Texas women had nearly 9,000 fewer abortions in the first full year since new restrictions forced more than half of the state's abortion clinics to close.
Provisional data recently released by the Department of State Health Services show a 14 percent reduction in the number of abortions performed in 2014 compared with the year before.
Nationally, abortion rates have steadily decreased in recent years, but the drop in Texas is dramatic. The Associated Press found that abortions decreased by about 12 percent nationwide from 2010 to 2013-14. Texas abortions decreased by 30 percent in that five-year span.
The reasons for the decrease, nationally and in Texas, are hard to nail down.
Cynthia Meyer, a spokeswoman for Texas Attorney General Ken Paxton, who is defending the law in a case pending before the U.S. Supreme Court, said the national trend suggested "that demand for abortion is decreasing as a whole."
"And that's a positive thing," Meyer said.
Kate Connors, a spokeswoman for the American College of Obstetricians and Gynecologists, said that although the final data are not yet available, it's "common sense" that when clinics close, "you make it harder for women to get abortions."
Dr. Daniel Grossman, an OB-GYN who studies the effects of recent reproductive health legislation in Texas with the Texas Policy Evaluation Project at the University of Texas, Austin, said the state drop in abortions is "much steeper than what's being seen nationally."
"It's highly likely that it is related to the limitations on access," Grossman said. "It all sort of fits together to indicate that this law is creating significant burdens on women that some are unable to overcome."
A survey by The Dallas Morning News revealed that 23 of the state's 40 abortion clinics had stopped offering the procedure since July 2013. That's when former Texas Gov. Rick Perry signed a bill into law requiring all doctors who perform abortions to maintain admitting privileges at a nearby hospital and all abortions to be performed in hospital-like surgical facilities.
The sweeping law also included a ban on the procedure after 20 weeks of pregnancy and changed the rules for how doctors can prescribe abortion-inducing drugs. It drew national attention in part because of the dramatic filibuster that then-Sen. Wendy Davis used to temporarily derail the bill.
Two Planned Parenthood clinics transferred their abortion services to facilities that comply with the new restrictions, and one additional compliant clinic opened in San Antonio in June 2015 _ bringing the total number of clinics open in Texas today to 18.
The state says the requirements are meant to make the procedure safer, but providers argue that they are unnecessary for patients to be safe and that the state is trying to force clinics to close.
Abortion providers sued to block the requirements, and after 2 years of back and forth in federal courts, the U.S. Supreme Court is now reviewing the restrictions.
During oral arguments before the justices March 2, Justice Samuel Alito, appointed by George W. Bush in 2006, lamented that the case record didn't provide more evidence about why each clinic closed.
Information about clinic closures can be difficult to nail down, even for providers and the state's health agency. The Department of State Health Services doesn't track why facilities close. Some stopped providing abortions before technically closing their clinics or surrendering their licenses. Others stopped providing abortions for a short time but then started again.
After surveying administrators from the closed clinics, The News determined that 18 clinics said they closed because of the 2013 law.
One of the contested provisions _ requiring all abortions to be performed in surgical centers _ went into effect for two weeks in October 2014 after the 5th U.S. Circuit Court of Appeals reviewed its constitutionality. Ten clinics closed before the Supreme Court blocked enforcement and allowed them to reopen.
Justice Elena Kagan, appointed by President Barack Obama in 2010, called the period a "controlled experiment" of the law's effect.
Virginia Braun's Routh Street Women's Clinic in Dallas was one of those that briefly closed. She said that upgrading her facility to meet the new structural and operational standards would have been physically impossible at her location.
"We reopened somehow after we had dismantled our clinic and took pictures off the wall and everything," Braun said.
University General Hospital in Dallas, where Routh Street's full-time physician had admitting privileges, closed in December 2014. The clinic continued operating with a part-time physician until the 5th Circuit upheld the restrictions a final time in June 2015. Even after the Supreme Court acted, she said, the uncertainty was too much, and she closed the clinic in June.
The staff "can't just work indefinitely knowing that tomorrow they may not have a job," Braun said. "At a certain point, you have to realize that this is self-destructive."
The state questioned whether the law caused the closures of seven facilities that stopped providing abortions before the restrictions went into effect.
Planned Parenthood affiliates in Texas, which operated six of the seven facilities, say the law was a factor in their decisions to close, as does the other clinic, All Women's Medical Center in San Antonio. Two clinics in San Antonio that provided only nonsurgical abortions using pills transferred all services to a separate clinic in the city.
A third clinic in Stafford that also provided only nonsurgical abortions stopped offering the procedure as well. Providers say the new regulations on abortion-inducing pills are outdated and against best practices.
Planned Parenthood clinics in Bryan, Midland and San Angelo shared a building with separately funded and operated family planning clinics that struggled after budget cuts in 2011 and a loss of state funding in 2013.
Rochelle Tafolla, a spokeswoman for Planned Parenthood Gulf Coast, told The News in August 2013 that the group's abortion operation was not affected by the family planning funding cuts "because there is no state funding for abortion, but they are housed in the same location."
Tafolla said Planned Parenthood decided to close the clinic when the family planning operation had to close. She also cited the new regulations.
Some providers say they would try to reopen if the Supreme Court strikes down the restrictions, but others say it's too late. The Supreme Court is expected to rule this summer.
"It's disappointing, but I don't have the money," said Dr. Lester Minto, who owned and operated Reproductive Services in Harlingen. He closed the clinic when the restrictions took effect in November 2013.
"I didn't have the money to stay in it for the long fight," Minto said.
(c)2016 The Dallas Morning News
