Abortion Reporting: Texas (2023)

Texas’ 2023 abortion report was released by Texas Health and Human Services in September 2024, showing a significant drop in abortions from 2022. Charlotte Lozier Institute (CLI) is summarizing the information in the abortion report published by the state. This data does not include all of the abortions obtained by Texas residents out of state (only a limited, unnamed number of states report back to Texas on the number of Texas women who obtain abortions in their states) or the number of abortion drugs obtained or taken by Texas residents prescribed by licensed abortion providers in other states under their shield laws. Lastly, Texas’ report does not include the number of self-managed abortions performed by women outside of the healthcare system. In a separate section, CLI will describe data provided by the Guttmacher Institute’s Monthly Abortion Provision Study that details the number of abortions obtained by Texas women in other states. Guttmacher’s abortion estimates include the number of abortions obtained at brick-and-mortar facilities and those provided via telehealth and virtual providers in the United States

Statistics and Changes in Texas Abortions, 2022-2023

This report does not include information on Planned Parenthood’s Texas abortion market share. However, no Planned Parenthoods in Texas perform abortion.

Abortion Totals and Trends

Sixty-two abortions were reported to have been performed in Texas in 2023, the first full year after the state’s law protecting life at conception went into effect. This was a massive decline from 17,514 abortions performed in Texas the previous year.

In addition to reporting abortions occurring in the state, Texas also shares data with other states and provides statistics on abortions performed on Texas residents out of state. In 2023, there were 7,906 Texas abortions reported, of which 62 were performed in Texas and 7,844 in other states that then shared this data with Texas. The drop in the total Texas abortions reported was a drop of 64% from 2022. Similarly, drug-induced abortions decreased by a significant percentage, 61%, from 13,310 in 2022 to 5,178 in 2023 (Fig. 1). Drug-induced abortions made up 65% of Texas abortions in 2023. CLI estimates that Texas’ abortion rate also fell by 64% to 1.3 abortions per 1,000 women ages 15 to 44 (Fig. 2).¹ As of November 2024, 21states have released 2023 abortion statistics, with 12 showing that abortions had decreased from the previous year.

State Report Summary

Texas abortions include abortions performed in Texas on residents and nonresidents, as well as abortions performed on Texas residents in other states. In 2023, just 0.78% of Texas abortions (62 abortions) were performed on state residents in Texas (a huge drop from 77% in 2022 and 95% in 2021). Zero abortions were performed on nonresidents in Texas, and 99.2% were performed on Texas women in other states (an increase of 358% from 2021).

To see how Texas’ 2021 heartbeat law as well as the state’s 2022 life at conception law impacted where Texas and non-Texas residents sought abortions, please see the table below:

Table 1 – Changes in Abortion Provision for Texas Residents due to Recent Legislative Changes, 2019-2023

While the total number of abortions performed in Texas on resident and nonresident women has decreased dramatically over the last five years, the number of reported abortions performed on Texas women out of state has increased 1,099% since 2019. Despite the change in where Texas women are seeking abortions, the state’s heartbeat and life at conception laws have decreased the number of reported abortions by 86.4%. While Texas women are mainly traveling out of state to obtain abortions, many states in the Southeast and Midwest have similar pro-life laws. Consequently, Texas women are traveling to New Mexico, Kansas, Colorado, and California to obtain a majority of the abortions performed on Texas residents according to Guttmacher Institute’s 2023 data.  Only certain states share information on Texas women who obtained abortions in their states, so the number of Texas women who received abortions out of state (7,844) is a significant undercount. The Guttmacher Institute estimates that at least 34,000 abortions were performed on Texas women in other states in 2023, and this estimate does not include states to which a low volume of Texas residents traveled. This total is far higher than the 7,844 abortions reported by the state, but still lower than the total number of Texas resident abortions reflected in official state data for 2021, the year prior to the Dobbs decision. Texas’ abortion report states that they have public health surveillance agreements with other states (for out-of-state Texas resident procedures) but does not list how many or with which states.

Reported Abortions on Texas Residents

In 2023, 8% of reported Texas resident abortions were performed on girls under the age of 20. Thirty-one percent of the abortions were obtained by women ages 20 to 24, and 29% were performed on women ages 25 to 29. Nineteen percent of the abortions were performed on women ages 30 to 34 and 10% on women ages 35 to 39. Three percent were performed on women ages 40 and older.

Hispanic women made up the largest group of women undergoing Texas abortions, comprising 34% of the total in 2023. Thirty-two percent of the abortions were on black women, and 22% on white women. Five percent of Texas abortions were performed on Asian women, 0.3% on Native American women, and 4% were on women of other races. Race was not reported for 4% of the abortions. CLI estimates that Texas’ black abortion rate was 2.9 abortions per 1,000 women ages 15 to 44, four times the white rate of 0.8, while the Hispanic rate was 1.0.

Sixty-five percent of Texas resident abortions were drug-induced. Thirty-one percent were suction curettage procedures, and 2% were conducted via dilation and evacuation. There were eleven sharp curettage abortions (0.14%) and two hysterectomy or hysterotomy abortions. The type of procedure was not reported for 2% of the abortions.

A majority of reported abortions on Texas residents, 96%, occurred before nine weeks post-fertilization (approximately 11 weeks of gestation). Six percent were performed between nine- and 10-weeks post-fertilization, and 3% were reported between 11 and 12 weeks. Two percent of Texas abortions occurred between 13- and 14-weeks post-fertilization, 1.6% between 15 and 16 weeks, and 1.5% from 17 to 20 weeks. There were four abortions reported between 21- and 24-weeks post-fertilization (approximately 23 to 26 weeks of gestation) and no abortions at 25 weeks post-fertilization or later. The post-fertilization age was not reported for one abortion.

From 2022 to 2023, the number of abortions on Texas residents performed before nine weeks post-fertilization through 14 weeks post-fertilization decreased by 65%, but the number of abortions performed at 15 weeks post-fertilization and beyond increased by 58% to 252 abortions. Texas’ abortion report notes that of the 62 abortions performed in the state in 2023, 49 were performed at 15 weeks post-fertilization and later, indicating that 203 of the 252 abortions performed at 15 weeks post-fertilization or later were performed on Texas women in other states. The states where Texas women most often travel to obtain abortions (NM, KS, CO, and CA) all have extremely permissive abortion laws or no limits at all.²

In 2023, 82% of the abortions obtained by Texas residents (both in Texas and in other states that shared data with Texas) were performed on unmarried women, while 15% were performed on married women and 3% were performed on women of unknown marital status. Forty-three percent of Texas abortions were performed on women with no previous live births. Twenty-two percent were on women with one prior live birth, and 36% were on women with two or more previous live births. Seventy-one percent of Texas resident abortions were obtained by women who reported no previous abortions, 21% by women with one prior abortion, and 8% by women with more than one previous abortion.

Abortions Performed in Texas

In 2023, zero abortions were performed in Texas abortion facilities, ambulatory surgery centers, or physicians’ offices. Sixty-two abortions were performed in Texas hospitals and 7,844 (99.2%) were performed in unknown facilities out of state.

In 2021, the Texas legislature passed S.B. 8 (the state’s heartbeat law), which also contains a requirement that if an abortion is performed due to a medical emergency or a threat to a woman’s physical health those reasons must be included in the physician’s abortion report submitted to the state. This information is only collected for abortions on Texas residents in and outside of Texas. In 2023, all 62 abortions performed in the state on Texas residents were allowed under an exception to the state’s law.  Two abortions were performed because the mother’s life was in danger due to a medical emergency, and 60 abortions were performed for both medical emergency and physical health reasons.³

Of the 7,844 abortions performed on Texas residents out of state, none were reported to have been performed for physical health or emergency reasons.

Abortion Complications

Texas’ 2023 abortion report includes the second full year of data for expanded complication reporting required under Texas Health and Safety Code (HSC) 171.006. These new requirements were added by S.B. 4, which was signed into law by Texas Governor Greg Abbott in 2021 and went into effect on December 2 of that year. The additional requirements expanded on the state’s complication reporting law, which was originally passed as H.B. 13 in 2017.

In 2023, Texas received 120 forms from abortion facilities, including seven duplicate forms.⁴ Multiple complications can be reported on each form, and multiple forms could be submitted for a single patient or complication. Although duplicates are included in the total number of forms received, Texas removes duplicates from the count before reporting the total number of complications. In 2023, 155 complications were reported by facilities.

The most frequent complication was incomplete abortion, which occurred 58 times. There were 40 cases of hemorrhage, 13 cases of infection, nine cases of failure to actually terminate the pregnancy, six cases of endometritis, and five cases each of shock and sepsis. There was one case each of uterine perforation, missed ectopic pregnancy, and an embolism. There were eight other, unspecified complications that met the Food and Drug Administration’s definition of “adverse event.” Seven babies were reported to have been born alive during an abortion in 2023, though there is no further information reported on the babies’ outcomes. There was one abortion-related maternal death reported in 2023.

Born Alive Abortion Data

As noted above, seven babies were reported to have been born alive during abortions in 2023. Since 2018, when strengthened reporting requirements went into effect, 21 born-alive abortion survivors have been reported in the state.

Legislative Changes and Subsequent Changes in Abortion Totals by Month

As previously summarized by CLI, Texas’ heartbeat law went into effect on September 1, 2021. The state’s 1925 law that protects life from conception went into effect on the day Roe v. Wade was overturned in June 2022, and Texas’ life at conception law that was passed in 2021 went into effect on August 25, 2022. The life at conception law from 1925 was blocked for part of June 2022 but has been in effect consistently since July 2022, while the state’s heartbeat law was superseded by the 1925 law in June 2022 and then by the 2021 life at conception law. All three laws were challenged in a 2023 lawsuit, Zurawski v. State of Texas. On August 4, 2023 a judge ruled that the heartbeat law violated the state constitution and that the life at conception laws could not apply to abortions performed on women with dangerous pregnancy complications. The laws remained in effect during the litigation because the state immediately appealed the August 4decision. However, on May 31, 2024 the Texas Supreme Court ruled that the challenged laws were constitutional and could remain in effect.

The effect of these laws, and their capacity to affect thousands of abortions, is displayed in the 2022-2023 monthly data.

Table 2 – Number of Resident Abortions in Texas Before and After the Heartbeat and Life at Conception Laws Went into Effect by Month, 2019-2023⁵

Guttmacher Data⁶

Guttmacher estimated that 34,210 abortions were obtained by Texas residents who traveled to other states to obtain an abortion. To compare, Texas reported 7,844 abortions obtained by Texas women out of state because not every state reports data back to Texas. To see the number of abortions obtained by Texas women according to Guttmacher in various states, see below:

State Ranking

In 2024, CLI published a paper reevaluating abortion reporting across the country, and Texas’ reporting was ranked 11^th best. Texas has made significant strides since 2016 when CLI originally evaluated states’ abortion reporting requirements. However, Texas could improve its reporting by reporting the states from which it did or did not receive data on abortions performed on Texas women.

1. National rates were calculated by Guttmacher Institute. Texas rates were calculated by CLI using the following formula: (total number of abortions performed in Texas ÷ number of resident women ages 15-44 [based on most recent population estimates]) x 1,000. Rates may differ slightly from previous CLI articles due to revised population estimates. Population estimates were obtained from CDC WONDER. Estimates for 2005-2009 are intercensal estimates of the July 1 resident population. Estimates for 2010-2019 are Vintage 2020 postcensal estimates of the July 1 resident population. Estimates for 2020-2022 are Vintage 2022 postcensal estimates of the July 1 resident population. Estimates were produced by the U.S. Census Bureau and the National Center for Health Statistics. Rates for 2023 were calculated using the Vintage 2022 postcensal estimates because 2023 population estimates have not yet been released by the CDC.
2. New Mexico and Colorado allow abortions up until the moment of birth. California has no effective limits because its health exception is so broad that it effectively allows abortion up until birth. Kansas limits abortion at 22 weeks of gestation.
3. CLI is reporting on this information as it appeared in Texas’ abortion report. However, it is important to note that the cases described as exceptions to the state’s abortion law are not the same as elective abortions. They are descriptions of medical care allowed under the state’s law to save the life or physical health of the mother. They are differentiated from an elective abortion which, when performed, has the sole intent of causing the death of an unborn baby.
4. Statistics on abortion complications reported here represent a minimal number of deaths and complications, as this data is collected in a non-systematic and non-verifiable way. As such, this data cannot be used to calculate either an accurate abortion mortality rate or an accurate abortion complication rate for the state.
5. The data in table 2 reflects only totals of abortions on resident women who obtained an abortion in Texas.
6. The Guttmacher Institute notes that their monthly abortion totals by states are estimates and that each state’s estimate is within a range of uncertainty. Guttmacher also notes that their estimates do not reflect self-managed abortions or those obtained by women in pro-life states under shield laws.

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