Bloomberg News

Abortion Clinics Close at Record Pace After States Tighten Rules

September 03, 2013

At least 58 U.S. abortion clinics -- almost 1 in 10 -- have shut or stopped providing the procedure since 2011 as access vanishes faster than ever amid a Republican-led push to legislate the industry out of existence.

A wave of regulations that makes it too expensive or logistically impossible for facilities to remain in business drove at least a third of the closings. Demographic changes, declining demand, industry consolidation, doctor retirements and crackdowns on unfit providers were also behind the drop. More clinics in Texas and Ohio are preparing to shut as soon as next month.

Opponents have tried to stop access to abortion through civil disobedience, blockades and legal action. Clinics were bombed and doctors killed. Now, legislatures are proving to be the most effective tool after Republicans made historic gains in the 2010 elections. Their success is creating one of the biggest shifts in reproductive health care since the Supreme Court’s Roe v. Wade decision in 1973 legalized abortion in all 50 states.

“People who don’t have power protest on the street,” said Cheryl Sullenger, senior policy adviser at Operation Rescue, an anti-abortion group based in Wichita, Kansas. “People who have influence work from within to enact change.”

Thinning Ranks

Clinics, not doctors’ offices or hospitals, are where most women go to terminate pregnancies. The ranks of the facilities have been thinning since the late 1980s, when the number of large nonhospital providers -- those performing 400 or more abortions per year -- peaked at 705, according to the Guttmacher Institute, a New York-based reproductive-health research organization. By 2008, the most recent year for which data are available, that number had fallen to 591.

The pace began accelerating in 2011. Since then, through Aug. 1 of this year, state lawmakers passed 200 abortion restrictions, according to Guttmacher. That’s about the same number that had passed in the prior 10 years combined.

In July, Republican Governor Rick Perry signed a bill making Texas the largest and most populous state to pass comprehensive clinic regulations. The law requires abortion facilities to become outpatient surgical centers and their doctors to have admitting privileges at nearby hospitals. Though the law won’t take effect until October, three clinics have already shut because of it, bringing closings there to at least six since 2011.

100 Miles

Planned Parenthood Center for Choice in Bryan, which stopped seeing patients the first week of August, was one of them. A message on its website now directs would-be patrons to a facility in Houston, about 100 miles (161 kilometers) away.

“Due to the recent passage of politicized health-care restrictions in Texas House Bill 2, women will lose access to safe abortion services in Brazos County,” it says. “While we believe the excessive and medically unnecessary requirements imposed on clinics providing early abortion are unconstitutional, we have made the difficult and practical decision to close at this time rather than face the prospect of having to do so in the foreseeable future.”

Two Virginia clinics, including NOVA Women’s Healthcare in Fairfax, the state’s busiest facility last year, have shut since April, when health officials approved building rules similar to Texas’s.

Arizona is now home to seven providers, down from 19 in 2010, after lawmakers effectively banned nurse practitioners from providing abortions. There weren’t enough doctors to replace them, making abortion inaccessible outside the areas of Phoenix and Tucson, the state’s two largest cities, said Cynde Cerf, a spokeswoman for the local Planned Parenthood affiliate.

Fighting Back

Across the nation, the number of closings would probably be higher were it not for legal fights that have prevented some laws from taking effect. The sole clinics in North Dakota and Mississippi, for instance, remain open after courts temporarily blocked requirements that their doctors gain hospital privileges.

Texas, Kansas, Louisiana, and Arizona have each seen one new clinic open since 2010.

Anti-abortion forces often claim credit for clinic closings, celebrating them as moral victories that double as evidence that their goal of eliminating the practice is working.

Operation Rescue’s Sullenger says she’s persuaded 40 abortion providers to quit, and that her sidewalk counseling ministry has saved more than 2,500 lives. The group, which operates out of a former clinic that it bought and closed in 2006, gained notice in the 1990s after leading demonstrations that led to hundreds of arrests. Sullenger spent two years in federal prison after pleading guilty to conspiring to gasoline-bomb a clinic in 1987.

Project Daniel

In 2009, the group introduced Project Daniel 5:25, “named after the biblical story of Daniel, who was able to read the handwriting on the wall and predict the fall of a wicked kingdom,” to determine the location of every clinic in the U.S. Now housed at www.abortiondocs.org, the addresses of current and former clinics are listed beside photos of doctors and owners.

It’s one of most comprehensive tallies, referenced by supporters and opponents of abortion rights alike. Using it as a starting point, Bloomberg verified at least 58 clinics that closed or ceased providing abortions in 24 states through phone calls to current and former area providers, information from state health officials and local news reports. Those that couldn’t be confirmed or were listed erroneously -- meaning they are in fact open or weren’t abortion providers -- weren’t included in the final count.

Record Pace

The reporting by Bloomberg, coupled with data from Guttmacher, which surveys providers every few years, show that clinics have closed at a record pace since 2011. During the past three years, an average of 19 closed each year. That’s more than double the rate in the decade ending in 2008.

Not all closings resulted from state laws. Internal funding issues drove the Family Planning Association of Maine to shut its South Portland location last year, said Nancy Audet, a spokeswoman. The Bours Health Center in Eugene, Oregon, ceased operation this year after its doctor retired, according to the National Abortion Federation, a trade association with 400 members in the U.S., Canada and Mexico.

In some cases, closings brought relief to both sides of the debate. Gone are two Pennsylvania clinics with ties to Steven Brigham, a doctor accused repeatedly of substandard care and barred from practicing medicine in that state.

Natural Changes

Part of the decrease in providers reflects natural changes in the marketplace, said Vicki Saporta, the federation’s president and chief executive officer. One bright spot, she said, is the number of private practitioners offering abortion-inducing drugs, which has climbed since the Food and Drug Administration approved them in 2000. Increased contraception use and the development of more effective methods have also pushed down unplanned pregnancy and abortion rates.

Still, the shrinking pool of clinics has raised concerns that a woman’s constitutional right to an abortion increasingly depends on whether she has money for travel.

“It’s disheartening beyond words,” said Renee Chelian, who opened her first clinic in suburban Detroit in 1976. She now owns three there that she’s fighting to keep open after the state legislature passed building regulations last year.

Fourteen clinics in Michigan and neighboring Ohio have shut in the past three years, prompting Chelian to add clinic hours and hire another physician to meet increased demand.

One of them was American Family Planning Inc. in Dearborn, less than 30 miles south of her facilities. In June, 160 activists gathered outside it to “pay tribute to the thousands of unborn children aborted there,” according to Citizens for a Pro-Life Society, based in nearby South Lyon.

Photos on the group’s website show “flowers for the dead” and a yellow-beaded rosary that participants left behind.

“May the blood of Christ triumph over all such places of death,” the caption reads.

To contact the reporter on this story: Esme E. Deprez in New York at edeprez@bloomberg.net

To contact the editor responsible for this story: Stephen Merelman at smerelman@bloomberg.net


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