Last year, Texas lawmakers passed the most restrictive abortion policy in the country. The state’s leading researchers on reproductive health care weren’t consulted when it was being crafted. But they started studying it the moment it passed.
“We are getting a glimpse in Texas of folks who, because of the way that the laws are written, are not able to get evidence-based care and their health and well-being is being put at risk,” said Kari White, the director of the Texas Policy Evaluation Project at the University of Texas Austin, which published two studies on the consequences of the law just six months after it went into effect.
White and other researchers founded TxPEP in 2011, seeing a dire need for research on the consequences of state legislation that sharply reduced and restricted funding for family planning and abortion care. It was the first among a small but growing number of independent research centers in states like Georgia, Ohio, and Wisconsin, that are focused on the local implications of access to reproductive health care being dramatically curtailed. Now, as an impending Supreme Court decision could overturn federal protections to abortion, these researchers are bracing for their work to become even more necessary — and harder to conduct.
“The very thing that makes the work so important here is also the thing that makes the work difficult,” said Jenny Higgins, director of the University of Wisconsin’s Collaborative for Reproductive Equity.
If the last remaining abortion protections are struck down, clinics in many states will face closures, delays, and staff turnover and burnout, making it all the more challenging for researchers to find patients and providers to speak with. Further restrictions will make it far harder to safely and securely track the number of people who obtain medication abortions in Mexico, count those who seek care online in states where it’s illegal, or document if people end up in emergency rooms after attempting to end their own pregnancies.
“This is going to be a very trying time for a lot of the folks who we typically engage in our work,” said Whitney Rice, the director of the Center for Reproductive Health Research in the Southeast at Emory University.
It will also prove difficult for the researchers themselves, who already face an uphill battle trying to do rigorous evaluation in such a highly politicized area. Higgins, who helped to found CORE in 2019, faced significant pushback from mentors who warned she’d have to constantly be combating accusations about bias in her work. But she and a small cadre of experts around the country have made it their priority to collect the kind of data that’s needed to inform local policy — even when policymakers don’t want to hear it.
“Some of the people who are the decision-makers are not invested in evidence-based information as a decision-making tool. And so the decisions continue to be made neglecting information that could be helpful for making the most health advantageous decisions,” said Alison Norris, a co-founder and co-principal investigator at Ohio Policy Evaluation Network.
The sheer number of regulations can be difficult to track, both for providers and for researchers.
From 2010 to 2020 in Ohio, there were more than 15 policy restrictions to abortion enacted, which can create situations that are even more complicated than closing a clinic. Take a 2013 Ohio law that any clinic performing surgical abortions must have a transfer agreement with a local hospital in case of emergencies; if a clinic can’t secure that agreement, they might close temporarily, permanently, or stay open only to provide medication abortion. This “care churn,” as OPEN identifies it, can confuse the public and dramatically affect where, when, and how they receive care. But researchers depend on clinics to contribute their own data, so interruptions in their operations can also interrupt the tracking of patterns like churn itself.
Retrieving data for researchers is often labor intensive for clinics that don’t have dedicated data staff or electronic medical records, and especially so for abortion funds that rely on volunteers. But monitoring data is the first key step to understanding the level of care in each state. Having solid “before” numbers will be key to analyzing any changes after the Supreme Court decision comes down.
“By being in a place and rooted in that spot, we really have been able to understand with a good deal of nuance what’s going on.”
Danielle Bessett, Ohio Policy Evaluation Network
“What’s often being asked in Ohio is: what will this mean for Ohio?” said Danielle Bessett, Norris’s co-founder and co-principal investigator at OPEN. “By being in a place and rooted in that spot, we really have been able to understand with a good deal of nuance what’s going on.”
Focusing the work in a single state or region also helps build trust with the local clinics and patients that are critical to this type of research. For centers like OPEN, it has taken years to forge strong relationships with clinics that can routinely provide data and valuable insights into what care and access actually look like. Due to the aggression of some anti-abortion protestors, clinic staff can be reasonably wary to trust new organizations. And many are significantly understaffed, and simply don’t have the time to add data collection to their to-do list.
“Alison Norris has this beautiful thing she says about collecting monitoring data,” Higgins said. “It’s not necessarily hypothesis-driven or very sexy, but when you need it, it’s really valuable.” Securing that kind of data is a slow-moving and cautious process that CORE — the newest of these institutions — is still navigating.
To Higgins and other researchers, their work pays off when they can clearly track impact. White’s team found in the first month under Texas Senate Bill 8 — which restricts abortion after six weeks or after “embryonic cardiac activity” — that in-state abortions fell by half. In a few months’ time, 12 times as many Texans traveled out-of-state for an abortion than in the same period the prior year, and the researchers knew from past studies the measure would take the biggest toll on poor, marginalized Texans. More than three times as many people ordered medication abortion online from the nonprofit Aid Access as did before the ban.
Another major research initiative, called the Turnaway Study and conducted by a team at the University of California San Francisco, has documented how being denied an abortion can impact a person’s health outcomes. The study found that people who were turned away for an abortion experienced increased poverty and economic hardship, were more likely to stay in contact with a violent partner, and saw the well-being of their children negatively affected.
“There are a lot of things that will cascade down from this decision that will affect a lot of different areas of health care, and not just reproductive health care,” said White on the Supreme Court’s potential decision.
Researchers are hoping to coordinate local, state-based projects similar to the Turnaway Study in the future, but it’s extremely difficult. Finding people who want an abortion and can’t get one, like that project did, is like trying to find a needle in a haystack.
As the researchers at these centers navigate the ever-changing legal storm around abortion, they are in constant communication with each other, sharing insights into best practices. From Texas, White — who once served on the dissertation committee for Rice — has been providing newer centers with advice on problems such as establishing a center’s presence early on or conducting surveys smoothly in clinics. And as Rice noted, each of these centers can now serve as a place for early-career researchers to train in supportive environments. As the prospect of other state restrictions loom large, experts say, their work will only become more pressing.
If you’re a researcher who focuses on abortion or reproductive health and would like to talk about your work, you can reach Theresa Gaffney at [email protected] or on the encrypted messaging app Signal at 617-302-6825.
Correction: A previous version of this story misstated when the Texas law was passed. It went into effect in September.