Citation
A Geo-Spatial Analysis of Abortion Facilities in Texas: Examining the Potential Impacts that a Reduction in Abortion Facilities could have on Accessibility and Services

Material Information

Title:
A Geo-Spatial Analysis of Abortion Facilities in Texas: Examining the Potential Impacts that a Reduction in Abortion Facilities could have on Accessibility and Services
Creator:
Riley, Jordan K.
Place of Publication:
[Gainesville, Fla.]
Publisher:
College of Design, Construction and Planning, University of Florida
Publication Date:
Language:
English
Physical Description:
Project in lieu of thesis

Thesis/Dissertation Information

Degree:
Master's ( Master of Urban and Regional Planning (M))
Degree Grantor:
University of Florida
Committee Chair:
Zwick, Paul D
Committee Co-Chair:
Bejleri, Ilir

Subjects

Subjects / Keywords:
Abortion ( jstor )
Demography ( jstor )
Family planning clinics ( jstor )
Federal district courts ( jstor )
Hospitals ( jstor )
Induced abortion ( jstor )
Mathematical dependent variables ( jstor )
Poverty ( jstor )
Travel ( jstor )
Women ( jstor )
Ordinary Least Squares (OLS)
Genre:
Project in Lieu of Thesis

Notes

Abstract:
Policy makers in Texas, and the United States Supreme Court, are considering the constitutionality of two amendments to Texas state health laws which regulates abortion laws. The Bill was passed as a law and was scheduled to become effective on September 1, 2014; however, the law has been challenged through the 5th Circuit Court of Appeals and is currently on the docket for review at the United States Supreme Court. If the Bill is upheld by the Supreme Court, many abortion clinics will be required to close their doors. According to NARAL Pro-Choice Texas, an abortion advocacy group that monitors the availability of abortion services in Texas, shows that there are approximately 17 abortion clinics currently functioning in Texas. These open facilities are located in Austin, Dallas, Fort Worth, Houston, San Antonio, El Paso and McAllen. The spatial clustering of abortion clinics in urban settings leaves many areas in Texas geographically isolated from abortion clinics. To determine if the supply of the existing abortion clinics meet the demands of women’s need abortion services, a geospatial analysis based on common abortion demographics was conducted in ArcGIS. Using United States Census Data in conjunction with ArcGIS spatial statistic processes of Ordinary Least Squares, Global Moran’s I test, and Geographic Weighted Regression, clusters for the poverty demographic were identified for the state of Texas. These cluster areas were then compared to the existing location of abortion facilities to see if there were gaps in coverage.
General Note:
Urban and regional planning terminal project

Record Information

Source Institution:
University of Florida
Holding Location:
University of Florida
Rights Management:
Copyright Jordan K. Riley. Permission granted to the University of Florida to digitize, archive and distribute this item for non-profit research and educational purposes. Any reuse of this item in excess of fair use or other copyright exemptions requires permission of the copyright holder.
Resource Identifier:
1022120507 ( OCLC )

Downloads

This item is only available as the following downloads:


Full Text

PAGE 1

A Geo Spatial Analysis of Abortion Facilities in Texas: Examining the Potential Impacts that a Reduction in Abortion Facilities could have on Accessibility and Services Jordan K. Riley University of Florida Urban and Regional Planning Department

PAGE 2

A Geo Spatial Analysis of A bortion Facilities in Texas: Examining the Potential Impacts that a Reduction in Abortion Facilities could have on Accessibility and Services 2 Abstract Policy makers in Texas, and the United States Supreme Court, are considering the constitutionality of two amendments to Texas state health laws which regulates abortion laws. The Bill was passed as a law and was scheduled to become effective on September 1, 2014; however, the law has been challenged through the 5 th Circuit Court of Appeals and is currently on the docket for review at the United States Supreme Court. If t he Bill is upheld by the Supreme Court, many abortion clinics will be required to close their doors. According to NARAL Pro Choice Texas, an abortion advocacy group that monitors the availability of abortion services in Texas, shows that there are approximately 17 abortion clinics currently functioning in Texas These open facilities are located in Austin, Dallas, Fort Worth, Houston, San Antonio, El Paso and McAllen. The spatial clustering of abortion clinics in urban settings leaves many areas in Texas geographically isolated from abortion clinics. To determine if the supply of the existing abortion clinics meet the demands of women need abortion services a geospatial analysis based on common abortion demographics was conducted in ArcGIS. Using United States Census Data in conjunction with ArcGIS spatial statistic processes of Ordinary Least Squares, Global I test, and Geographic Weighted Regression clusters for the poverty demographic were identified for the state of Texas. These cluste r areas were then compared to the existing location of abortion facilities to see if there were gaps in coverage. Keywords: Ordinary Least Squares (OLS)

PAGE 3

A Geo Spatial Analysis of A bortion Facilities in Texas: Examining the Potential Impacts that a Reduction in Abortion Facilities could have on Accessibility and Services 3 A Geo Spatial Analysis of Abortion Facilities in Texas: Examining the Potential Impacts that a Reduc tion in Abortion Facilities could have on Accessibility and Services P olicy makers in Texas, and the United States Supreme Court, are considering the constitutionality of two amendments to T exas state health laws which regulates abortion laws One of the amendments proposed in the H ouse B ill N o 2 Bill is that all abortion clinics in Texas must me et the minimum standards of an a mbulatory s urgical c enter. 1 The Bill was passed as a law and was scheduled to become effective on September 1, 2014; however the law has been challenged through the 5 th C ircuit Court of A ppeals and is currently on the docket for review at the United States Supreme Court If the legislation is upheld in the United States Supreme Court many existing abortion clinics in the State of Texas, will not meet the ambulatory surgical center minimum standards and will be required to cease operations. It is questioned whether or not the Texas legislature is using this proposed amendment as a thinly veiled guise to reduce the ac cessibility and availability of abortion practices. In an article published on October 9, 2014 in The Texas Tribune reporter Alex Ura states that only eight abortion clinics, out of the existing forty clinics, will remain open if the law were to go into e ffect. 2 This would result in a drastic decrease in the supply of abortion clinic locations for Texas women seeking abortion services, noting that the remaining open abortion facility are located in major metropolitan areas. Due to the sheer vastness of the state of Texas, there will be women who live in an area that do not easily access abortion facilities; as result th ese women will need to trav el great distances in order to receive abortion services. 1 House Bill No. 2, Texas Congress, (2013). 2 th The Texas Tribune (October 9, 2014) p.10.

PAGE 4

A Geo Spatial Analysis of A bortion Facilities in Texas: Examining the Potential Impacts that a Reduction in Abortion Facilities could have on Accessibility and Services 4 This paper will examine how accessibility and service s of Texas abortion facilities will be affected if the H ouse B ill No. 2 law is upheld in the United States Supreme Court It is anticipated that t he geographic clustering of abortion facilities that meet the minimum ambulatory surgical centers standard in major metropolitan cities will not provide equitable abortion service access to the women of Texas Ultimately some wome n will be required in travel ing extended distances in order to obtain abortion services. With an inequity in abortion supply, by the means of ArcGIS spatial analysis, this paper will examine areas that have been denoted as hotspots for abortion services Based off of previous academic studies, which have identified common characteristics of American women in need of a bortion services t he hotspots will be selected through the analysis of 2010 Census demographic data. The hotspot analysis will highlight demographic areas in Texas believed to be in most need of abortion services, and these areas will then be reviewed in relation to existin g abortion clinic facilities. Utilizing the concept of distance equity, future ambulatory surgical center abortion clinics will be proposed in locations that will serve the needs of multiple communities of women in Texas. Abortion in the United States In American History, i t was not until relati vely recently that women were given the right to legally seek medically induced abortions The seminal verdict of the Roe vs. Wade Supreme Court Case in the year 1973, which ruled that it is unconstitutional for in dividual states to restrict the use and availability of first trimester induced abortions drastically changed the face of American politics, culture an d infrastructure. 3 Whereas in the years prior to the Supreme 3 servic es in the U nited S Annals of the Association of American Geographers, Vol. 84, No. 2 (1994) 233

PAGE 5

A Geo Spatial Analysis of A bortion Facilities in Texas: Examining the Potential Impacts that a Reduction in Abortion Facilities could have on Accessibility and Services 5 Court only a few selected states had opted to offer induced abortion services within its jurisdiction W hile the remaining states restricted, or banned, the medical procedure By the year 1969 only 11 states had instituted policies which allowed for women to obtain induced abortion s and only a total of 25,000 induced abortions had been reported to the Center for Disease Control (CDC ) 4 As such in the years leading up to 1973, it was common for a woman in need of an abortion to travel to those states which offered legal induced abortions if her state of residence had not yet legalized abortion services. However, the Roe vs. Wade ruling would change the physical landscape of abortion clinic availability. Now that individual states were una ble to restrict the access/availability of abortion services there would be a dramatic increase in the availability of abortion services and clinics. As a result, the total number of induced abortions obtained across the United States greatly increased in the years immediately following the 1973 Supreme Court verdict By the year 1980 the number of legal abortions obtained and reported to the CDC had risen to 1.6 million. 5 This is a dramatic increase from the 25,000 reported induced abortions of the year 1969 The increased number of performed induced abortions was coupled with a decrease in the number of intersta te travel for abortion services. 1973 decision allowed for the increase of abortion facilities across the entirety of the Uni ted States, of state abortions fell from 44 percent of the total in 1972 to only seven percent ten 6 The increased demand of abortion services experienced in 4 Abortion Surveillance United States, 2012 Morbidity and Mortality Weekly Report, Surveillance Summaries, Vol. 64(SS10) (Nov. 27, 2015) p. 3. 5 Ibid, p. 4. 6 servic es in the U nited S Annals of the Association of A merican Geographers, Vol. 84, No. 2 (1994) 234

PAGE 6

A Geo Spatial Analysis of A bortion Facilities in Texas: Examining the Potential Impacts that a Reduction in Abortion Facilities could have on Accessibility and Services 6 similarly produced an increase i n supp ly in the availability of abortion clinics and services. This increase in supply of abortion clinic s had helped to alleviate extensive travel in order to obtain an abortion. W omen were now able to seek abortion services within their resident jurisdictions. However, g iven the controversial nature of abortion rights it would not take long for states to challenge the authority of the Roe vs. Wade verdict Numerous states would enact laws that would attempt to limit the scope or applicatio n of the Supreme Court ruling within its own jurisdiction. More often than not, these regulatory legislations would be fruitless attempts to shorten the long arm of the Federal law. However, the political tides would change in 1992 with the Casey vs. Plann ed Parenthood Supreme Court decision which afforded states the latitude to enact laws which would regulate abortion utilization in as much as the law promotes the general health and welfare of the community enact regulations to further the health or safety of a woman seeking an abortion, but may not impose unnecessary health regulations that present a substantial obstacle to a woman seeking an 7 This historic ruling would once again change abortion access and availability in the United States; and as a result, we will see a variability in abortion regulations between states with regards to the interpretation of promoting the health and safety of women seeking abortions. Researcher Patricia Gober note s that the various legal challenges to Roe vs. Wade Casey vs. Planned Parenthood 7 Planned Parenthood of Southeastern Pennsylvania et al. v. Casey, Governor of Pennsylvania No. 91 744 (1992).

PAGE 7

A Geo Spatial Analysis of A bortion Facilities in Texas: Examining the Potential Impacts that a Reduction in Abortion Facilities could have on Accessibility and Services 7 case in 1992, created an environmental where the supply of abortion clinics and services was onc e again unequal between states. 8 Abortion in the State of Texas Since the nation wide legalization of abortion in year 1973, the Guttmacher Institute has been collecting abortion data and producing a statistical overview of women who seek abortion services nationally, as well as by state. Abortion data can be can be an alyzed by two separate metric valuations: the first being the total number of abortions, which is the numeric value of all abortion that took place in one calendar year; and second, the rate of abortion, which is calculated as the number of induced abortio ns per 1,000 pregnancies. These two categories can be further subdivided to differentiate between: resident abortion by state, which only accounts for the abortion data of residents of a particular state; or occurrence of abortion, which accounts for both resident and non resident abortions taking place within said state. In examining the total number of abortions and abortion rate by occurrence and residency in Texas from 1973 through 2011 it is apparent that there has been great fluctuation in these numb ers over the years. Table 1: Guttmacher Institute, Abortion Data in Texas (2014) provides a breakdown of the number of abortion and the rate of abortions obtained in the State of Texas by state of resident and by state of occurrence between the years of 19 73 2011. 9 In the years immediately following the Supreme Roe vs. Wade ruling we see an uptick in number and rate of legal induced abortions in Texas, as graphically expressed in Table 2 : Guttmacher Institute, Abortion Data in Texas (2014), 8 and for abortion servic es in the United S Annals of the Association of American Geographers, Vol. 84, No. 2 (1994) 236 9 The Guttm acher Institute Abortion Data in Texas (2014).

PAGE 8

A Geo Spatial Analysis of A bortion Facilities in Texas: Examining the Potential Impacts that a Reduction in Abortion Facilities could have on Accessibility and Services 8 Number o f Abortion and Table 3: Guttmacher Institute, Abortion Data in Texas (2014), Rate of Abortion 10 In referencing Table 1 one can see the steady rise of the number and rate of abortion in both the state of resident and state of occurrence variables. Most not ably, in the years 1980 and 1981, t here is a peak in both the state of resident and state of occurrence variables; and in subsequent years there is a slight downw ard trend in abortion these abortion variables However, after the year 1992 there is a precipitous decline the number of abortion incidences in Texas, and this, in part, can be attributed to the change in legislature which allows for state intervention and regulation of abortion practices. The Casey vs. Planned Parenthood ruling had a profound impact on Texas ability to regulate abortion services. T he State of Texas has exercised its right to create laws which regulates the proces ses by which women obtain abortion s by enacting bills which narrows the scope of abortio n services in Texas In more recent Texas legislative history, the Right to Know Act, e ffective in early 2004, amended Title 2, Chapter 171, of the Health and Safety Code. 11 regarding abortion facilities and practices The following procedural regulations have been instituted by the State of Texas as measures to better promote health and safety to women seeking abortion services The first amendment to the Texas abortion law e ntailed a change to abortion facility requirements : Section 171.004. ABORTION OF FETUS AGE 16 WEEKS OR MORE. An abortion of a fetus age 16 weeks or more may be performed only at an ambulatory surgical center or hospital license to perform the abortion. 12 As per the Roe vs. Wade ruling, a state is 10 Ibid. 11 Silvie Colman and Theodore J. Joyce Patient and Providers in Texas, National Bureau of Economic Research 2010) 1. 12 Texas Constitution, T itle 2, Subtitle H., Chapter 171 004

PAGE 9

A Geo Spatial Analysis of A bortion Facilities in Texas: Examining the Potential Impacts that a Reduction in Abortion Facilities could have on Accessibility and Services 9 unable to restrict or regulate abortion access during the first trimester ; however, states are able to place restrictions upon abortion practices in subsequent trimesters. The State of Texas declared that all abor tion performed after the sixteen (16) week of gestation, also known as the second trimester, must be conducted in an ambulatory surgical center or hospital The State declared that the reasoning for this escalation in facility standards is due to the perc eived increased risk to mother and fetus during a second trimester medically induced abortion procedure Ambulatory surgical centers are a designated type of medical facility that are held to higher design standards than the average abortion clinic medica l office. The Texas Health and 13 Furthermore, ambulatory surgical cente rs require a separate license for operation; and these medical facilities are also differentiated by their heightened staffing requirements, and highly specified design and construction criteria. Due to these elevated facility requirements, not all abortio n clinics meet these minimum ambulatory surgical standards. Thus, the abortion clinic as a result she may be required to leave her community in search of an ambula tory surgical center, or hospital, which performs second trimester abortions. Another Act regulation presented within the Texas State Health and Safety Code is outlined in Section 171.0012 which implements a 24 hour waiting period that require s a woman to visit an abortion clinic twice in tw o consecutive days 14 The reasoning behind the 24 ho woman can hear 13 Texas Constitution, Title 4, Subtitle B., Chapter 243. 002. 14 Texas Constitution, T itle 2, Subtitle H., Chapter 171 012

PAGE 10

A Geo Spatial Analysis of A bortion Facilities in Texas: Examining the Potential Impacts that a Reduction in Abortion Facilities could have on Accessibility and Services 10 the hear tbeat of the fetus, see a sonogram of the fetus hear a verbal explanation of the sonogram, a n d then have ample time to consider the implications of the abortion in lieu of the newly presented evidence s However, the State of Texas has made provisions which revoke s the 24 hour waiting period stipulation for women who live further than 100 miles away from an abortion clinic. If a woman can provide a certified waiver stating that she does in fact live further than 10 0 miles away from an abortion clinic, then she will only be subjected to a two hour waiting period between the initial sonogram appointment and the medical abortion procedure. 15 Even still, for some women traveling up to 100 miles in one direction to obtai n an abortion may be a 16 This obstacle of distance may play a large role in the abortion decisions of women in Texas. There is no doubt that Texas is a large and expansive state. If a woman in need of abortion services were to live in a Texas county without an abortion clinic, there is an opportunity that she would have to drive rather far to obtain such service s This is actually not so much of a hypothetical scenario as it is an actual state of li fe for many women residing in Texas. 35% of Texas wo men liv ed 17 Thus it is plausible that the thirty five percent of women who live in a county without the presence of an abortion clinic may have to travel 15 Texas Constitution, T itle 2, Subtitle H., Chapter 171 012 16 Family Planning Perspectives Vol. 8. No. 6 (1976) 262 17

PAGE 11

A Geo Spatial Analysis of A bortion Facilities in Texas: Examining the Potential Impacts that a Reduction in Abortion Facilities could have on Accessibility and Services 11 extended distances in order to obtain such services. And f or a state as vast as Texas, covering over 268,000 square miles of land, it is no stretch of the imagination that this scenario may play out for a woman in need of an abortion. Researchers Robert W. Brown, R. Todd Jewell and Jeffrey J. Rous specifically examines the implications of geographic availability of abortions in the state of Texas, and how the cost of (ages 20 44) who, in the year 1992, sought out abortion services in Texas. Through th e use of a questionnaire method of data collection, the authors gathered data from the study groups Ultimately the authors determine that County with longer travel distances to the nearest provider has a significantly lower probability of abortion a pregnancy 18 In essence, the limited supply and geographical distribution of ambulatory surgical abortion centers in Texas may require certain women to travel distances that are simply unfeasible. Thus, the physical location of a health care facility could be the deci ding factor as to whether or not a woman obtains an abortion. Texas House Bill No. 2 The latest attempt to regulate abortion laws in Texas came in the form of House Bill No. 2, which proposed amending current abortion laws to further limit the scope of a bortion practices and to decrease the supply of abortion clinics. There are two major amendments to Texas abortion legislation proposed in House Bill No. 2. The first change applies to Section 18 Brown, Robert W., R. Todd Jewell and Jeffrey J. Rous Availabil Southern Economic Journal Vol 67, No. 3 (2001) 669.

PAGE 12

A Geo Spatial Analysis of A bortion Facilities in Texas: Examining the Potential Impacts that a Reduction in Abortion Facilities could have on Accessibility and Services 12 171.031(1)A REQUIREMENTS OF THE PHYSICIAN of the Texas Health and Safety Code. The proposed amendment states that the physician conducting the medically induced abortion the location at which the abortion is performed or induced 19 If existing abortion clinics are not located within 30 miles of a hospital, in which the doctor has admitting privileges, the abortion medical facility will not meet this requirement of the amended law. This would result in one of two courses of action; the first being that, the abortion clinic must move to a new location that meets the standards set forth, or the second the abortion facility must close the business. The most notab le proposed amendment to Texas a bortion legislation occurs in Chapter abortion facility must be equivalent to the minimum standards adopted under Section 243.010 for 20 This pro posed addition to the abortion law caused an uproar exas. As stated above, the 2004 Act which required that all abortions performed in the second trimester must be conducted at either an ambulatory surgical center or hospital, greatly limited the number of compliant abortion facilities available to women. In fact, authors Silvie Coleman and Theodore J. Joy ce reported that at the time when the law went into effect, there were no abortion clinics in Texas that met the minimum ambulatory surgical center standards. 21 Thus any Texas women seeking abortion services past the 1 5 week gestation period was required to travel to neighboring states in search of an abortion facility that offer s such services. 19 House Bill No. 2, Texas Congr ess, (2013) 171.031 20 Ibid. 21 Silvie Colman and Theodore J. Joyce Patient and Providers in Texas, National Bureau of Economic Research 2010) 1.

PAGE 13

A Geo Spatial Analysis of A bortion Facilities in Texas: Examining the Potential Impacts that a Reduction in Abortion Facilities could have on Accessibility and Services 13 O r if traveling to a differe nt state was not an option, the woman had to find an in state hospital that offered post 1 5 week gestation period abortion services As a result, the authors noted a decline in post 15 week gestation period abortions in the state of Texas, this decline was also coupled with a slight increase in birth rates. However, by the year 2014, the supply of ambulatory surgical abortion centers in Texas had increased since the implementation of the 2004 Act. As stated above by Texas Tribune reporter Alex Ura, in 2014, only eight abortion clinics out of the existing forty aborti on clinics, in the State of Texas met the requirements of the two amendments proposed in House Bill No. 2. 22 The passing of this Bill into a law would result with the closure of thirty two abortion clinics across the state. Texas legislators passed House B ill No. 2, and the Bill was scheduled to go into effect as a law on September 1, 2014; however, the constitutionality of the law was called into question, and the Bill was reviewed by s Health et al. (a collection of Abortion Providers across the State of Texas) claim ed that the Defendant, Kirk Cole, M.D., Commissioner of the Texas Department of State Health Services, places undue burden upon Texas women seeking abortion services though the enactment of House Bill No. 2 In particular, the Plaintiff emphasize s that the extensive travel a woman must undergo in order to obtain an abortion after the implementation o f House Bill No. 2 constitutes undue burden. Since the Bill will cause the closure of appr oximately 32 abortion clinics across Texas, this will greatly reduce the su pply of abortion clinics. The remaining 8 facilities that meet the requirement of House Bill No. 2 are geographically clustered in the Dallas Fort Worth, Austin, San Antonio, 22 th The Texas Tribune (October 9, 2014) p.10.

PAGE 14

A Geo Spatial Analysis of A bortion Facilities in Texas: Examining the Potential Impacts that a Reduction in Abortion Facilities could have on Accessibility and Services 14 and Houston areas 23 W omen requiring an abortion will have to travel to these metropolitan areas to receive the health care they need. Health et al. showed the distance constraints tha t some Texas woman would have to overcome in order to obtain an abortion. According to the Plaintiff there are 5.4 million women of reproductive age (that being between the ages of 15 44) in Texas; and: (1) 7.4% o r 1/13 of women of reproductive age faced trave l distances of 150 miles or more after the admitting privileges requirement went into effect; and (2) 16.7% or 1/6 of women of reproductive age would face travel distances of 150 miles or more after both requirements went into effect. 24 To further exhibit the severity of the effect that the Bill will have certain communities, t he Plaintiffs drew attention to the extensive travel requirements of two Texas communities in particular, McAllen and El Paso. It was demonstrated to the District Court that residents of 25 The distance provided is calculated in one way distance. Applying existing Texas abortion laws which provides and exception to the minimum of a 24 hour waiting period between the sonogram appointment and the medically induced abortion appointment for those Texas residents that live over 100 mi les away from an abortion clinic it is reasonable to assume that a woma n from the Rio Grande Valley will have t o travel a total of 47 0 miles in order to obtain an abortion. A similar, even more extreme case is 23 The New York Times. (June 29, 2015) p. 5 24 50928 (5 th Cir. 2015) 39 25 Whole 50928 (5 th Cir. 2015) 47

PAGE 15

A Geo Spatial Analysis of A bortion Facilities in Texas: Examining the Potential Impacts that a Reduction in Abortion Facilities could have on Accessibility and Services 15 shown for El Paso. The admitting privileges requirement of House Bill No. 2 would force the sole abortion provider in El Paso to be shut down, and the nearest abortion clinic that meets the standards of House Bill No. 2 is located over 550 miles away in San Antonio, Texas. Applying the same exception to the 24 hour waiting period requirement as above, it is reasonable to assume that a woman from El Paso would be required to travel a to tal of 1 1 00 round trip miles in order to obtain an abortion in the State of Texas. Even though an exception is made for women who live extended distances away from an abortion clinic, women still may need to make multiple trips to the abortion clinic for post operative care and services. In these extreme cases it is clear to see that women living in the non cent ralized portions of Texas will be required to travel extreme di stances; and for some women, overcoming the distance obstacle involves many other challenges, such as finding the economic means to cover the travel and procedural costs, taking time off of wo rk, etc. 26 Based on the evidence provided by the Plaintiff the District Court found that the Plaintiff s claim of the undue burden placed upon women to be substantiated. T he reque st of the Plaintiff to vacate the legislation was granted by the District Court All abortion facilities in Texas were to remain open. However, shortly thereafter, the State sought recourse with the 5 th Circuit of Appeals. After reviewing the determination of the District Court the 5 th Circuit of Appeal asserte d that the District Court had erred in their cl aim that House Bill No. 2 places undue burden on all women of Texas T hus the 5 th claim. However, the 5 th Circuit di d affirm, in part, that undue burden is placed up on the McAllen abortion clinic: 26 50928 (5 th Cir. 2015) 40

PAGE 16

A Geo Spatial Analysis of A bortion Facilities in Texas: Examining the Potential Impacts that a Reduction in Abortion Facilities could have on Accessibility and Services 16 In plain terms, H.B. 2 and its provisions may be applied throughout Texas, except injunction of the ASC (ambulatory surgical center) requireme nt as applied to the 27 As for El Paso, it was determined that women living in this area could travel to Ne w Mexico for abortion services, thus the travel distance to a Texas abortion facility it moot. 28 Residents in McAllen do not have the same recourse as residents of El Paso due to its geography; located in the bottom tip of Texas residents of McAllen cannot easily travel to another State in order to obtain an abortion. The only other recourse f or the residents of McAllen would be to travel to Mexico for an abortion. Thus it was determined to uphold injunction on the application of the House Bill No. 2 to abortion facility in McAllen Otherwise, House Bill No. 2 would be applied to the rest of th e State of Texas. Unsatisfied by the 5 th et al. has en treated the Supreme Court to review the constitutionality of the 5 th in order to uphold the legalization of House Bill No. 2. At yet been established. While the case lies in wait on the docket, the Supreme Court issued a stay to abortion clinic s that were open and functioning prior as of September 1, 2014 29 The stay allows these facilities to remain open in Texas until the Supreme Court has made a ruling on the constitutionality of the Bill. However, in the time between the enactment of th e law on 27 50928 (5 th Cir. 2015) 3 28 le, M.D., No. 14 50928 (5 th Cir. 2015) 53 29 The New York Times. (June 29, 2015) p. 1

PAGE 17

A Geo Spatial Analysis of A bortion Facilities in Texas: Examining the Potential Impacts that a Reduction in Abortion Facilities could have on Accessibility and Services 17 September 1, 2014 and the challenge in the District Court many abortion clinics across Texas had closed their doors in anticipation of the new law. According to NARAL Pro Choice Texas, an abortion advocacy group that monitors the availability of abortion services in Texas shows th at ther e are approximately 17 functioning abortion clinics These open facilities are located in Austin, Dallas, Fort Worth, Houston, San Antonio, El Paso and McAllen. 30 Pl ease reference Figure 1 for a graphical depiction of open abortion clinics in Texas. As one can see from the map, most abortion providers are located to the in the eastern part of the state, with a clustering of clinics to the north and the center. This map will look very simila r to what the geographic distribution of abortion clinics will look like in Texas if House Bill No. 2 were to go into effect, excepting the abortion clinics in El Paso. In this scenario, that would mean that there would be no abortion clinics in the state of Texas located west of San Antonio. If the Supreme Court upholds the 5 th become a law, it will result in the closure of numerous abortion facilities in Texas, and would limit, and even potentially isolate, certain Generating vast overarching policies that effects a large swath of the populatio n without taking geographic limitations into account could have a negative, or even detrimental, effect on a particular subgroup of a population. Changing regulations that could result in the cessation of services and the closure of physical businesses wil l have a direct impact on the availability of 31 Given that Texas 30 NARAL Pro Choice Texas Do You Need an Abortion? (2015). 31 Harvey J. Annals of the Association of American Geographers, Vol. 94, No. 2 (2004) 284

PAGE 18

A Geo Spatial Analysis of A bortion Facilities in Texas: Examining the Potential Impacts that a Reduction in Abortion Facilities could have on Accessibility and Services 18 has a very lar ge spatial system, it is crucial that the individual locations of abortion clinics are spatially distributed in a way that the supply of clinics meets the demands of the community. If House Bill No. 2 is upheld by the Supreme Court, the current spatial di stribution of as depicted in Figure 1 a ppears to not provide an equitable access to the supply of abortion facility. While Figure 1 shows the clustering of abortion facilities solely in major metropolitan areas, leaving rural res idents to commute to city centers for abortion services, it may lead viewers to believe that those living outside of the metropolis are underserved. However, appearances can be deceptive Is there actually an unequal distribution of abortion clinic facilit ies to serve the potential demand of abortion services in Texas? What if the current configuration of abortion clinic locations meets the needs of the vast majority of Texas women? There is the possibility that the population densities or potential aborti on demand in rural areas does not justify the cost of building an ambulatory surgical center in a non metropolitan area. However, there is the possibility that the converse is true, and that the current configuration of abortion clinic locations does not m eet the needs of women most as risk of needing to utilize abortion services. How then do health care providers plan to bring equity to the spatial distribution of future ambulatory surgical centers in Texas in order to provide better services to women ? Methodology The first step in understanding the whether or not abortion clinics are located in areas that meet the needs of Texas women is to fi r st comprehend the common demographic trends of women who are at most risk for utilizing abortion services :

PAGE 19

A Geo Spatial Analysis of A bortion Facilities in Texas: Examining the Potential Impacts that a Reduction in Abortion Facilities could have on Accessibility and Services 19 A be background characteristics can improve our ability to identify subgroups in a population who have the highest levels of unintended pregnancies and induced abortions and who, theref ore, are in the greatest need of effective contraceptive and post abortion services. 32 Then, using this demographic framework, utilize spatial distribution analysis in ArcGIS to locate areas in Texas where these demographic characteristics are prevalent. T his spatial analysis should yield the areas in Texas where, statistically speaking, women are in most need of abortion services. We can then compare these statistically significant areas to the locations of existing abortion clinics. This comparison will a id in determining whether or not the supply of abortion clinics is lacking in the demographically designated areas. A study published in 2002, entitled Patterns in the Socioeconomic Characteristics of Women Obtaining Abortions in 2000 2001 written by authors Rachel K. Jones, Jacqueline E. Darroch and Stanley K. Henshaw, examines abortion data/statistics and a survey published by the American Guttmacher Institute and the Center for Disease Control (CDC) in order to track trends among women seeking abort ion services strictly in the United States between the years of 1994 2000. 33 The survey was administered to both hospitals and private abortion facilities that offered abortion services. Based on the completeness of the surveys received from the facilities, 32 worldwide review, International Family Planning Perspectives, Vol. 25, No. 2 (1999) 68 33 Women Obtaining Abortion in 2000 Perspectives on Sexual and Rep roductive Health, Vol. 34, No. 5 (2001 ) 226 227

PAGE 20

A Geo Spatial Analysis of A bortion Facilities in Texas: Examining the Potential Impacts that a Reduction in Abortion Facilities could have on Accessibility and Services 20 34 The authors used a weighted system in their data analysis in order to account for biasness that may occur in the data from incomplete, or unreported, respo nses from the questionnaire. Additionally, the researchers compared the results of the survey findings to National Census Data in order to corroborate the voracity of the data collected. Upon comparison was determined that the survey data tended to model t hat of what was reported in the National Census Data, and thus representative of the p opulation. This survey asked women questions from the following demographic and socioeconomic categories: age, marital status, cohabitating, number of live births, reside nce, poverty status, Medicaid coverage, race/ethnicity, education, and religion. 35 The metric by which the authors measure the incident of abortion calculated abortion rate by applying the percentage distributions found in our surveys to the numbers of medical and surgical abortions estimated to have occurred nationally, and then dividing by the relevant estimated populations 36 The authors then calculated minimum and maximum confidence levels of the weighted normally distributed survey sampl e, and the data that met the minimum confidence level was used to extrapolate the following conclusions: Information gathered from this nationally representative sample reveals that the typical woman having an abortion is between the ages of 20 and 30, has never been married, has had a previous birth, lives in a metropolitan area, a nd is an economically disadvantaged and Christian. 34 Ibid, 227. 35 Ibid, 227. 36 of Women Obtaining Abortion in 2000 Perspectives on Sexual and Reproductive Health, Vol. 34, No. 5 (2001 ) 228 229

PAGE 21

A Geo Spatial Analysis of A bortion Facilities in Texas: Examining the Potential Impacts that a Reduction in Abortion Facilities could have on Accessibility and Services 21 However, women who have abortions are diverse, and unintended pregnancy leading to abortion is common i n all population subgrou ps 37 This resolution affirms that younger, economically disadvantaged, single mothers, living in urban areas are in most need of abortion services. This statistical analysis would seem to validate the siting locations of existing Texas abortion clinics. However, the study did not disclose the physical locations of the hospitals and abortion clinics from whence the data was extrapolated It is very possible that the hospitals and abortion clinics fea tured in the survey are located in urban areas, thus these locations would be more accessible to urban women. Researchers for the Guttmacher Institute have reported that the accessibility of a service influences the types of people that utilize such servic es: Women in urban areas are more likely than their rural counterparts to obtain an abortion. This finding probably reflects that it is easier to obtain abortion services in urban than rural areas. 38 Proximity to services is crucial for the utilization of said service. It is quite possible that urban women are more likely to obtain abortions than their rural counterparts simply because they are in closer physical proximity to locations that offer abortion services. Women can only receive safe and legal indu ced abortions where such facilities are physically located. In addition to overcoming the obstacle of distance access to capital may play a role as to why rural women are less likely travel in town to obtain an abortion. two percent of women obtaining abortion in 2008 reported family incomes that qualified them as 37 Ibid, 239. 38 International Family Planning Perspectives, Vol. 25, No. 2 (1999 )75

PAGE 22

A Geo Spatial Analysis of A bortion Facilities in Texas: Examining the Potential Impacts that a Reduction in Abortion Facilities could have on Accessibility and Services 22 poor, and an additional 27% were low income (i.e., had family incomes of 100 199% of the 39 E very source encountered during the literature review process of enumerated on the fact that economic hardships is a common thread among women seeking abortion services T he statistical analysis of this paper will focus on locating areas with heightened lev els of poverty in Texas In doing s o this will draw attention to areas of Texas in which a major demographic characteristic of women who obtain abortions is prevalent. This will help to planners better understand where impoverished women are living, and d iscern whether or not an abortion clinic is located in near an area that could serve these economically disadvantaged women Using United States block g roups with associated economic and census data, I was able to create a geographical display of areas in Texas where there were clusters of statistically significant poverty incidents at levels higher than that of the standard deviation of the data. 40 Based on the findings from the abortion demographic data research, isolating the areas of Texas in wh ich women are living in poverty would be the most effective way to see where there is potential need for abortion services. To do so it was determined that the best way to show the prevalence of poverty in the state of Texas, with the given economic and ce nsus data, would be to conduct a series of regression models on a particular set of attribute variables. Since the object of the analysis was to find areas with heightened poverty l evels, an Ordinary Least Squares (OLS) test was conducted. OLS test allows the modeler to select a dependent variable which is then related to a set of selected independent variables. The goal of the test is to see how well the 39 Rachel K. Jones Lawrence B. Finer & Susheela Sing h, Characteristic of U.S. Abortion Patience, 2008. The Gut tmacher Institute (2010) 8 40 United States Census Bureau TIGER/Line with Selecte d Demographic and Economic Data, 2007 2011 Bl ock Group Data, Texas (2015).

PAGE 23

A Geo Spatial Analysis of A bortion Facilities in Texas: Examining the Potential Impacts that a Reduction in Abortion Facilities could have on Accessibility and Services 23 independent variables explain the dependent variable by means of exploratory regression. Extrapolated f rom the United Sates Census Bureau 2007 2011 Block Group Data the Poverty Status of Individuals in the Past 12 Month s by Living Arrangement attribute was selected as the dependent variable, the variable for which an explanation is sought. 41 The independent variables selected to explain the dependent variable s distribution are: Pe r Capita Income in the Past 12 M onth s (In 2011 Inflation Adjusted Dollars), Public Assistance Income in the Past 12 M onths for Household, Race, and Reproductive Age Female (15 44 years old). The variable Reproductive Age Female (15 44 years old), was created for the purpose of this exercise T he variable accounts for the total number of females of reproductive age living in each block group. This was done so tha t the sex and age group variable defining the poverty variable is directly related to women of reproductive age. Table 4: Summary of OLS Model Variables and Table 5: OLS Diagnosis provide an overview of the model results. All four variables have p robab ility [b] values denoted with and asterisk mark (*), which indicates that the data is statistically significant. 42 Meaning that the poverty values for which the data are attempting to account for are not randomly located space, but rather that the data are in fact a part of a n identifiable cluster. Additionally, VIF scores less than 7.5 denotes that the independent va riables selected to explain the dependent variable are statistically significant and are doing a good job of explaining the locations of poverty in Texas. 43 The lower the VIF score, the better the variable explains the dependent variable. The following is a list of the independent variables in sequential order starting with the best 41 Ibid. 42 Paul Zwick, Spatial Patten Analysis: Mapping Trends & Clusters (2015). 43 Ibid.

PAGE 24

A Geo Spatial Analysis of A bortion Facilities in Texas: Examining the Potential Impacts that a Reduction in Abortion Facilities could have on Accessibility and Services 24 explanatory vari able: Per Capita Income in the P ast 12 M onths (In 2011 Inflation Adjusted Dollars), Public Assistance Income in the Past 12 M onths for Household, Race, and Repro ductive Age. Another indicator that the model is performing properly is a normally distributed standardized residuals, Figure 2: OLS Histogram of Standardized Residuals shows that the data are normally distributed and fall within the confines of the normal curve. Furthermore, the R Squared value produced in the OLS Diagnosis is the percentage of explanation that the independent variables provide to the dependent variable. In this particular instance, the independent variables of: Per Capita Income in the pa st 12 M onths (In 2011 Inflation Adjusted Dollars), Public As sistance Income in the Past 12 M onths for Household, Race, and Reproductive Age, provide a 93.3316% explanation for the Poverty Status of Individuals in the Past 12 Months by Living Arrangement de pendent variable. Additionally, since the Jarque Bera Statistic is not statistically significant, we can trust that the data is not biased. 44 Further proof that the data are reliable, and that the clustering of poverty is not random. To check the voracity of the OLS model the residuals are tested to see if there is any spatial autocorrelation This test is a safe measure to once again ensure that the data are not randomly distributed, but rather that the data are clustered providing evidence as to why there are pockets of poverty in particular areas of Texas shows that a z score of 25.348254 and a p value of 0.000000 infers that there is less than a 1% likelihood that this clustered pattern could the result of random chance. 45 This indicates that the data are clustered and that the 44 Ibid. 45 ArcGIS (2010).

PAGE 25

A Geo Spatial Analysis of A bortion Facilities in Texas: Examining the Potential Impacts that a Reduction in Abortion Facilities could have on Accessibility and Services 25 independent variables provide the explanation as to why there are geographic clustering in the dependent variable Since the OLS model verifies that the dependent variable is clustered as a result of the s I test confirm s that the OLS model residuals are not spatially auto correlated, a Geographic Weighted Regression model wa s conducted in order to provide a visual representation of the Poverty Status of Individuals in the Past 12 Months by Living Arrangement variable clustering. Figure 3: Geographic Weighted Regression for Poverty Status of Individuals in the Past 12 Months b y Living Arrangement, in Texas shows the geographic visualization created from the Geographic Weighted Regression model. The areas in red on the map show statistically significant poverty incidents at levels higher than that of the standard deviation of t he data, and the areas in blue show statistically significant poverty incidents at levels lower than that of the standard deviation of the data. The output report generated from the mode, please reference Table 7: Geographic Weighted Regression shows that the regression produced a reliable model. The R2 value is a measurement of between the values of 0.0 1.0, the close the R2 value approaches 1.0 the better the model. The high R2 value indicates that the Geographic Weighed Regression Model is a good tool for modeling the proportion that the independent variables explain the dependent variable. The visual representation of this model can be viewed in Figure 3: Geographic Weighted Regression for Poverty Status of Individuals in the Past 12 Months by Living Arrangement, in Texas This map shows the varying scale of poverty levels The poverty levels range from low (blue) to neutral (beige) to high (red) predictions of poverty based on the number of standard deviations the cluster groups are removed from the base line of 0.00 (or neutral) standard deviations. Areas that

PAGE 26

A Geo Spatial Analysis of A bortion Facilities in Texas: Examining the Potential Impacts that a Reduction in Abortion Facilities could have on Accessibility and Services 26 are 0.5+ standard deviations away from the base line are location that are predicted for higher levels of poverty, these areas are represented by the color red. Conclusion and Further Resear ch Now that is has been confirmed that there are in fact statistically significant clusters of poverty, as related to the variable Poverty Status of Individuals in the Past 12 Months by Living Arrangement, we can look at the locations of Texas abortion cl inics in relation to identified areas of poverty. Figure 4: Geographic Weighted Regression for Poverty Status of Individuals in the Past 12 Months by Living Arrangement in Relation to Existing Abortion Clinics, in Texas provides a visual representation of abortion clinics in relation to poverty clusters that have been identified as 0.5+ standard deviations away from the base line. Here we can see that there are a great number of poverty clus ters all across the state of Texas; however, there is an apparent lacking of abortion clinics to serve the women of reproductive age that are living in poverty stricken areas. In an effort to demonstrate scale and travel expectations of women seeking an abortion a 100 mile buffer has been placed around all abortion clinics. This is the limit that Texas legislations have determined as the service area to women seeking an abortion. All who live within the 100 mile buffer will be required to adhere to the 24 hour waiting period requirement, and all those who live outsid e of the buffer zone will only have to endure a 2 hour waiting period in the abortion clinic but countless hours on the road in the form of travel will be accumulated for some. It is important to note that there are no abortion clinics in any part of Texas north of Dallas, and if House Bill No. 2 is upheld in the Supreme Court there will be no abortion clinic facilities west of San Antonio. There are clearly identifiable areas in the Panhandle and the

PAGE 27

A Geo Spatial Analysis of A bortion Facilities in Texas: Examining the Potential Impacts that a Reduction in Abortion Facilities could have on Accessibility and Services 27 northern parts of Texas, such as Pam pa, that are in close relation to poverty clusters and yet thousands of miles away from any abortion facility. Access to population density data and application of standard distance and mean center spatial analysis could provide researchers the ability to quantify the demand of services in these area s. 46 As the state of Texas continues to grow, and as residential development patterns change over time, health care providers will need to devise a plan as to how presently under served women will receive abortion care services in a place relatively close to home. 46 Aharon Area, Vol. 13 No. 3 (1981) 246

PAGE 28

A Geo Spatial Analysis of A bortion Facilities in Texas: Examining the Potential Impacts that a Reduction in Abortion Facilities could have on Accessibility and Services 28 References ArcGIS (2010). Association of Schools of Public Health (1961). Areawide Planning for Hospital Facilities. Public Health Reports, 76(11) 1039 2040. Retrieved from http://www.jstor.org/stable/4591362 Bankole, A kinrinola S usheela Singh, & T aylor Haas (1999). Characteristics o f women who obtain induced abortion: A worldwide review. International Family Planning Perspectives, 25 (2), 68 77. Retrieved from http://www.jstor.org/stable/2991944 Brown, Robert W., R. Todd Jewell and Jeffrey J. Rous (2001). Availability, Race, and Abortion Demand. Southern Economic Journal 67(3), 656 671. Retrieved from http://www.jstor.org/stable/1061465 Castro, M arcia C aldas d e (2007). Spatial demography: An opportunity to improve policy making at diverse decision levels. Population Research and Policy Review, 26 (5/6, Spatial Demography. Part I), 477 509. Retrieved from htt p://www.jstor.org/stable/40230989 Cates, Willard Jr., David A. Grimes & Kenneth F. Schulz (2003). The Public Health Impact of Legal Abortion: 30 Years Later. Perspectives on Sexual and Reproductive Health, 35(1). Retrieved from https://www.guttmacher.org/pubs/journals/3502503.html Chi, G uangging & J un Zhu (2008). Spatial regression models for demographic analysis. Population Research and Policy Review, 27 (1, Spatial Demography. Part II) 17 42. Retrieved from http://www.jstor.org/stable/41217935

PAGE 29

A Geo Spatial Analysis of A bortion Facilities in Texas: Examining the Potential Impacts that a Reduction in Abortion Facilities could have on Accessibility and Services 29 Colman, Silvie and Theodore J. Joyce (2010). Regulating Abortion: Impact on Patient and Providers in Texas. National Bureau of Economic Research Accessed May 28, 2015. http://www.nber.org/papers/w15825 Gobalet, J eanne G., & R ichard K. Thomas (1996). Demographic data and geographic information systems for decision making: The case of public health. Population Research and Policy Review, 15 (5/6, Applied Demography: Demography and Decision Making), 537 548. Retrieved from http://www.jstor.org/stable/40230123 Gober, P atr icia (1994). Why abortion rates vary: A geographical examination of the supply of and demand for abortion services in the united states in 1988. Annals of the Association of American Geographers, 84 (2), 230 250. Retrieved from http://www.jstor.org/stable/2563395 Guttmacher Insti tute (2014). Abortion Data in T exas. Retrieved from http://www.guttmacher.org/datacenter/tren d.jsp# Guttmacher Institute (2014). State facts about abortion: Texas. Retrieved from http://www.guttmacher.org/pubs/sfaa/pdf/texas.pdf Guttmacher Institute (2014). Texas state reproductive health profile. Retrieved from http://www.guttmacher.org/datacenter/profiles/TX.jsp Heard, N athan J., U lla Larsen, & D ai riku Hozumi (2004). Investigating access to reproductive health services using GIS: Proximity to services and the u se of modern contraceptives in M alawi. African Journal of Reproductive Health / La Revue Africaine De La Sant Reproductive, 8 (2), 164 179. R etrieved from http://www.jstor.org/stable/3583189

PAGE 30

A Geo Spatial Analysis of A bortion Facilities in Texas: Examining the Potential Impacts that a Reduction in Abortion Facilities could have on Accessibility and Services 30 Henshaw, S tanley K. (1991). The accessibility of abortion servi ces in the United S tates. Family Planning Perspectives, 23 (6), 246 252+263. Re trieved from http://www.jstor.org/stable/2135775 House Bill No. 2, Texas Congress, (2013). Jones, Rachel K., Jacqueline E. Darroch & Stanley K. Henshaw (2002). Patterns in the Socioeconomic Characteristics of Women Obtaining Abortion in 2000 2001. Perspectives on Sexual and Reproductive Health, 34(5), 226 235. Retrieved from http://www.jstor.org/stable/3097821 Jones, Rachel K., Lawrence B. Finer & Susheela Singh (2010). Characteristic of U.S. Abortion Patience, 2008. The Guttmacher Institute. Retrieved from http://www.guttmacher.org/pubs/US Abortion Patients.pdf Liptak, Adam & Manny Fernandez (June 29, 2015). ). The New York Times Retrieved from http://nyti.m s/1NuzoOC Kellerman, Aharon (1981). The Use of Standard Distance as an Equity Criterion for Public Facility Location. Area, 13(3) 245 249. Retrieved from https://www.jstor.org/stable/20001732 Maantay, Juliana ( 2002). Mapping Environmental Injustices: Pitfalls and Potential of Geographic Information Systems in Assessing Environmental Health and Equity. Environmental Health Perspectives, 110(2) 161 171. Retrieved from http://www.jstor.org/stable/3455050 Miller, H arvey J. (2004). Tobler's first law and spatial analysis. Annals of the Association of American Geographers, 94 (2), 284 289. Retrieved from http://www.jstor.org/stable/3693985

PAGE 31

A Geo Spatial Analysis of A bortion Facilities in Texas: Examining the Potential Impacts that a Reduction in Abortion Facilities could have on Accessibility and Services 31 NARAL Pro Choice Texas (2015). Do You Need an Abortion? Retrieved from http ://prochoicetexas.org/resources/how to get an abortion in tx/ Planned Parenthood of Southeastern Pennsylvania et al. v. Casey, Governor of Pennsylvania No. 91 744 (1992). Porterfield, W. J. (1977). On health facility planning. Operational Research Quarter ly (1970 1977), 28 (2, Part 2), p. 465. Retrieved from http://www.jstor.org/stable/3008994 Pritchard, A nita & Sharon Kay Parsons. (1999). The effects of state abortion policies on states' abo rtion rates. State & Local Government Review, 31 (1), 43 52. Retrieved from http://www.jstor.org/stable/4355222 Rossier, C lementine (2003). Estimating induced abortion rates: A review. Studie s in Family Planning, 34 (2), 87 102. Retrieved from http://www.jstor.org/stable/3181181 Sedgh, G ilda ., S tanley K. Henshaw, S usheela Singh A kinrinola Bankole & J oanna Drescher (2007). Legal abortion worldwide: Incidence and recent trends. Perspectives on Sexual and Reproductive Health, 39 (4), 216 225. Retrieved from http://www.jstor.org/stable/30042979 Sedgh, G il da S usheela Singh, S tanley K. Henshaw & A kinrinola Bankole (2011). Legal abortion worldwide in 2008: Levels and recent trends. Perspectives on Sexual and Reproductive Health, 43 (3), 188 198. Retrieved from http://www.jstor.org/stable/23048853 Shelton, J ames D., Edward A. Brann & K enneth F. Schulz (1976). Abortion utilization: Does travel distance matter? Family Planning Perspectives, 8 (6), 260 262. Retrieved from http://www.jstor.org/stable/2134397 Tatalovich, R aymond & Byron W. Daynes. (1989). The geographic distribution of U.S. hospitals with abortion facilities. Family Planning Perspectives, 21 (2), 81 84. Retrieved from http://www.jstor.org/stable/2135558

PAGE 32

A Geo Spatial Analysis of A bortion Facilities in Texas: Examining the Potential Impacts that a Reduction in Abortion Facilities could have on Accessibility and Services 32 Texas Constitution, Title 2, Subtitle H., Chapter 171. Texas Constitution, Title 4, Subtitle B., Chapter 243. United States Census Bureau (2015). TIGER /Line with Selected Demographic and Economic Data. 2007 2011 Block Group Data Texas Retrieved from https://www.census.gov/geo/maps data/data/tiger data.html United States Department of H ealth and Human Services (November 27, 2015) Center for Disease Control and Prevention Abortion Surveillance United States, 201 2 Morbidity and Mortality Weekly Report, Surveillance Summaries, Vol. 6 4(SS10) 1 40 http://www.cdc.gov/mmwr/preview/mmwrhtml/ss6410a1.htm th The Texas Tribune Retrieved from http://www.texastribune.org/2014/10/09/5th circuit refuses reconsider first hb2 lawsuit/ 50928 (5 th Cir. 2015). Zwick, Paul (2015). Spatial Pattern Analysis: Mapping Trends & Clusters Retrieve from http://www.elearning.ufl.edu

PAGE 33

A Geo Spatial Analysis of A bortion Facilities in Texas: Examining the Potential Impacts that a Reduction in Abortion Facilities could have on Accessibility and Services 33 Table 1: Guttmacher Institute, Abortion Data in Texas (2014) 47 Abortion Rate is defined as the number of abortions per 1,000 women aged 15 44 differentiating between resident (abortion incidents of Texas residents) and occurrence abortions (i nclusive of both resident and non resident abortion incidents) This table is an exact replica of The Guttmacher Institute Abortion Data in Texas datasets. The line charts below provide graphical representations of the data provided in Table 1 47 The Guttm acher Institute Abortion Data in Texas (2014).

PAGE 34

A Geo Spatial Analysis of A bortion Facilities in Texas: Examining the Potential Impacts that a Reduction in Abortion Facilities could have on Accessibility and Services 34 Table 2: Guttmacher Institute, Abortion Data in Texas (2014) 48 Number of Aborti on Table 3: Guttmacher Institute, Abortion Data in Texas (2014) 49 Rate of Abortion Abortion Rate is defined as the number of abortions per 1,000 women aged 15 44 48 The Guttm acher Institute Abortion Data in Texas (2014). 49 Ibid.

PAGE 35

A Geo Spatial Analysis of A bortion Facilities in Texas: Examining the Potential Impacts that a Reduction in Abortion Facilities could have on Accessibility and Services 35 Table 4: Summary of OLS Model Variables Probability [b] values with indicate that the data is statistically significant. Additionally, VIF scores less than 7.5 denotes that the independent variables selected to explain the dependent variable are statistically significant. The lower the VIF score, the better the variable explains the dependent variable. The following is a list of the independent variables sequential order from starting with the best explanatory variable: Per Capita Inc ome in the past 12 months (In 2011 Inflation Adjusted Dollars), Public Assistance Income in the Past 12 months for Household, Race, Reproductive Age. Table 5 : OLS Diagnosis Number of Observations: 15811 Multiple R Squared [d]: 0.933316 Joint F Statistic [e]: 55305.397148 Join Wald Statistic [e]: 55671.216979 Koenker (BP) Statistic [f]: 661.862043 Jarque Bera Statistic [g]: 147698534.626354 The R Squared value produced in the OLS diagnosis is the percentage of explanation that the independent variables provide to the dependent variable. I n this particular instance, the independent variables of: Per Capita Income in the past 12 months (In 2011 Inflation Adjusted Dollars), Public Assistance Inco me in the Past 12 months for Household, Race, and Reproductive Age, provide a 93.3316% explanation for the Poverty Status of Individuals in the Past 12 Months by Living Arrangement dependent variable. Additionally, since the Jarque Bera Statistic is not st atistically significant, we can trust that the data is not biased.

PAGE 36

A Geo Spatial Analysis of A bortion Facilities in Texas: Examining the Potential Impacts that a Reduction in Abortion Facilities could have on Accessibility and Services 36 Table 6 : Moran's Index: 0.012096 Expected Index: 0.000063 Variance: 0.000000 z scores: 25.348254 p value: 0.000000 Given the z score of 25.348254 and p value of 0.000000, there is a less than a 1% likelihood that this clustered pattern could the result of random chance. This indicates t hat the data are clustered and that the independent variables provide the explanation as to why there are geographic clustering of data. Table 7 : Geographic Weighted Regression Model Neighbors: 167 Residual Squares: 315650112.907777 Effective Number: 1674.147450 Sigma: 149.426151 AICc: 204140.301145 R2: 0.979435729 R2 Adjusted: 0.977001874 The R2 value is a measurement of between the values of 0.0 1.0, the close the R2 value approaches 1.0 the better the model. The high R2 value indicates that the Geographic Weighed Regression Model is a good tool for modeling the proportion that the independent variables explain the dependent variables.

PAGE 37

A Geo Spatial Analysis of A bortion Facilities in Texas: Examining the Potential Impacts that a Reduction in Abortion Facilities could have on Accessibility and Services 37 Figure 1: Abortion Clinics, Texas, 2016 Abortion Clinic Location Data retrieved from NARAL Pro Choice Texas, Do You Need an Abortion? (2015). Austin San Antonio Houston Dallas McAllen Fort Worth El Paso

PAGE 38

A Geo Spatial Analysis of A bortion Facilities in Texas: Examining the Potential Impacts that a Reduction in Abortion Facilities could have on Accessibility and Services 38 Figure 2 : OLS Histogram of Standardized Residuals The standard deviation residuals from the OLS model fall within the confines of the normal curve, thus the model is a reliable representation of the data distribution.

PAGE 39

A Geo Spatial Analysis of A bortion Facilities in Texas: Examining the Potential Impacts that a Reduction in Abortion Facilities could have on Accessibility and Services 39 Figure 3 : Geographic Weighted Regression for Poverty Status of Individuals in t he Past 12 Months by Living Arrangement, in Texas

PAGE 40

A Geo Spatial Analysis of A bortion Facilities in Texas: Examining the Potential Impacts that a Reduction in Abortion Facilities could have on Accessibility and Services 40 Figure 4 : Geographic Weighted Regression for Poverty Status of Individuals in the Past 12 Months by Living Arrangement in Relation to Existing Abortion Clinics, in Texas



PAGE 1

A Geo Spatial Analysis of Abortion Facilities in Texas: Examining the Potential Impacts that a Reduction in Abortion Facilities could have on Accessibility and Services Jordan K. Riley University of Florida Urban and Regional Planning Department

PAGE 2

A Geo Spatial Analysis of A bortion Facilities in Texas: Examining the Potential Impacts that a Reduction in Abortion Facilities could have on Accessibility and Services 2 Abstract Policy makers in Texas, and the United States Supreme Court, are considering the constitutionality of two amendments to Texas state health laws which regulates abortion laws. The Bill was passed as a law and was scheduled to become effective on September 1, 2014; however, the law has been challenged through the 5 th Circuit Court of Appeals and is currently on the docket for review at the United States Supreme Court. If t he Bill is upheld by the Supreme Court, many abortion clinics will be required to close their doors. According to NARAL Pro Choice Texas, an abortion advocacy group that monitors the availability of abortion services in Texas, shows that there are approximately 17 abortion clinics currently functioning in Texas . These open facilities are located in Austin, Dallas, Fort Worth, Houston, San Antonio, El Paso and McAllen. The spatial clustering of abortion clinics in urban settings leaves many areas in Texas geographically isolated from abortion clinics. To determine if the supply of the existing abortion clinics meet the demands of women need abortion services , a geospatial analysis based on common abortion demographics was conducted in ArcGIS. Using United States Census Data in conjunction with ArcGIS spatial statistic processes of Ordinary Least Squares, Global I test, and Geographic Weighted Regression , clusters for the poverty demographic were identified for the state of Texas. These cluste r areas were then compared to the existing location of abortion facilities to see if there were gaps in coverage. Keywords: Ordinary Least Squares (OLS)

PAGE 3

A Geo Spatial Analysis of A bortion Facilities in Texas: Examining the Potential Impacts that a Reduction in Abortion Facilities could have on Accessibility and Services 3 A Geo Spatial Analysis of Abortion Facilities in Texas: Examining the Potential Impacts that a Reduc tion in Abortion Facilities could have on Accessibility and Services P olicy makers in Texas, and the United States Supreme Court, are considering the constitutionality of two amendments to T exas state health laws which regulates abortion laws . One of the amendments proposed in the H ouse B ill N o . 2 Bill is that all abortion clinics in Texas must me et the minimum standards of an a mbulatory s urgical c enter. 1 The Bill was passed as a law and was scheduled to become effective on September 1, 2014; however , the law has been challenged through the 5 th C ircuit Court of A ppeals and is currently on the docket for review at the United States Supreme Court . If the legislation is upheld in the United States Supreme Court , many existing abortion clinics in the State of Texas, will not meet the ambulatory surgical center minimum standards and will be required to cease operations. It is questioned whether or not the Texas legislature is using this proposed amendment as a thinly veiled guise to reduce the ac cessibility and availability of abortion practices. In an article published on October 9, 2014 in The Texas Tribune , reporter Alex Ura states that only eight abortion clinics, out of the existing forty clinics, will remain open if the law were to go into e ffect. 2 This would result in a drastic decrease in the supply of abortion clinic locations for Texas women seeking abortion services, noting that the remaining open abortion facility are located in major metropolitan areas. Due to the sheer vastness of the state of Texas, there will be women who live in an area that do not easily access abortion facilities; as result , th ese women will need to trav el great distances in order to receive abortion services. 1 House Bill No. 2, Texas Congress, (2013). 2 th The Texas Tribune , (October 9, 2014) p.10.

PAGE 4

A Geo Spatial Analysis of A bortion Facilities in Texas: Examining the Potential Impacts that a Reduction in Abortion Facilities could have on Accessibility and Services 4 This paper will examine how accessibility and service s of Texas abortion facilities will be affected if the H ouse B ill No. 2 law is upheld in the United States Supreme Court . It is anticipated that t he geographic clustering of abortion facilities that meet the minimum ambulatory surgical centers standard in major metropolitan cities will not provide equitable abortion service access to the women of Texas . Ultimately , some wome n will be required in travel ing extended distances in order to obtain abortion services. With an inequity in abortion supply, by the means of ArcGIS spatial analysis, this paper will examine areas that have been denoted as hotspots for abortion services . Based off of previous academic studies, which have identified common characteristics of American women in need of a bortion services , t he hotspots will be selected through the analysis of 2010 Census demographic data. The hotspot analysis will highlight demographic areas in Texas believed to be in most need of abortion services, and these areas will then be reviewed in relation to existin g abortion clinic facilities. Utilizing the concept of distance equity, future ambulatory surgical center abortion clinics will be proposed in locations that will serve the needs of multiple communities of women in Texas. Abortion in the United States In American History, i t was not until relati vely recently that women were given the right to legally seek medically induced abortions . The seminal verdict of the Roe vs. Wade Supreme Court Case in the year 1973, which ruled that it is unconstitutional for in dividual states to restrict the use and availability of first trimester induced abortions , drastically changed the face of American politics, culture , an d infrastructure. 3 Whereas in the years prior to the Supreme 3 servic es in the U nited S Annals of the Association of American Geographers, Vol. 84, No. 2 (1994) 233 .

PAGE 5

A Geo Spatial Analysis of A bortion Facilities in Texas: Examining the Potential Impacts that a Reduction in Abortion Facilities could have on Accessibility and Services 5 Court , only a few selected states had opted to offer induced abortion services within its jurisdiction . W hile the remaining states restricted, or banned, the medical procedure . By the year 1969 only 11 states had instituted policies which allowed for women to obtain induced abortion s , and only a total of 25,000 induced abortions had been reported to the Center for Disease Control (CDC ) . 4 As such , in the years leading up to 1973, it was common for a woman in need of an abortion to travel to those states which offered legal induced abortions if her state of residence had not yet legalized abortion services. However, the Roe vs. Wade ruling would change the physical landscape of abortion clinic availability. Now that individual states were una ble to restrict the access/availability of abortion services there would be a dramatic increase in the availability of abortion services and clinics. As a result, the total number of induced abortions obtained across the United States greatly increased in the years immediately following the 1973 Supreme Court verdict . By the year 1980 the number of legal abortions obtained and reported to the CDC had risen to 1.6 million. 5 This is a dramatic increase from the 25,000 reported induced abortions of the year 1969 . The increased number of performed induced abortions was coupled with a decrease in the number of intersta te travel for abortion services. 1973 decision allowed for the increase of abortion facilities across the entirety of the Uni ted States, of state abortions fell from 44 percent of the total in 1972 to only seven percent ten 6 The increased demand of abortion services experienced in 4 Abortion Surveillance United States, 2012 , Morbidity and Mortality Weekly Report, Surveillance Summaries, Vol. 64(SS10) (Nov. 27, 2015) p. 3. 5 Ibid, p. 4. 6 servic es in the U nited S Annals of the Association of A merican Geographers, Vol. 84, No. 2 (1994) 234 .

PAGE 6

A Geo Spatial Analysis of A bortion Facilities in Texas: Examining the Potential Impacts that a Reduction in Abortion Facilities could have on Accessibility and Services 6 similarly produced an increase i n supp ly in the availability of abortion clinics and services. This increase in supply of abortion clinic s had helped to alleviate extensive travel in order to obtain an abortion. W omen were now able to seek abortion services within their resident jurisdictions. However, g iven the controversial nature of abortion rights it would not take long for states to challenge the authority of the Roe vs. Wade verdict . Numerous states would enact laws that would attempt to limit the scope or applicatio n of the Supreme Court ruling within its own jurisdiction. More often than not, these regulatory legislations would be fruitless attempts to shorten the long arm of the Federal law. However, the political tides would change in 1992 with the Casey vs. Plann ed Parenthood Supreme Court decision which afforded states the latitude to enact laws which would regulate abortion utilization in as much as the law promotes the general health and welfare of the community enact regulations to further the health or safety of a woman seeking an abortion, but may not impose unnecessary health regulations that present a substantial obstacle to a woman seeking an 7 This historic ruling would once again change abortion access and availability in the United States; and as a result, we will see a variability in abortion regulations between states with regards to the interpretation of promoting the health and safety of women seeking abortions. Researcher Patricia Gober note s that the various legal challenges to Roe vs. Wade Casey vs. Planned Parenthood 7 Planned Parenthood of Southeastern Pennsylvania et al. v. Casey, Governor of Pennsylvania , No. 91 744 (1992).

PAGE 7

A Geo Spatial Analysis of A bortion Facilities in Texas: Examining the Potential Impacts that a Reduction in Abortion Facilities could have on Accessibility and Services 7 case in 1992, created an environmental where the supply of abortion clinics and services was onc e again unequal between states. 8 Abortion in the State of Texas Since the nation wide legalization of abortion in year 1973, the Guttmacher Institute has been collecting abortion data and producing a statistical overview of women who seek abortion services nationally, as well as by state. Abortion data can be can be an alyzed by two separate metric valuations: the first being the total number of abortions, which is the numeric value of all abortion that took place in one calendar year; and second, the rate of abortion, which is calculated as the number of induced abortio ns per 1,000 pregnancies. These two categories can be further subdivided to differentiate between: resident abortion by state, which only accounts for the abortion data of residents of a particular state; or occurrence of abortion, which accounts for both resident and non resident abortions taking place within said state. In examining the total number of abortions and abortion rate by occurrence and residency in Texas from 1973 through 2011 it is apparent that there has been great fluctuation in these numb ers over the years. Table 1: Guttmacher Institute, Abortion Data in Texas (2014) provides a breakdown of the number of abortion and the rate of abortions obtained in the State of Texas by state of resident and by state of occurrence between the years of 19 73 2011. 9 In the years immediately following the Supreme Roe vs. Wade ruling we see an uptick in number and rate of legal induced abortions in Texas, as graphically expressed in Table 2 : Guttmacher Institute, Abortion Data in Texas (2014), 8 and for abortion servic es in the United S Annals of the Association of American Geographers, Vol. 84, No. 2 (1994) 236 . 9 The Guttm acher Institute , Abortion Data in Texas (2014).

PAGE 8

A Geo Spatial Analysis of A bortion Facilities in Texas: Examining the Potential Impacts that a Reduction in Abortion Facilities could have on Accessibility and Services 8 Number o f Abortion and Table 3: Guttmacher Institute, Abortion Data in Texas (2014), Rate of Abortion . 10 In referencing Table 1 , one can see the steady rise of the number and rate of abortion in both the state of resident and state of occurrence variables. Most not ably, in the years 1980 and 1981, t here is a peak in both the state of resident and state of occurrence variables; and in subsequent years there is a slight downw ard trend in abortion these abortion variables . However, after the year 1992 , there is a precipitous decline the number of abortion incidences in Texas, and this, in part, can be attributed to the change in legislature which allows for state intervention and regulation of abortion practices. The Casey vs. Planned Parenthood ruling had a profound impact on Texas ability to regulate abortion services. T he State of Texas has exercised its right to create laws which regulates the proces ses by which women obtain abortion s by enacting bills which narrows the scope of abortio n services in Texas . In more recent Texas legislative history, the Right to Know Act, e ffective in early 2004, amended Title 2, Chapter 171, of the Health and Safety Code. 11 regarding abortion facilities and practices . The following procedural regulations have been instituted by the State of Texas as measures to better promote health and safety to women seeking abortion services . The first amendment to the Texas abortion law e ntailed a change to abortion facility requirements : Section 171.004. ABORTION OF FETUS AGE 16 WEEKS OR MORE. An abortion of a fetus age 16 weeks or more may be performed only at an ambulatory surgical center or hospital license to perform the abortion. 12 As per the Roe vs. Wade ruling, a state is 10 Ibid. 11 Silvie Colman and Theodore J. Joyce , Patient and Providers in Texas, National Bureau of Economic Research . 2010) 1. 12 Texas Constitution, T itle 2, Subtitle H., Chapter 171 . 004

PAGE 9

A Geo Spatial Analysis of A bortion Facilities in Texas: Examining the Potential Impacts that a Reduction in Abortion Facilities could have on Accessibility and Services 9 unable to restrict or regulate abortion access during the first trimester ; however, states are able to place restrictions upon abortion practices in subsequent trimesters. The State of Texas declared that all abor tion performed after the sixteen (16) week of gestation, also known as the second trimester, must be conducted in an ambulatory surgical center , or hospital . The State declared that the reasoning for this escalation in facility standards is due to the perc eived increased risk to mother and fetus during a second trimester medically induced abortion procedure . Ambulatory surgical centers are a designated type of medical facility that are held to higher design standards than the average abortion clinic medica l office. The Texas Health and 13 Furthermore, ambulatory surgical cente rs require a separate license for operation; and these medical facilities are also differentiated by their heightened staffing requirements, and highly specified design and construction criteria. Due to these elevated facility requirements, not all abortio n clinics meet these minimum ambulatory surgical standards. Thus, the abortion clinic as a result she may be required to leave her community in search of an ambula tory surgical center, or hospital, which performs second trimester abortions. Another Act regulation presented within the Texas State Health and Safety Code is outlined in Section 171.0012 , which implements a 24 hour waiting period that require s a woman to visit an abortion clinic twice in tw o consecutive days . 14 The reasoning behind the 24 ho woman can hear 13 Texas Constitution, Title 4, Subtitle B., Chapter 243. 002. 14 Texas Constitution, T itle 2, Subtitle H., Chapter 171 . 012

PAGE 10

A Geo Spatial Analysis of A bortion Facilities in Texas: Examining the Potential Impacts that a Reduction in Abortion Facilities could have on Accessibility and Services 10 the hear tbeat of the fetus, see a sonogram of the fetus , hear a verbal explanation of the sonogram, a n d then have ample time to consider the implications of the abortion in lieu of the newly presented evidence s . However, the State of Texas has made provisions which revoke s the 24 hour waiting period stipulation for women who live further than 100 miles away from an abortion clinic. If a woman can provide a certified waiver stating that she does in fact live further than 10 0 miles away from an abortion clinic, then she will only be subjected to a two hour waiting period between the initial sonogram appointment and the medical abortion procedure. 15 Even still, for some women , traveling up to 100 miles in one direction to obtai n an abortion may be a 16 This obstacle of distance may play a large role in the abortion decisions of women in Texas. There is no doubt that Texas is a large and expansive state. If a woman in need of abortion services were to live in a Texas county without an abortion clinic, there is an opportunity that she would have to drive rather far to obtain such service s . This is actually not so much of a hypothetical scenario as it is an actual state of li fe for many women residing in Texas. 35% of Texas wo men liv ed 17 Thus it is plausible that the thirty five percent of women who live in a county without the presence of an abortion clinic may have to travel 15 Texas Constitution, T itle 2, Subtitle H., Chapter 171 . 012 16 Family Planning Perspectives , Vol. 8. No. 6 (1976) 262 . 17

PAGE 11

A Geo Spatial Analysis of A bortion Facilities in Texas: Examining the Potential Impacts that a Reduction in Abortion Facilities could have on Accessibility and Services 11 extended distances in order to obtain such services. And f or a state as vast as Texas, covering over 268,000 square miles of land, it is no stretch of the imagination that this scenario may play out for a woman in need of an abortion. Researchers Robert W. Brown, R. Todd Jewell and Jeffrey J. Rous specifically examines the implications of geographic availability of abortions in the state of Texas, and how the cost of (ages 20 44) who, in the year 1992, sought out abortion services in Texas. Through th e use of a questionnaire method of data collection, the authors gathered data from the study groups Ultimately the authors determine that , County with longer travel distances to the nearest provider has a significantly lower probability of abortion a pregnancy 18 In essence, the limited supply and geographical distribution of ambulatory surgical abortion centers in Texas may require certain women to travel distances that are simply unfeasible. Thus, the physical location of a health care facility could be the deci ding factor as to whether or not a woman obtains an abortion. Texas House Bill No. 2 The latest attempt to regulate abortion laws in Texas came in the form of House Bill No. 2, which proposed amending current abortion laws to further limit the scope of a bortion practices and to decrease the supply of abortion clinics. There are two major amendments to Texas abortion legislation proposed in House Bill No. 2. The first change applies to Section 18 Brown, Robert W., R. Todd Jewell and Jeffrey J. Rous Availabil Southern Economic Journal , Vol 67, No. 3 (2001) 669.

PAGE 12

A Geo Spatial Analysis of A bortion Facilities in Texas: Examining the Potential Impacts that a Reduction in Abortion Facilities could have on Accessibility and Services 12 171.031(1)A , REQUIREMENTS OF THE PHYSICIAN , of the Texas Health and Safety Code. The proposed amendment states that the physician conducting the medically induced abortion the location at which the abortion is performed or induced 19 If existing abortion clinics are not located within 30 miles of a hospital, in which the doctor has admitting privileges, the abortion medical facility will not meet this requirement of the amended law. This would result in one of two courses of action; the first being that, the abortion clinic must move to a new location that meets the standards set forth, or the second , the abortion facility must close the business. The most notab le proposed amendment to Texas a bortion legislation occurs in Chapter abortion facility must be equivalent to the minimum standards adopted under Section 243.010 for 20 This pro posed addition to the abortion law caused an uproar exas. As stated above, the 2004 Act , which required that all abortions performed in the second trimester must be conducted at either an ambulatory surgical center or hospital, greatly limited the number of compliant abortion facilities available to women. In fact, authors Silvie Coleman and Theodore J. Joy ce reported that , at the time when the law went into effect, there were no abortion clinics in Texas that met the minimum ambulatory surgical center standards. 21 Thus , any Texas women seeking abortion services past the 1 5 week gestation period was required to travel to neighboring states in search of an abortion facility that offer s such services. 19 House Bill No. 2, Texas Congr ess, (2013) , 171.031 . 20 Ibid. 21 Silvie Colman and Theodore J. Joyce , Patient and Providers in Texas, National Bureau of Economic Research . 2010) 1.

PAGE 13

A Geo Spatial Analysis of A bortion Facilities in Texas: Examining the Potential Impacts that a Reduction in Abortion Facilities could have on Accessibility and Services 13 O r , if traveling to a differe nt state was not an option, the woman had to find an in state hospital that offered post 1 5 week gestation period abortion services . As a result, the authors noted a decline in post 15 week gestation period abortions in the state of Texas, this decline was also coupled with a slight increase in birth rates. However, by the year 2014, the supply of ambulatory surgical abortion centers in Texas had increased since the implementation of the 2004 Act. As stated above by Texas Tribune reporter Alex Ura, in 2014, only eight abortion clinics , out of the existing forty aborti on clinics, in the State of Texas met the requirements of the two amendments proposed in House Bill No. 2. 22 The passing of this Bill into a law would result with the closure of thirty two abortion clinics across the state. Texas legislators passed House B ill No. 2, and the Bill was scheduled to go into effect as a law on September 1, 2014; however, the constitutionality of the law was called into question, and the Bill was reviewed by s Health et al. (a collection of Abortion Providers across the State of Texas) , claim ed that the Defendant, Kirk Cole, M.D., Commissioner of the Texas Department of State Health Services, places undue burden upon Texas women seeking abortion services though the enactment of House Bill No. 2 . In particular, the Plaintiff emphasize s that the extensive travel a woman must undergo in order to obtain an abortion after the implementation o f House Bill No. 2 constitutes undue burden. Since the Bill will cause the closure of appr oximately 32 abortion clinics across Texas, this will greatly reduce the su pply of abortion clinics. The remaining 8 facilities that meet the requirement of House Bill No. 2 are geographically clustered in the Dallas , Fort Worth, Austin, San Antonio, 22 th The Texas Tribune , (October 9, 2014) p.10.

PAGE 14

A Geo Spatial Analysis of A bortion Facilities in Texas: Examining the Potential Impacts that a Reduction in Abortion Facilities could have on Accessibility and Services 14 and Houston areas . 23 W omen requiring an abortion will have to travel to these metropolitan areas to receive the health care they need. Health et al. showed the distance constraints tha t some Texas woman would have to overcome in order to obtain an abortion. According to the Plaintiff there are 5.4 million women of reproductive age (that being between the ages of 15 44) in Texas; and: (1) 7.4% o r 1/13 of women of reproductive age faced trave l distances of 150 miles or more after the admitting privileges requirement went into effect; and (2) 16.7% or 1/6 of women of reproductive age would face travel distances of 150 miles or more after both requirements went into effect. 24 To further exhibit the severity of the effect that the Bill will have certain communities, t he Plaintiffs drew attention to the extensive travel requirements of two Texas communities in particular, McAllen and El Paso. It was demonstrated to the District Court that residents of 25 The distance provided is calculated in one way distance. Applying existing Texas abortion laws which provides and exception to the minimum of a 24 hour waiting period between the sonogram appointment and the medically induced abortion appointment for those Texas residents that live over 100 mi les away from an abortion clinic , it is reasonable to assume that a woma n from the Rio Grande Valley will have t o travel a total of 47 0 miles in order to obtain an abortion. A similar, even more extreme case , is 23 The New York Times. (June 29, 2015) p. 5 . 24 50928 (5 th Cir. 2015) 39 . 25 Whole 50928 (5 th Cir. 2015) 47 .

PAGE 15

A Geo Spatial Analysis of A bortion Facilities in Texas: Examining the Potential Impacts that a Reduction in Abortion Facilities could have on Accessibility and Services 15 shown for El Paso. The admitting privileges requirement of House Bill No. 2 would force the sole abortion provider in El Paso to be shut down, and the nearest abortion clinic that meets the standards of House Bill No. 2 is located over 550 miles away in San Antonio, Texas. Applying the same exception to the 24 hour waiting period requirement as above, it is reasonable to assume that a woman from El Paso would be required to travel a to tal of 1 , 1 00 round trip miles in order to obtain an abortion in the State of Texas. Even though an exception is made for women who live extended distances away from an abortion clinic, women still may need to make multiple trips to the abortion clinic for post operative care and services. In these extreme cases it is clear to see that women living in the non cent ralized portions of Texas will be required to travel extreme di stances; and , for some women, overcoming the distance obstacle involves many other challenges, such as finding the economic means to cover the travel and procedural costs, taking time off of wo rk, etc. 26 Based on the evidence provided by the Plaintiff , the District Court found that the Plaintiff s claim of the undue burden placed upon women to be substantiated. T he reque st of the Plaintiff to vacate the legislation was granted by the District Court . All abortion facilities in Texas were to remain open. However, shortly thereafter, the State sought recourse with the 5 th Circuit of Appeals. After reviewing the determination of the District Court , the 5 th Circuit of Appeal asserte d that the District Court had erred in their cl aim that House Bill No. 2 places undue burden on all women of Texas . T hus , the 5 th claim. However, the 5 th Circuit di d affirm, in part, that undue burden is placed up on the McAllen abortion clinic: 26 50928 (5 th Cir. 2015) 40 .

PAGE 16

A Geo Spatial Analysis of A bortion Facilities in Texas: Examining the Potential Impacts that a Reduction in Abortion Facilities could have on Accessibility and Services 16 In plain terms, H.B. 2 and its provisions may be applied throughout Texas, except injunction of the ASC (ambulatory surgical center) requireme nt as applied to the 27 As for El Paso, it was determined that women living in this area could travel to Ne w Mexico for abortion services, thus the travel distance to a Texas abortion facility it moot. 28 Residents in McAllen do not have the same recourse as residents of El Paso due to its geography; located in the bottom tip of Texas , residents of McAllen cannot easily travel to another State in order to obtain an abortion. The only other recourse f or the residents of McAllen would be to travel to Mexico for an abortion. Thus it was determined to uphold injunction on the application of the House Bill No. 2 to abortion facility in McAllen . Otherwise, House Bill No. 2 would be applied to the rest of th e State of Texas. Unsatisfied by the 5 th et al. has en treated the Supreme Court to review the constitutionality of the 5 th in order to uphold the legalization of House Bill No. 2. At yet been established. While the case lies in wait on the docket, the Supreme Court issued a stay to abortion clinic s that were open and functioning prior as of September 1, 2014 . 29 The stay allows these facilities to remain open in Texas until the Supreme Court has made a ruling on the constitutionality of the Bill. However, in the time between the enactment of th e law on 27 50928 (5 th Cir. 2015) 3 . 28 le, M.D., No. 14 50928 (5 th Cir. 2015) 53 . 29 The New York Times. (June 29, 2015) p. 1 .

PAGE 17

A Geo Spatial Analysis of A bortion Facilities in Texas: Examining the Potential Impacts that a Reduction in Abortion Facilities could have on Accessibility and Services 17 September 1, 2014 and the challenge in the District Court , many abortion clinics across Texas had closed their doors in anticipation of the new law. According to NARAL Pro Choice Texas, an abortion advocacy group that monitors the availability of abortion services in Texas , shows th at ther e are approximately 17 functioning abortion clinics . These open facilities are located in Austin, Dallas, Fort Worth, Houston, San Antonio, El Paso and McAllen. 30 Pl ease reference Figure 1 for a graphical depiction of open abortion clinics in Texas. As one can see from the map, most abortion providers are located to the in the eastern part of the state, with a clustering of clinics to the north and the center. This map will look very simila r to what the geographic distribution of abortion clinics will look like in Texas if House Bill No. 2 were to go into effect, excepting the abortion clinics in El Paso. In this scenario, that would mean that there would be no abortion clinics in the state of Texas located west of San Antonio. If the Supreme Court upholds the 5 th become a law, it will result in the closure of numerous abortion facilities in Texas, and would limit, and even potentially isolate, certain Generating vast overarching policies that effects a large swath of the populatio n without taking geographic limitations into account could have a negative, or even detrimental, effect on a particular subgroup of a population. Changing regulations that could result in the cessation of services and the closure of physical businesses wil l have a direct impact on the availability of 31 Given that Texas 30 NARAL Pro Choice Texas , Do You Need an Abortion? (2015). 31 Harvey J. Annals of the Association of American Geographers, Vol. 94, No. 2 (2004) 284 .

PAGE 18

A Geo Spatial Analysis of A bortion Facilities in Texas: Examining the Potential Impacts that a Reduction in Abortion Facilities could have on Accessibility and Services 18 has a very lar ge spatial system, it is crucial that the individual locations of abortion clinics are spatially distributed in a way that the supply of clinics meets the demands of the community. If House Bill No. 2 is upheld by the Supreme Court, the current spatial di stribution of , as depicted in Figure 1 , a ppears to not provide an equitable access to the supply of abortion facility. While Figure 1 shows the clustering of abortion facilities solely in major metropolitan areas, leaving rural res idents to commute to city centers for abortion services, it may lead viewers to believe that those living outside of the metropolis are underserved. However, appearances can be deceptive . Is there actually an unequal distribution of abortion clinic facilit ies to serve the potential demand of abortion services in Texas? What if the current configuration of abortion clinic locations meets the needs of the vast majority of Texas women? There is the possibility that the population densities or potential aborti on demand in rural areas does not justify the cost of building an ambulatory surgical center in a non metropolitan area. However, there is the possibility that the converse is true, and that the current configuration of abortion clinic locations does not m eet the needs of women most as risk of needing to utilize abortion services. How then do health care providers plan to bring equity to the spatial distribution of future ambulatory surgical centers in Texas in order to provide better services to women ? Methodology The first step in understanding the whether or not abortion clinics are located in areas that meet the needs of Texas women is to fi r st comprehend the common demographic trends of women who are at most risk for utilizing abortion services :

PAGE 19

A Geo Spatial Analysis of A bortion Facilities in Texas: Examining the Potential Impacts that a Reduction in Abortion Facilities could have on Accessibility and Services 19 A be background characteristics can improve our ability to identify subgroups in a population who have the highest levels of unintended pregnancies and induced abortions and who, theref ore, are in the greatest need of effective contraceptive and post abortion services. 32 Then, using this demographic framework, utilize spatial distribution analysis in ArcGIS to locate areas in Texas where these demographic characteristics are prevalent. T his spatial analysis should yield the areas in Texas where, statistically speaking, women are in most need of abortion services. We can then compare these statistically significant areas to the locations of existing abortion clinics. This comparison will a id in determining whether or not the supply of abortion clinics is lacking in the demographically designated areas. A study published in 2002, entitled Patterns in the Socioeconomic Characteristics of Women Obtaining Abortions in 2000 2001 , written by authors Rachel K. Jones, Jacqueline E. Darroch and Stanley K. Henshaw, examines abortion data/statistics and a survey published by the American Guttmacher Institute and the Center for Disease Control (CDC) in order to track trends among women seeking abort ion services strictly in the United States between the years of 1994 2000. 33 The survey was administered to both hospitals and private abortion facilities that offered abortion services. Based on the completeness of the surveys received from the facilities, 32 worldwide review, International Family Planning Perspectives, Vol. 25, No. 2 (1999) 68 . 33 Women Obtaining Abortion in 2000 Perspectives on Sexual and Rep roductive Health, Vol. 34, No. 5 (2001 ) 226 227 .

PAGE 20

A Geo Spatial Analysis of A bortion Facilities in Texas: Examining the Potential Impacts that a Reduction in Abortion Facilities could have on Accessibility and Services 20 34 The authors used a weighted system in their data analysis in order to account for biasness that may occur in the data from incomplete, or unreported, respo nses from the questionnaire. Additionally, the researchers compared the results of the survey findings to National Census Data in order to corroborate the voracity of the data collected. Upon comparison was determined that the survey data tended to model t hat of what was reported in the National Census Data, and thus representative of the p opulation. This survey asked women questions from the following demographic and socioeconomic categories: age, marital status, cohabitating, number of live births, reside nce, poverty status, Medicaid coverage, race/ethnicity, education, and religion. 35 The metric by which the authors measure the incident of abortion calculated abortion rate by applying the percentage distributions found in our surveys to the numbers of medical and surgical abortions estimated to have occurred nationally, and then dividing by the relevant estimated populations . 36 The authors then calculated minimum and maximum confidence levels of the weighted normally distributed survey sampl e, and the data that met the minimum confidence level was used to extrapolate the following conclusions: Information gathered from this nationally representative sample reveals that the typical woman having an abortion is between the ages of 20 and 30, has never been married, has had a previous birth, lives in a metropolitan area, a nd is an economically disadvantaged and Christian. 34 Ibid, 227. 35 Ibid, 227. 36 of Women Obtaining Abortion in 2000 Perspectives on Sexual and Reproductive Health, Vol. 34, No. 5 (2001 ) 228 229 .

PAGE 21

A Geo Spatial Analysis of A bortion Facilities in Texas: Examining the Potential Impacts that a Reduction in Abortion Facilities could have on Accessibility and Services 21 However, women who have abortions are diverse, and unintended pregnancy leading to abortion is common i n all population subgrou ps . 37 This resolution affirms that younger, economically disadvantaged, single mothers, living in urban areas are in most need of abortion services. This statistical analysis would seem to validate the siting locations of existing Texas abortion clinics. However, the study did not disclose the physical locations of the hospitals and abortion clinics from whence the data was extrapolated . It is very possible that the hospitals and abortion clinics fea tured in the survey are located in urban areas, thus these locations would be more accessible to urban women. Researchers for the Guttmacher Institute have reported that the accessibility of a service influences the types of people that utilize such servic es: Women in urban areas are more likely than their rural counterparts to obtain an abortion. This finding probably reflects that it is easier to obtain abortion services in urban than rural areas. 38 Proximity to services is crucial for the utilization of said service. It is quite possible that urban women are more likely to obtain abortions than their rural counterparts simply because they are in closer physical proximity to locations that offer abortion services. Women can only receive safe and legal indu ced abortions where such facilities are physically located. In addition to overcoming the obstacle of distance , access to capital may play a role as to why rural women are less likely travel in town to obtain an abortion. two percent of women obtaining abortion in 2008 reported family incomes that qualified them as 37 Ibid, 239. 38 International Family Planning Perspectives, Vol. 25, No. 2 (1999 )75 .

PAGE 22

A Geo Spatial Analysis of A bortion Facilities in Texas: Examining the Potential Impacts that a Reduction in Abortion Facilities could have on Accessibility and Services 22 poor, and an additional 27% were low income (i.e., had family incomes of 100 199% of the 39 E very source encountered during the literature review process of enumerated on the fact that economic hardships is a common thread among women seeking abortion services . T he statistical analysis of this paper will focus on locating areas with heightened lev els of poverty in Texas . In doing s o , this will draw attention to areas of Texas in which a major demographic characteristic of women who obtain abortions is prevalent. This will help to planners better understand where impoverished women are living, and d iscern whether or not an abortion clinic is located in near an area that could serve these economically disadvantaged women . Using United States block g roups , with associated economic and census data, I was able to create a geographical display of areas in Texas where there were clusters of statistically significant poverty incidents at levels higher than that of the standard deviation of the data. 40 Based on the findings from the abortion demographic data research, isolating the areas of Texas in wh ich women are living in poverty would be the most effective way to see where there is potential need for abortion services. To do so it was determined that the best way to show the prevalence of poverty in the state of Texas, with the given economic and ce nsus data, would be to conduct a series of regression models on a particular set of attribute variables. Since the object of the analysis was to find areas with heightened poverty l evels, an Ordinary Least Squares (OLS) test was conducted. OLS test allows the modeler to select a dependent variable which is then related to a set of selected independent variables. The goal of the test is to see how well the 39 Rachel K. Jones , Lawrence B. Finer & Susheela Sing h, Characteristic of U.S. Abortion Patience, 2008. The Gut tmacher Institute (2010) 8 . 40 United States Census Bureau , TIGER/Line with Selecte d Demographic and Economic Data, 2007 2011 Bl ock Group Data, Texas (2015).

PAGE 23

A Geo Spatial Analysis of A bortion Facilities in Texas: Examining the Potential Impacts that a Reduction in Abortion Facilities could have on Accessibility and Services 23 independent variables explain the dependent variable by means of exploratory regression. Extrapolated f rom the United Sates Census Bureau 2007 2011 Block Group Data , the Poverty Status of Individuals in the Past 12 Month s by Living Arrangement attribute was selected as the dependent variable, the variable for which an explanation is sought. 41 The independent variables selected to explain the dependent variable s distribution are: Pe r Capita Income in the Past 12 M onth s (In 2011 Inflation Adjusted Dollars), Public Assistance Income in the Past 12 M onths for Household, Race, and Reproductive Age Female (15 44 years old). The variable , Reproductive Age Female (15 44 years old), was created for the purpose of this exercise . T he variable accounts for the total number of females of reproductive age living in each block group. This was done so tha t the sex and age group variable defining the poverty variable is directly related to women of reproductive age. Table 4: Summary of OLS Model Variables and Table 5: OLS Diagnosis provide an overview of the model results. All four variables have p robab ility [b] values denoted with and asterisk mark (*), which indicates that the data is statistically significant. 42 Meaning that the poverty values for which the data are attempting to account for are not randomly located space, but rather that the data are in fact a part of a n identifiable cluster. Additionally, VIF scores less than 7.5 denotes that the independent va riables selected to explain the dependent variable are statistically significant , and are doing a good job of explaining the locations of poverty in Texas. 43 The lower the VIF score, the better the variable explains the dependent variable. The following is a list of the independent variables in sequential order starting with the best 41 Ibid. 42 Paul Zwick, Spatial Patten Analysis: Mapping Trends & Clusters (2015). 43 Ibid.

PAGE 24

A Geo Spatial Analysis of A bortion Facilities in Texas: Examining the Potential Impacts that a Reduction in Abortion Facilities could have on Accessibility and Services 24 explanatory vari able: Per Capita Income in the P ast 12 M onths (In 2011 Inflation Adjusted Dollars), Public Assistance Income in the Past 12 M onths for Household, Race, and Repro ductive Age. Another indicator that the model is performing properly is a normally distributed standardized residuals, Figure 2: OLS Histogram of Standardized Residuals shows that the data are normally distributed and fall within the confines of the normal curve. Furthermore, the R Squared value produced in the OLS Diagnosis is the percentage of explanation that the independent variables provide to the dependent variable. In this particular instance, the independent variables of: Per Capita Income in the pa st 12 M onths (In 2011 Inflation Adjusted Dollars), Public As sistance Income in the Past 12 M onths for Household, Race, and Reproductive Age, provide a 93.3316% explanation for the Poverty Status of Individuals in the Past 12 Months by Living Arrangement de pendent variable. Additionally, since the Jarque Bera Statistic is not statistically significant, we can trust that the data is not biased. 44 Further proof that the data are reliable, and that the clustering of poverty is not random. To check the voracity of the OLS model the residuals are tested to see if there is any spatial autocorrelation . This test is a safe measure to once again ensure that the data are not randomly distributed, but rather that the data are clustered providing evidence as to why there are pockets of poverty in particular areas of Texas . , shows that a z score of 25.348254 and a p value of 0.000000 , infers that there is less than a 1% likelihood that this clustered pattern could the result of random chance. 45 This indicates that the data are clustered and that the 44 Ibid. 45 ArcGIS (2010).

PAGE 25

A Geo Spatial Analysis of A bortion Facilities in Texas: Examining the Potential Impacts that a Reduction in Abortion Facilities could have on Accessibility and Services 25 independent variables provide the explanation as to why there are geographic clustering in the dependent variable . Since the OLS model verifies that the dependent variable is clustered as a result of the s I test confirm s that the OLS model residuals are not spatially auto correlated, a Geographic Weighted Regression model wa s conducted in order to provide a visual representation of the Poverty Status of Individuals in the Past 12 Months by Living Arrangement variable clustering. Figure 3: Geographic Weighted Regression for Poverty Status of Individuals in the Past 12 Months b y Living Arrangement, in Texas , shows the geographic visualization created from the Geographic Weighted Regression model. The areas in red on the map show statistically significant poverty incidents at levels higher than that of the standard deviation of t he data, and the areas in blue show statistically significant poverty incidents at levels lower than that of the standard deviation of the data. The output report generated from the mode, please reference Table 7: Geographic Weighted Regression , shows that the regression produced a reliable model. The R2 value is a measurement of between the values of 0.0 1.0, the close the R2 value approaches 1.0 the better the model. The high R2 value indicates that the Geographic Weighed Regression Model is a good tool for modeling the proportion that the independent variables explain the dependent variable. The visual representation of this model can be viewed in Figure 3: Geographic Weighted Regression for Poverty Status of Individuals in the Past 12 Months by Living Arrangement, in Texas . This map shows the varying scale of poverty levels . The poverty levels range from low (blue) , to neutral (beige) , to high (red) predictions of poverty based on the number of standard deviations the cluster groups are removed from the base line of 0.00 (or neutral) standard deviations. Areas that

PAGE 26

A Geo Spatial Analysis of A bortion Facilities in Texas: Examining the Potential Impacts that a Reduction in Abortion Facilities could have on Accessibility and Services 26 are 0.5+ standard deviations away from the base line are location that are predicted for higher levels of poverty, these areas are represented by the color red. Conclusion and Further Resear ch Now that is has been confirmed that there are in fact statistically significant clusters of poverty, as related to the variable Poverty Status of Individuals in the Past 12 Months by Living Arrangement, we can look at the locations of Texas abortion cl inics in relation to identified areas of poverty. Figure 4: Geographic Weighted Regression for Poverty Status of Individuals in the Past 12 Months by Living Arrangement in Relation to Existing Abortion Clinics, in Texas , provides a visual representation of abortion clinics in relation to poverty clusters that have been identified as 0.5+ standard deviations away from the base line. Here we can see that there are a great number of poverty clus ters all across the state of Texas; however, there is an apparent lacking of abortion clinics to serve the women of reproductive age that are living in poverty stricken areas. In an effort to demonstrate scale and travel expectations of women seeking an abortion a 100 mile buffer has been placed around all abortion clinics. This is the limit that Texas legislations have determined as the service area to women seeking an abortion. All who live within the 100 mile buffer will be required to adhere to the 24 hour waiting period requirement, and all those who live outsid e of the buffer zone will only have to endure a 2 hour waiting period in the abortion clinic but countless hours on the road in the form of travel will be accumulated for some. It is important to note that there are no abortion clinics in any part of Texas north of Dallas, and if House Bill No. 2 is upheld in the Supreme Court there will be no abortion clinic facilities west of San Antonio. There are clearly identifiable areas in the Panhandle and the

PAGE 27

A Geo Spatial Analysis of A bortion Facilities in Texas: Examining the Potential Impacts that a Reduction in Abortion Facilities could have on Accessibility and Services 27 northern parts of Texas, such as Pam pa, that are in close relation to poverty clusters and yet thousands of miles away from any abortion facility. Access to population density data and application of standard distance and mean center spatial analysis could provide researchers the ability to quantify the demand of services in these area s. 46 As the state of Texas continues to grow, and as residential development patterns change over time, health care providers will need to devise a plan as to how presently under served women will receive abortion care services in a place relatively close to home. 46 Aharon Area, Vol. 13 , No. 3 (1981) 246 .

PAGE 28

A Geo Spatial Analysis of A bortion Facilities in Texas: Examining the Potential Impacts that a Reduction in Abortion Facilities could have on Accessibility and Services 28 References ArcGIS (2010). Association of Schools of Public Health (1961). Areawide Planning for Hospital Facilities. Public Health Reports, 76(11) , 1039 2040. Retrieved from http://www.jstor.org/stable/4591362 Bankole, A kinrinola , S usheela Singh, & T aylor Haas (1999). Characteristics o f women who obtain induced abortion: A worldwide review. International Family Planning Perspectives, 25 (2), 68 77. Retrieved from http://www.jstor.org/stable/2991944 Brown, Robert W., R. Todd Jewell and Jeffrey J. Rous (2001). Availability, Race, and Abortion Demand. Southern Economic Journal , 67(3), 656 671. Retrieved from http://www.jstor.org/stable/1061465 Castro, M arcia C aldas d e (2007). Spatial demography: An opportunity to improve policy making at diverse decision levels. Population Research and Policy Review, 26 (5/6, Spatial Demography. Part I), 477 509. Retrieved from htt p://www.jstor.org/stable/40230989 Cates, Willard Jr., David A. Grimes & Kenneth F. Schulz (2003). The Public Health Impact of Legal Abortion: 30 Years Later. Perspectives on Sexual and Reproductive Health, 35(1). Retrieved from https://www.guttmacher.org/pubs/journals/3502503.html Chi, G uangging , & J un Zhu (2008). Spatial regression models for demographic analysis. Population Research and Policy Review, 27 (1, Spatial Demography. Part II) , 17 42. Retrieved from http://www.jstor.org/stable/41217935

PAGE 29

A Geo Spatial Analysis of A bortion Facilities in Texas: Examining the Potential Impacts that a Reduction in Abortion Facilities could have on Accessibility and Services 29 Colman, Silvie and Theodore J. Joyce (2010). Regulating Abortion: Impact on Patient and Providers in Texas. National Bureau of Economic Research . Accessed May 28, 2015. http://www.nber.org/papers/w15825 Gobalet, J eanne G., & R ichard K. Thomas (1996). Demographic data and geographic information systems for decision making: The case of public health. Population Research and Policy Review, 15 (5/6, Applied Demography: Demography and Decision Making), 537 548. Retrieved from http://www.jstor.org/stable/40230123 Gober, P atr icia (1994). Why abortion rates vary: A geographical examination of the supply of and demand for abortion services in the united states in 1988. Annals of the Association of American Geographers, 84 (2), 230 250. Retrieved from http://www.jstor.org/stable/2563395 Guttmacher Insti tute (2014). Abortion Data in T exas. Retrieved from http://www.guttmacher.org/datacenter/tren d.jsp# Guttmacher Institute (2014). State facts about abortion: Texas. Retrieved from http://www.guttmacher.org/pubs/sfaa/pdf/texas.pdf Guttmacher Institute (2014). Texas state reproductive health profile. Retrieved from http://www.guttmacher.org/datacenter/profiles/TX.jsp Heard, N athan J., U lla Larsen, & D ai riku Hozumi (2004). Investigating access to reproductive health services using GIS: Proximity to services and the u se of modern contraceptives in M alawi. African Journal of Reproductive Health / La Revue Africaine De La Santé Reproductive, 8 (2), 164 179. R etrieved from http://www.jstor.org/stable/3583189

PAGE 30

A Geo Spatial Analysis of A bortion Facilities in Texas: Examining the Potential Impacts that a Reduction in Abortion Facilities could have on Accessibility and Services 30 Henshaw, S tanley K. (1991). The accessibility of abortion servi ces in the United S tates. Family Planning Perspectives, 23 (6), 246 252+263. Re trieved from http://www.jstor.org/stable/2135775 House Bill No. 2, Texas Congress, (2013). Jones, Rachel K., Jacqueline E. Darroch & Stanley K. Henshaw (2002). Patterns in the Socioeconomic Characteristics of Women Obtaining Abortion in 2000 2001. Perspectives on Sexual and Reproductive Health, 34(5), 226 235. Retrieved from http://www.jstor.org/stable/3097821 Jones, Rachel K., Lawrence B. Finer & Susheela Singh (2010). Characteristic of U.S. Abortion Patience, 2008. The Guttmacher Institute. Retrieved from http://www.guttmacher.org/pubs/US Abortion Patients.pdf Liptak, Adam & Manny Fernandez (June 29, 2015). ). The New York Times . Retrieved from http://nyti.m s/1NuzoOC Kellerman, Aharon (1981). The Use of Standard Distance as an Equity Criterion for Public Facility Location. Area, 13(3) , 245 249. Retrieved from https://www.jstor.org/stable/20001732 Maantay, Juliana ( 2002). Mapping Environmental Injustices: Pitfalls and Potential of Geographic Information Systems in Assessing Environmental Health and Equity. Environmental Health Perspectives, 110(2) , 161 171. Retrieved from http://www.jstor.org/stable/3455050 Miller, H arvey J. (2004). Tobler's first law and spatial analysis. Annals of the Association of American Geographers, 94 (2), 284 289. Retrieved from http://www.jstor.org/stable/3693985

PAGE 31

A Geo Spatial Analysis of A bortion Facilities in Texas: Examining the Potential Impacts that a Reduction in Abortion Facilities could have on Accessibility and Services 31 NARAL Pro Choice Texas (2015). Do You Need an Abortion? Retrieved from http ://prochoicetexas.org/resources/how to get an abortion in tx/ Planned Parenthood of Southeastern Pennsylvania et al. v. Casey, Governor of Pennsylvania . No. 91 744 (1992). Porterfield, W. J. (1977). On health facility planning. Operational Research Quarter ly (1970 1977), 28 (2, Part 2), p. 465. Retrieved from http://www.jstor.org/stable/3008994 Pritchard, A nita , & Sharon Kay Parsons. (1999). The effects of state abortion policies on states' abo rtion rates. State & Local Government Review, 31 (1), 43 52. Retrieved from http://www.jstor.org/stable/4355222 Rossier, C lementine . (2003). Estimating induced abortion rates: A review. Studie s in Family Planning, 34 (2), 87 102. Retrieved from http://www.jstor.org/stable/3181181 Sedgh, G ilda ., S tanley . K. Henshaw, S usheela Singh , A kinrinola Bankole , & J oanna Drescher (2007). Legal abortion worldwide: Incidence and recent trends. Perspectives on Sexual and Reproductive Health, 39 (4), 216 225. Retrieved from http://www.jstor.org/stable/30042979 Sedgh, G il da , S usheela Singh, S tanley K. Henshaw , & A kinrinola Bankole (2011). Legal abortion worldwide in 2008: Levels and recent trends. Perspectives on Sexual and Reproductive Health, 43 (3), 188 198. Retrieved from http://www.jstor.org/stable/23048853 Shelton, J ames D., Edward A. Brann & K enneth F. Schulz (1976). Abortion utilization: Does travel distance matter? Family Planning Perspectives, 8 (6), 260 262. Retrieved from http://www.jstor.org/stable/2134397 Tatalovich, R aymond , & Byron W. Daynes. (1989). The geographic distribution of U.S. hospitals with abortion facilities. Family Planning Perspectives, 21 (2), 81 84. Retrieved from http://www.jstor.org/stable/2135558

PAGE 32

A Geo Spatial Analysis of A bortion Facilities in Texas: Examining the Potential Impacts that a Reduction in Abortion Facilities could have on Accessibility and Services 32 Texas Constitution, Title 2, Subtitle H., Chapter 171. Texas Constitution, Title 4, Subtitle B., Chapter 243. United States Census Bureau (2015). TIGER /Line with Selected Demographic and Economic Data. 2007 2011 Block Group Data , Texas . Retrieved from https://www.census.gov/geo/maps data/data/tiger data.html United States Department of H ealth and Human Services (November 27, 2015) . Center for Disease Control and Prevention . Abortion Surveillance United States, 201 2 , Morbidity and Mortality Weekly Report, Surveillance Summaries, Vol. 6 4(SS10) , 1 40 . http://www.cdc.gov/mmwr/preview/mmwrhtml/ss6410a1.htm th The Texas Tribune . Retrieved from http://www.texastribune.org/2014/10/09/5th circuit refuses reconsider first hb2 lawsuit/ 50928 (5 th Cir. 2015). Zwick, Paul (2015). Spatial Pattern Analysis: Mapping Trends & Clusters . Retrieve from http://www.elearning.ufl.edu

PAGE 33

A Geo Spatial Analysis of A bortion Facilities in Texas: Examining the Potential Impacts that a Reduction in Abortion Facilities could have on Accessibility and Services 33 Table 1: Guttmacher Institute, Abortion Data in Texas (2014) 47 * Abortion Rate is defined as the number of abortions per 1,000 women aged 15 44 . differentiating between resident (abortion incidents of Texas residents) and occurrence abortions (i nclusive of both resident and non resident abortion incidents) . This table is an exact replica of The Guttmacher Institute Abortion Data in Texas datasets. The line charts below provide graphical representations of the data provided in Table 1 . 47 The Guttm acher Institute , Abortion Data in Texas (2014).

PAGE 34

A Geo Spatial Analysis of A bortion Facilities in Texas: Examining the Potential Impacts that a Reduction in Abortion Facilities could have on Accessibility and Services 34 Table 2: Guttmacher Institute, Abortion Data in Texas (2014) 48 , Number of Aborti on Table 3: Guttmacher Institute, Abortion Data in Texas (2014) 49 , Rate of Abortion * Abortion Rate is defined as the number of abortions per 1,000 women aged 15 44 . 48 The Guttm acher Institute , Abortion Data in Texas (2014). 49 Ibid.

PAGE 35

A Geo Spatial Analysis of A bortion Facilities in Texas: Examining the Potential Impacts that a Reduction in Abortion Facilities could have on Accessibility and Services 35 Table 4: Summary of OLS Model Variables Probability [b] values with * indicate that the data is statistically significant. Additionally, VIF scores less than 7.5 denotes that the independent variables selected to explain the dependent variable are statistically significant. The lower the VIF score, the better the variable explains the dependent variable. The following is a list of the independent variables sequential order from starting with the best explanatory variable: Per Capita Inc ome in the past 12 months (In 2011 Inflation Adjusted Dollars), Public Assistance Income in the Past 12 months for Household, Race, Reproductive Age. Table 5 : OLS Diagnosis Number of Observations: 15811 Multiple R Squared [d]: 0.933316 Joint F Statistic [e]: 55305.397148 Join Wald Statistic [e]: 55671.216979 Koenker (BP) Statistic [f]: 661.862043 Jarque Bera Statistic [g]: 147698534.626354 The R Squared value produced in the OLS diagnosis is the percentage of explanation that the independent variables provide to the dependent variable. I n this particular instance, the independent variables of: Per Capita Income in the past 12 months (In 2011 Inflation Adjusted Dollars), Public Assistance Inco me in the Past 12 months for Household, Race, and Reproductive Age, provide a 93.3316% explanation for the Poverty Status of Individuals in the Past 12 Months by Living Arrangement dependent variable. Additionally, since the Jarque Bera Statistic is not st atistically significant, we can trust that the data is not biased.

PAGE 36

A Geo Spatial Analysis of A bortion Facilities in Texas: Examining the Potential Impacts that a Reduction in Abortion Facilities could have on Accessibility and Services 36 Table 6 : Moran's Index: 0.012096 Expected Index: 0.000063 Variance: 0.000000 z scores: 25.348254 p value: 0.000000 Given the z score of 25.348254 and p value of 0.000000, there is a less than a 1% likelihood that this clustered pattern could the result of random chance. This indicates t hat the data are clustered and that the independent variables provide the explanation as to why there are geographic clustering of data. Table 7 : Geographic Weighted Regression Model Neighbors: 167 Residual Squares: 315650112.907777 Effective Number: 1674.147450 Sigma: 149.426151 AICc: 204140.301145 R2: 0.979435729 R2 Adjusted: 0.977001874 The R2 value is a measurement of between the values of 0.0 1.0, the close the R2 value approaches 1.0 the better the model. The high R2 value indicates that the Geographic Weighed Regression Model is a good tool for modeling the proportion that the independent variables explain the dependent variables.

PAGE 37

A Geo Spatial Analysis of A bortion Facilities in Texas: Examining the Potential Impacts that a Reduction in Abortion Facilities could have on Accessibility and Services 37 Figure 1: Abortion Clinics, Texas, 2016 Abortion Clinic Location Data retrieved from NARAL Pro Choice Texas, Do You Need an Abortion? (2015). Austin San Antonio Houston Dallas McAllen Fort Worth El Paso

PAGE 38

A Geo Spatial Analysis of A bortion Facilities in Texas: Examining the Potential Impacts that a Reduction in Abortion Facilities could have on Accessibility and Services 38 Figure 2 : OLS Histogram of Standardized Residuals The standard deviation residuals from the OLS model fall within the confines of the normal curve, thus the model is a reliable representation of the data distribution.

PAGE 39

A Geo Spatial Analysis of A bortion Facilities in Texas: Examining the Potential Impacts that a Reduction in Abortion Facilities could have on Accessibility and Services 39 Figure 3 : Geographic Weighted Regression for Poverty Status of Individuals in t he Past 12 Months by Living Arrangement, in Texas

PAGE 40

A Geo Spatial Analysis of A bortion Facilities in Texas: Examining the Potential Impacts that a Reduction in Abortion Facilities could have on Accessibility and Services 40 Figure 4 : Geographic Weighted Regression for Poverty Status of Individuals in the Past 12 Months by Living Arrangement in Relation to Existing Abortion Clinics, in Texas


xml version 1.0 encoding UTF-8
REPORT xmlns http:www.fcla.edudlsmddaitss xmlns:xsi http:www.w3.org2001XMLSchema-instance xsi:schemaLocation http:www.fcla.edudlsmddaitssdaitssReport.xsd
INGEST IEID ERVWP3ZAP_BJX7CL INGEST_TIME 2017-07-11T21:14:14Z PACKAGE AA00047562_00001
AGREEMENT_INFO ACCOUNT UF PROJECT UFDC
FILES