Abortion bans affect access in states without restrictions

A new study in JAMA Network Open outlines the impacts abortion bans and restrictions have on the protective states around them, with researchers showing a link between Texas abortion bans to heightened demand in the neighboring state of Colorado, which has no bans.

The study looked at how Texas law SB8, enacted in 2021 to create a six-week gestational limit, affected access to abortion in Colorado. Using data from the Colorado Department of Public Health and Environment, the researchers found an influx in abortion access in the state following SB8's passage.

These findings add to the literature outlining the ways in which abortion bans and restrictions affect surrounding protective states that have no restrictions. A 2023 report from the Guttmacher Institute showed that about a fifth of patients seeking abortion travel out of state to get the procedure. Presumably, these patients are traveling from restrictive states to those without abortion bans.

But that increased demand has downstream effects, the JAMA study, completed by researchers from Colorado State University, found. With more people seeking abortion in protective states, such as Colorado, abortion providers are faced with challenges in meeting demand.

That much was evident following the passage of SB8. Using information about abortion access, patient state of residence and gestational week at the time of the procedure, the researchers found that more patients funneled into Colorado once six-week abortion bans were set in place in Texas.

Specifically, the number of abortions provided in Colorado to out-of-state residents increased from 13% in 2020 to 30% in 2023.

The influx of Texans accessing abortion in Colorado might have strained Colorado's system and pushed some of the state's residents to receive an abortion later into pregnancy. The analysis showed that Coloradans were 11% more likely to have the procedure in the first trimester following the Texas SB8 law and 83% more likely to have it in the second trimester.

"This aligns with reports from area clinicians who experienced dramatic increases in patient demand after SB8, also reported by the media, resulting in delayed appointments for everyone," the researchers explained.

Although abortion is safe during the second trimester, and Colorado has no gestational limits on the procedure, there are some consequences to procedure delays.

"Potential consequences of delayed procedures may include increased cost, increased complexity of the procedure, the emotional toll of waiting and the potential for having the pregnancy revealed," the researchers explained.

Since 2022, the state of Colorado has been able to somewhat ameliorate care access snags resulting from higher abortion demand. In particular, access to telehealth abortion, access to self-managed abortion and care in other protective states have helped Colorado manage the demand.

Shield laws, in particular, have been essential to protecting clinicians in abortion states in providing remote or in-person care to individuals accessing the procedure in abortion-ban states. However, those shield laws are presently being challenged.

Earlier this month, a Louisiana grand jury indicted a New York doctor for prescribing abortion pills for a patient in Louisiana, per CBS. New York Governor Kathy Hochul has rejected Louisiana's extradition request for the doctor, NBC reports. Moreover, Hochul recently passed an additional shield law that would conceal the identities of doctors who prescribe abortion medications, says the AP.

The JAMA study did not investigate shield laws. However, understanding how abortion bans affect states without bans will be essential as the abortion access discussion continues.

Sara Heath has covered news related to patient engagement and health equity since 2015.