 and 2013 made it more difficult for women to obtain abortions and for clinics to provide the procedure, laws which have resulted in practical obstacles and the closure of clinics. Less is known about whether that political activity has extended to public opinion on abortion in Texas, especially in the national context of increasing partisanship.Study Design: Data from the cross-sectional Houston Area Survey (HAS; n=4856) were used to compare attitudes about abortion at three time points: in 2010 before the major waves of legislation, in 2012 after the 2011 legislation, and in 2014 after the 2013 legislation. Logistic regressions estimated support for legal abortion over time, after adjusting for personal characteristics, views on other social issues, religiosity, political party identification and political ideology.Results: At all three time points studied, slightly more than half of Houstonians supported legal abortion for any reason a woman wanted to obtain one. Compared to 2010, support was significantly higher in 2012 and 2014, whereas the decline in support between 2012 and 2014 was not statistically significant after adjusting for religiosity and politics.Conclusions: This study identified increased public support for legal abortion following the Texas state legislature's restrictive laws in 2011 and 2013.Implications: As the Texas legislature increasingly restricts access to abortion, residents of the state's largest and most diverse city do not hold attitudes in line with those restrictions. Clinicians may thus have more public support for their services than the divided political climate would suggest. [ABSTRACT FROM AUTHOR]

INTRODUCTION: The Texas legislature cut its family planning budget in 2011 and restricted access to abortion in 2013. Our objective was to evaluate how the availability of contraceptive services correlated with a change in the abortion rate before and after these legislative changes. METHODS: We obtained 2010 and 2015 data on contraceptive provision (number of publicly-funded clinics and number of contraceptive clients served) from the Guttmacher Institute and county-level abortion data from Texas Department of State Health Services. We categorized counties by an abortion rate that increased or was less than (low decline) versus greater than or equal to (high decline) the decline seen nationally. We used the chi-square test, t-tests, and logistic regression to evaluate differences in contraceptive provision between high and low abortion decline counties, adjusting for county demographic and health care characteristics. RESULTS: The Texas abortion rate declined by 23% from 2010 to 2015. Statewide, the total number of publicly-funded family planning clinics increased by 11% and total number of contraceptive clients served decreased 4%. Compared to low decline counties (n=79), high decline counties (n=175) had a higher mean number of contraceptive clients served per 1000 women 18-44 years old (51.35 ± 124.26 vs. 81.85 ± 202.66, P <.05) and contraceptive clinics (0.82 ± 1.06 vs. 2.22 ± 5.57, P <.05) in 2015. Abortion decline did not differ by other county characteristics. CONCLUSION: Texas counties with higher abortion rate declines had more publicly-funded contraceptive clinics and served more contraceptive clients than counties with lower declines, demonstrating the importance of greater access to publicly-funded contraceptive services. [ABSTRACT FROM AUTHOR]

Background: In 2013, the Texas legislature passed House Bill 2, restricting use of medication abortion to comply with Food and Drug Administration labeling from 2000. The Food and Drug Administration updated its labeling for medication abortion in 2016, alleviating some of the burdens imposed by House Bill 2.Objective: Our objective was to identify the impact of House Bill 2 on medication abortion use by patient travel distance to an open clinic and income status.Materials and Methods: In this retrospective study, we collected patient zip code, county of residence, type of abortion, family size, and income data on all patients who received an abortion (medication or aspiration) from 7 Texas abortion clinics in 3 time periods: pre-House Bill 2 (July 1, 2012-June 30, 2013), during House Bill 2 (April 1, 2015-March 30, 2016), and post-Food and Drug Administration labeling update (April 1, 2016-March 30, 2017). Patient driving distance to the clinic where care was obtained was categorized as 1-24, 25-49, 50-99, or 100+ miles. Patient county of residence was categorized by availability of a clinic during House Bill 2 (open clinic), county with a House Bill 2-related clinic closure (closed clinic), or no clinic any time period. Patient income was categorized as ≤110% federal poverty level (low-income) and >110% federal poverty level. Change in medication abortion use in the 3 time periods by patient driving distance, residence in a county with an open clinic, and income status were evaluated using χ2 tests and logistic regression. We used geospatial mapping to depict the spatial distribution of patients who obtained a medication abortion in each time period.Results: Among 70,578 abortion procedures, medication abortion comprised 26%, 7%, and 29% of cases pre-House Bill 2, during House Bill 2, and post-Food and Drug Administration labeling update, respectively. During House Bill 2, patients traveling 100+ miles compared to 1- 24 miles were less likely to use medication abortion (odds ratio, 0.21; 95% confidence interval, 0.15, 0.30), as were low-income compared to higher-income patients (odds ratio, 0.76; 95% confidence interval, 0.68, 0.85), and low-income, distant patients (adjusted odds ratio, 0.14; 95% confidence interval, 0.08, 0.25). Similarly, post-Food and Drug Administration labeling update, rebound in medication abortion use was less pronounced for patients traveling 100+ miles compared to 1-24 miles (odds ratio, 0.82; 95% confidence interval, 0.74, 0.91), low-income compared to higher-income patients (odds ratio, 0.77; 95% confidence interval, 0.72, 0.81), and low-income, distant patients (adjusted odds ratio, 0.80; 95% confidence interval, 0.68, 0.94). Post-Food and Drug Administration labeling update, patients residing in counties with House Bill 2-related clinic closures were less likely to receive medication abortion as driving distance increased (52% traveling 25-49 miles, 41% traveling 50-99 miles, and 26% traveling 100+ miles, P < .05). Geospatial mapping demonstrated that patients traveled from all over the state to receive medication abortion pre-House Bill 2 and post-Food and Drug Administration labeling update, whereas during House Bill 2, only those living in or near a county with an open clinic obtained medication abortion.Conclusion: Texas state law drastically restricted access to medication abortion and had a disproportionate impact on low-income patients and those living farther from an open clinic. After the Food and Drug Administration labeling update, medication abortion use rebounded, but disparities in use remained. [ABSTRACT FROM AUTHOR]

Objectives: To compare pregnancy options counseling and referral practices at state- and Title X-funded family planning organizations in Texas after enforcement of a policy restricting abortion referrals for providers participating in state-funded programs, which differed from Title X guidelines to provide referrals for services upon request.Study Design: Between November 2014 and February 2015, we conducted in-depth interviews with administrators at publicly funded family planning organizations in Texas about how they integrated primary care and family planning services, including pregnancy options counseling and referrals for unplanned pregnancies. We conducted a thematic analysis of transcripts related to organizations' pregnancy options counseling and referral practices, and compared themes across organizations that did and did not receive Title X funding.Results: Of the 37 organizations with transcript segments on options counseling and referrals, 15 received Title X and 22 relied on state funding only. All Title X-funded organizations but only nine state-funded organizations reported offering pregnancy options counseling. Respondents at state-only-funded organizations often described directing pregnant women exclusively to prenatal care. Regardless of funding source, most organizations provided women a list of agencies offering abortion, adoption and prenatal care. However, some respondents expressed concern that providing other information about abortion would threaten their state funding. In contrast, respondents indicated staff would make appointments for prenatal care, assist with Medicaid applications and, in some instances, directly connect women with adoption-related services.Conclusions: Pregnancy options counseling varied by organizations' funding guidelines. Additionally, abortion referrals were less common than referrals for other pregnancy-related care.Implications: Programmatic guidelines restricting information on abortion counseling and referrals may adversely affect care for pregnant women at publicly funded family planning organizations. [ABSTRACT FROM AUTHOR]