Reflection on “How Far is Too Far? New Evidence on Abortion Clinic Closures, Access, and Abortions”

A brief essay on a working paper from researchers at The National Bureau of Economic Research, along with other data about abortion access.


I believe one of our basic human rights is the right to privacy — and that includes a woman’s right to make the hard decision of whether or not to have an abortion. Access to that decision should not be restricted in any way, especially through laws that use protection as a façade. Here, I examine the results of a working study (not peer reviewed, not published) and briefly look at the effect of these laws on abortion access.

This working paper examines how abortion rates are effected by clinic closures due to limiting laws disguised to, in politicians’ words, help women or “force” them to be “more personally responsible” (Note: this quote is is in regards to a separate law with similar intentions). HB2 was the culmination of abortion hatred among Republican lawmakers in Texas, and ultimately had an effect on women’s right to choose in the state. While there were abstract arguments about the “undue burden” of this law, no data were available to prove the claims. In this paper, Scott Cunningham, Jason M. Lindo, Caitlin Myers, and Andrea Schlosser use real-world data from this Texas law and create a model analyzing abortion access to support these claims.

Access to the paper in full: https://www.nber.org/papers/w23366

(Note: permission is limited, due to its work-in-progress status)

Change in distance to nearest abortion clinic. Map from “HOW FAR IS TOO FAR? NEW EVIDENCE ON ABORTION CLINIC CLOSURES, ACCESS, AND ABORTIONS” by Scott Cunningham, Jason M. Lindo, Caitlin Myers, Andrea Schlosser

HB2 was designed to hurt women by taking away choice. Politicians, especially the ones who pushed the bill, cite medical necessities for the bill, when in reality it exists only to discourage women from receiving abortions. The bill’s changes range from requiring admitting privileges for staff to emergency room dimensions — two so-called necessary actions that are not required to support the safety of women (according to many health professionals). When clinics need to meet these requirements but don’t have the ability, time, or funds to do so, there are widespread closures and less access for women who would like to be able to make a choice about their own body.

“The fact that Texas has singled out abortion by itself for the imposition of these requirements shows that their true purpose isn’t to improve patient health and safety; it’s just to burden abortion,” — Lawyer Stephanie Toti (via NPR)

As clinics close, the real intentions behind abortion access bills becomes apparent — they exist to take away that that choice from women. HB2 and others are the prime example of restricting access; the paper, and many anecdotal stories, clearly show this trend.

Texas isn’t the only state to restrict access to clinics; many states have jumped on the bandwagon, following and implementing concepts found in HB2. States that currently have laws in place similar to HB2’s strict requirements of emergency-room-like clinics and admitting privileges include (NPR):

  • Hospital-Like Requirements: Michigan, Pennsylvania, Virginia, Missouri
  • Admitting Privileges: North Dakota, Missouri, Tennessee

While this paper looks only at the effects of HB2 in Texas, the similar laws in many other states surely produce similar effects. Texas is one of many states to take action limiting women’s rights, seen in the list above. This paper shows the ripple effect of clinic closures and works toward defining one element of the “undue burden” clause used to protect abortion access. In the next sections, I will break down two key points this paper makes.

More Closures, More Waiting

As women are forced to wait longer for abortion services, abortion rate falls (17). When clinics close because of laws like HB2, open facilities can experience an influx of clients. This means that women have to wait longer to even receive information regarding abortion; in the immediate aftermath of HB2 wait times “hit three weeks in Austin, Dallas, and Fort Worth clinics” (8). Wait times like this go hand-in-hand with explicit wait time laws in many states. Forcing women to wait is a burden that has an effect on abortion rates, even if it’s relatively small.

According to the Guttmacher Institute, laws mandating waiting periods are an “unnecessary hurdle” to making the choice of abortion. Forcing women to wait even 24 hours further alienates them, as if the state is even suspicious of their decision. In a qualitative study from 2008, 92% of women were already sure of their decision before going to a clinic. In reality, this data does not just represent legally mandated waiting times, but also waiting times related to closures.

In the working paper, researchers found that increased patients, which led to increased waiting times, might be the cause of lower abortion rates in some cases (17). Because distance to a clinic and amount of patients are correlated, it is hard to determine which factor is more important. I believe they work hand-in-hand; this hypothesis is supported by the dual-focused actions anti-abortion lawmakers take. Laws requiring waiting periods as well as laws requiring clinic regulations both disadvantage women by removing their access to choice.

Longer Travel, Less Access

When women need to travel longer distances to receive information, abortion rates in the cities, counties, and communities decrease significantly (15). The supreme court decision in Whole Women’s Health v. Hellerstedt (2016) in reference to Planned Parenthood v. Casey (1992) stated that an “undue burden” is upwards of 150 miles — a number seemingly arbitrarily stated by Justice Alito (19). Forcing women to travel longer distances makes it harder for specific groups to have access to abortion services.

Traveling under 50 miles to an abortion clinic has little impact on abortion rates. As distances increase, more women lose access and abortion rates fall. If a women needs to travel 100–200 miles to a facility, rates drop by 36 percent (15). Similarly, when the nearest clinic is over 200 miles away, rates decrease by almost 40 percent (15–16). This is a significant change, and shows the negative impact on access from laws like HB2.

Travel is not always possible for women, especially for certain groups of people who already experience certain circumstances. Low income women generally have a harder time traveling due to a couple factors. First, mode of transportation plays a important role in travel. If someone doesn’t have access to a car regularly, moving even 50 miles is difficult. Second, travel requires “free” time — not working and not needing to take care of children. For low income women, requesting time off work might be impossible; and paying for childcare could be a large share of their income.

As Access Decreases, Abortion Rates Decrease

Closures only remove the choice that women should be able to have over their own body. A lower clinic-to-client ratio forces women to unnecessarily wait to carry out a choice they’ve most likely already come to a conclusion about. Longer distances to clinics means women must spend extra time and money to have access.

This paper finds that as clinics close due to specific legislation like HB2, abortion rates also decrease. HB2 and similar laws impose an “undue burden” on women by forcing them to wait for access and travel longer distances. Texas isn’t the only state affected by laws like this, and it wouldn’t be surprising if similar consequences were found in other states with similar restrictions.

We need to oppose coded legislation that restricts women’s access to abortion through covert measures — like imposing hospital-like requirements and forcing doctors to have admitting privileges. Both put an unnecessary hurdle in the way of a woman’s right to choose. This paper quantifies the extent to which abortion restriction laws cross the threshold of “undue burden” and should be a key factor in future court rulings.


Thank you for taking the time to read my reflection on this working paper and abortion access in general. Find me on twitter, not very active: @alexbruens

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