Early in the pandemic, Texas banned most abortions. After the ban lifted, second-trimester abortions jumped, a new study shows.

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The number of Texas residents who went out of state to receive abortions leapt from 157 in February to 947 in April, after Gov. Greg Abbott ordered that all procedures not “immediately, medically necessary” be postponed to contend with the nascent coronavirus pandemic, according to a new study published in the Journal of the American Medical Association.

The number of abortions performed in Texas plummeted 38% in April 2020 when compared to the previous year. But after the order had expired in May, second-trimester abortions increased 61% likely reflecting “delays in care among those who waited for an appointment and facilities’ limited capacity to meet backlogged patient need,” the researchers found. Abortions performed later during a pregnancy are safe, but have a greater risk for complications and may need more appointments, the study said.

The study relied on data from 30 out of 37 open facilities in Arkansas, Colorado, Kansas, Louisiana, Oklahoma and New Mexico, and from 18 out of 24 facilities in Texas that provide more than 90% of abortions in the state.

The governor’s order, which went into effect March 22, “put additional barriers in place” compounding restrictions Texas already has on abortion access, said Kari White, an author of the study, and lead investigator of the Texas Policy Evaluation Project at the University of Texas at Austin.

Another author of the study, Dr. Robin Wallace, was among several abortion providers who this spring challenged Abbott’s executive order, which Attorney General Ken Paxton said extended to abortions. The case pingponged between a district judge and the 5th U.S. Circuit Court of Appeals before the ban on nearly all abortions in Texas lifted April 22.

Another author, Dr. Bhavik Kumar, an abortion provider, has sued state officials over access to abortion.

A second research brief published by the Texas Policy Evaluation Project said clinics canceled and rescheduled hundreds of appointments while the governor’s order was in effect and as the courts issued a flurry of different rulings.

In interviews with 10 people seeking access to an abortion, the brief said most had “to delay their abortion visits until they were past the 10-week limit for medication abortion, which many women prefer” and which can be cheaper. Half had an abortion performed, with one 26-year-old, who was unable to get a pill-induced abortion or travel out of state to get the procedure, telling the researchers she felt depressed and afraid.

A 30-year-old nursing student traveled more than 700 miles to New Mexico where she got an abortion after “learning her fetus had significant anomalies,” the brief said. She felt feverish on her return trip and was worried she had been exposed to the virus.

“For all of the people that we talked to, it was a time period where they were facing a lot of economic insecurity. They didn’t necessarily know when the next paycheck was coming in. They were confused about what was really happening in the state in terms of their ability to get services, and they found it very stressful to remain pregnant and try to figure out what they were going to do,” White said. “And that was true, regardless of whether or not they were able to get an abortion or whether or not they ended up continuing their pregnancy.”

The Texas Policy Evaluation Project’s researchers “evaluate the impact of legislation and policies in Texas related to family planning and abortion” and has received funding from the Susan Thompson Buffett Foundation and the Society of Family Planning, which says it supports abortion and contraception research. The foundation is one of the largest private funders of sexual and reproductive health work and has given money to pro-abortion access groups, according to media reports. Funders don’t design, interpret or approve the project’s research, it says.

Abbott’s office did not immediately respond to a request for comment.

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