DALLAS – Texas has had an estimated 26,000 rape-related pregnancies since the state enacted its abortion bans, according to new research published Wednesday.
Doctors performed fewer than 10 abortions per month in Texas in the first eight months of 2023, meaning that survivors of rape may have crossed state lines for the procedure or self-managed an abortion. Texas’ abortion bans don’t include exceptions for rape or incest.
“Many women who become impregnated by rape, at least some of them are going to be able to go out-of-state, some of them are going to be able to get a self-managed abortion with pills acquired surreptitiously,” said Dr. Steffie Woolhandler, a professor of public health at the City University of New York’s Hunter College and co-author of the report.
“But we’re pretty sure that many of these women are going to be left with no viable option other than carrying the pregnancy to term,” she said.
Completed vaginal rapes were associated with nearly 65,000 pregnancies in the 14 states that implemented total abortion bans since the U.S. Supreme Court overturned Roe v. Wade, researchers estimated. About 59,000 of those pregnancies, or around 91%, occurred in states without abortion exceptions for rape.
Texas – which implemented a total abortion ban in late July 2022 – accounts for an estimated 45% of rape-related pregnancies in states without such exceptions. Missouri and Tennessee represented the next two highest pregnancy rates among states without rape exceptions, with 5,825 and 4,993, respectively.
The report, published in the Journal of the American Medical Association, included researchers representing The City University of New York’s Hunter College, Harvard Medical School, the University of Texas and the University of California, San Francisco.
Abortions plummeted after Texas’ bans took effect, dropping from 50,000 in 2021 to 40 in the first eight months of 2023, according to Texas Health and Human Services Commission data. Meanwhile, nationwide abortions have slightly increased, while travel for abortions more than doubled.
The state’s overall fertility rate – measured as births per 1,000 women aged 15 to 44 – rose for the first time since 2014, climbing 2% in 2022 compared to 2021, while the rate in the U.S. overall fell. Texas’ so-called Heartbeat Act, which banned abortions after six weeks of pregnancy, went into effect in September 2021.
Those changes haven’t been equal. Most of the additional births in Texas in 2022 occurred among Hispanic women, who saw a fertility rate increase of more than 5%, or an additional 13,503 births, according to a new University of Houston study. Texas fertility rates for non-Hispanic Black and non-Hispanic White women each declined in the same period.
Teen fertility rates in the state also reversed course, marking an increase for the first time in 15 years. The jump was small – just 0.39% – but notable, given nationwide trends for teens continued to fall.
Fertility rates for Texas teens varied by race and ethnicity, with Hispanic, non-Hispanic Black and non-Hispanic Asian teens seeing increases, while non-Hispanic White teens saw a decrease.
A number of factors could explain the differing fertility changes, said Elizabeth Gregory, principal author of the University of Houston study and director of the UH Institute for Research on Women, Gender & Sexuality.
“That’s the issue to explore. It might have to do with access to contraception. That would be the first step,” Gregory said. “We know that, with cuts to abortion access, there’s also been closing of clinics. So that could also affect that kind of access.”
Income level and the ability to travel out-of-state for an abortion or travel farther for contraception could also correlate to how fertility rates changed.
What was most notable in the data was that older women saw bigger increases.
“It has to be followed up with more exploration, but it’s suggested that it might have something to do with having children at home already and the ability to travel,” Gregory said.
The plight of Texans leaving the state for abortion care has captured national attention in the last two years. The definition of the state’s only exception to the bans – which allows abortion only when the mother is at risk of death or serious bodily harm – was at the center of two high-profile lawsuits.
Twenty Texas women sued the state as part of the Zurawski v. State of Texas case that is still awaiting a decision from the state supreme court. The women allege their abortions were denied or delayed during medical emergencies because of the exception’s unclear language.
Kate Cox, a Dallas mom who received a lethal fetal diagnosis in her third pregnancy, filed a separate lawsuit while she was still pregnant, asking for permission for her doctor to terminate her pregnancy. After a swift court battle, the state’s highest court denied Cox’s request, but not before she left the state for the abortion.
Cox, who has become the face of the movement to challenge abortion bans in Texas and beyond, recently accepted an invitation to be one of first lady Jill Biden’s guests at this year’s State of the Union address.
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