National Partnership for Women & Families

Monthly Women's Health Research Review

Study examines reproductive-age women's reasons for supporting, opposing Texas abortion restrictions

Summary of "Women's knowledge of and support for abortion restrictions in Texas: Findings from a statewide representative survey," White et al., Perspectives on Sexual and Reproductive Health, April 15, 2016.

Despite a proliferation of state-level abortion restrictions over the past five years, "public attitudes toward restrictions on abortion providers that limit women's access to services have not been assessed," according to Kari White, an assistant professor in the Department of Health Care Organization and Policy at the University of Alabama at Birmingham School of Public Health, and colleagues.

The researchers noted that "few studies have homed in on support for" abortion restrictions "among women of reproductive age, who may be directly affected by the regulations." For the study, the researchers examined "women's opinions of abortion regulations that extends beyond the general assessment provided in many national surveys" by examining statewide data on women's "knowledge of and attitudes toward recent abortion laws in Texas," as well as "the reasons women hold the opinions they do."

Background

According to the researchers, Texas has "passed numerous regulations on abortion since 2011." Texas lawmakers in 2011 passed a bill (HB 15) that "expand[ed] the preprocedure requirements" regarding state-mandated counseling and requires a woman to visit a provider at least 24 hours before the abortion to receive an ultrasound, which medical staff must describe in detail. In 2013, Texas lawmakers passed an omnibus antiabortion-rights bill (HB 2) that bans most abortion care at 20 weeks, requires abortion providers to have admitting privileges at a hospital within 30 miles of the abortion clinic and holds abortion clinics to the same building standards as ambulatory surgical centers. At the time of the researchers' writing, the law also restricted the use of medication abortion by requiring providers to follow an outdated FDA label for mifepristone.

The researchers noted that HB 2's ambulatory surgical center requirement, which briefly took effect in 2014, has been halted pending the outcome of a Supreme Court challenge. Meanwhile, two clinics have been granted judicial relief from the admitting privileges provision.

The researchers explained that these recent abortion restrictions have had a significant effect on access to abortion in the state. According to the researchers, more than 50 percent of Texas clinics have closed since HB 2 took effect, and some regions in Texas are completely without an abortion provider. The researchers also noted that appointment wait times have increased among "several of the remaining facilities" and at the time of the study, the "use of medication abortion ha[d] declined by 70%."

Methods

For their study, the authors used survey data from reproductive-age women in Texas who are members of a nationally representative online survey group called the GfK KnowledgePanel. The researchers solicited responses to a 15-minute survey from women who spoke English and/or Spanish.

The 41-item survey was open from December 2014 to January 2015. It asked respondents about their use of contraception, access to family planning services and personal pregnancy and abortion experiences. Women were also asked about their opinions on abortion restrictions and their knowledge of eight possible abortion restrictions in the state. Five of the eight listed restrictions -- the ultrasound requirement, the admitting privileges requirement, medication abortion restrictions, the 20-week abortion ban and the ambulatory surgical center requirements -- were in place in Texas, while three -- spousal consent for abortion, ban on abortion sought because of the sex of the fetus and a ban on abortion sought because of a fetal Down syndrome diagnosis -- were not in place in the state.

Results

The final sample included 737 respondents, the majority of whom "were black or Latina, were married or cohabiting, had at least one child and had more than a high school education." In terms of other demographic information, the researchers found:

  • 69 percent had household incomes of 200 percent of the federal poverty level (FPL) or higher;
  • 45 percent were conservative or somewhat conservative Republicans;
  • 39 percent were liberal or somewhat liberal Democrats;
  • 16 percent were moderates or Independents;
  • 30 percent were Catholic;
  • 17 percent were Baptist;
  • 13 percent "reported no religious affiliation"; and
  • 12 percent had had an abortion.

According to the study, more than two-thirds of respondents "believed that the government should not prevent women from obtaining an abortion -- despite different personal views on morality," while less than 25 percent "believed abortion was morally wrong and should be illegal." In total, 31 percent indicated that they would favor a law that would make it harder for a woman to access abortion, while 36 percent said they would not support such legislation and 34 percent were unsure.

The researchers found that women with incomes between 100 and 199 percent FPL were more likely than those with higher incomes, and that foreign-born Latinas were more likely than whites, to support laws that restrict abortion access. Meanwhile, conservative Republicans were more likely -- and liberal Democrats less likely -- than moderates or Independents to support such restrictions on abortion access. In terms of religious affiliation, the researchers found that "women who reported an affiliation with 'other Protestant' denominations and women with no religious affiliation were less likely than Catholic respondents to support a law making abortion more difficult to obtain." Women who had previously had an abortion were "marginally" less likely to indicate support for restrictions on abortion access.

Looking at women's awareness of Texas abortion restrictions, the researchers found that 13 percent reported being very aware, 32 percent reported being somewhat aware, 36 percent reported being not very aware and 19 percent said they were unware of any recent laws. When the researchers assessed the 603 women who indicated they were aware of recent antiabortion-rights law, they found that 90 percent correctly identified the three possible restrictions listed in the survey that were not law in Texas: spousal consent for abortion, a ban on abortion sought because of the sex of the fetus and a ban on abortion sought because of fetal diagnosis of Down syndrome.

In terms of the five restrictions that were state laws at the time of the survey, 25 to 30 percent of respondents knew of the ultrasound requirement, the admitting privileges requirement, the ambulatory surgical center requirement and the 20-week ban. According to the researchers, "only 7% were aware" of the medication abortion restrictions in place at the time of the study. The researchers found that participants who said they were very or somewhat aware of the new rules "were significantly more likely than those who were not very aware to correctly identify the five restrictions that were passed in Texas, but there was no difference among groups regarding knowledge of the three restrictions that are not state laws."

Among "women with any awareness of Texas laws," the researchers found that 19 percent supported the laws, 17 percent supported certain requirements in the laws while opposing other parts, 7 percent said they somewhat opposed the restrictions and 11 percent said they strongly opposed the laws. The remaining 46 percent of women were unsure how they felt about the laws, and three-quarters of those women indicated they were largely unaware of the laws. According to the researchers, 42 percent of women who supported the laws and 64 percent of the women who said they supported certain parts of the laws said their main reason for supporting the legislation was the belief that the restrictions would make abortion care safer. Meanwhile, making abortion care more difficult to access was the primary reason cited by one-third of women who supported the laws and 25 percent of those who supported parts of the laws.

The researchers found that 49 percent of respondents who said they opposed such restrictions did so because they thought the restrictions would make abortion less accessible, 30 percent said they did so because physicians rather than lawmakers should make health care decisions and 15 percent said they did so because the restrictions would not make abortion care safer.

The researchers also found that the proportion of women among different political ideologies and party affiliations who opposed the abortion restrictions ranged from 8 to 40 percent. In terms of awareness and support of such restrictions, the researchers found that "18-24% of conservative and somewhat conservative Republicans, moderates and Independents, and somewhat liberal Democrats had not heard of recent Texas abortion laws, but only 9% of liberal Democrats were unaware of the laws." According to the researchers, "There was no significant difference among groups in support for the laws because they make abortion safer (versus being opposed to the laws)." In comparison, the researchers found that "somewhat conservative Republicans, somewhat liberal Democrats and liberal Democrats were less likely than conservative Republicans to support the laws (versus oppose them) because they would make abortion harder to get (2-7% vs. 24%)."

According to researchers, "White women and both U.S.-born and foreign-born Latinas were more likely to report that they had not heard of Texas abortion laws or were not sure of their opinions about the laws than to say they held a position for or against the laws." In addition, the researchers found that 42 percent of foreign-born Latinas, compared with 31 percent of whites, were unsure of their opinions. The researchers also noted that blacks seemed more likely than whites to express support for abortion restrictions because they thought the restrictions improved abortion safety. The researchers wrote, "Across all subgroups, no more than 12% supported the laws because they would make abortion harder to get." The authors added that "the proportion was particularly low," at 3 percent, "among foreign-born Latinas."

Discussion

The researchers wrote that the study enabled them "to move beyond broad, hypothetical questions" about public opinions on abortion and "more closely examine women's knowledge of and support for recent abortion legislation in Texas." According to the researchers, the study showed "that the majority of women are not well informed about these regulations and that there is not strong support for restricting access."

The researchers wrote that their findings on women who opposed abortion rights and those who supported abortion restrictions aligned with findings in other studies, as did the study's finding on increased support for abortion restrictions among certain subgroups, such as foreign-born Latinas and Catholics compared with whites and those with "other Protestant" or no religious affiliation, respectively.

However, the researchers noted that questions "about specific laws in Texas" afforded them "a different perspective." The researchers wrote, for instance, that while "a small proportion of foreign-born Latinas opposed current abortion regulations in Texas, very few said they supported these restrictions because they would make abortion harder to get, and the majority were uninformed about the laws or were unsure of their opinions." The researchers added that "even women who said they were very aware of the laws had poor knowledge of the specific regulations." According to the researchers, "These findings ... suggest that given the recent increase in abortion restrictions in Texas, a growing number of women may find they are unable to obtain time-sensitive abortion care when they need it."

In addition, the "findings also point to a relationship between poor knowledge of the safety of abortion and support for additional regulations among women of reproductive age," the researchers wrote. They explained that "[w]ith few exceptions, ... the most common reason" cited by women for supporting Texas abortion restrictions "was that they believe these laws will make abortion provision safer." These findings "are consistent with the messaging strategy used by proponents of such restrictions," including targeted antiabortion-rights messaging toward black women, the researchers wrote. They continued, "Because women of reproductive age tend to overestimate the risks associated with abortion, claims about safety may seem reasonable and, in turn, may attenuate or neutralize opposition to restrictions among those who support access to legal abortion."

The researchers contended that providing women with "more complete and accurate information about the trend in and nature of abortion restrictions in Texas" could make women "even less likely to support recent laws, because they generally support access to safe, legal abortion." Further, the researchers wrote that the Texas regulations not only do not make abortion safer, but actually "may make abortion less safe" because reduced care access and longer wait times "may lead some women to attempt to self-induce abortions using ineffective or unsafe methods."

Citing the antiabortion-rights movement likely propelling the passage of these laws, "despite the lack of broad public support," the researchers wrote that "protecting women's access to legal abortion may depend on the efforts of reproductive rights advocates in effectively communicating the combined impact of abortion restrictions on women's access to care and safety, because these efforts could energize likely voters and policymakers who are supportive of these issues." Other "[p]otentially effective strategies might also promote the commonly held values that the government should not prevent women from making personal decisions about abortion," the researchers wrote.

The researchers noted that their findings suggest that Texas abortion laws "do not reflect the opinions of the majority" of reproductive-age women in Texas, "and that misinformation about the safety of abortion may lead some to support medically unnecessary restrictions." They concluded, "Accurate information about abortion and the impact of restrictions on women could inform strategies to oppose legislation that impedes access to this essential health service."