6 Abortion Clinics for 13 Million Women? Inside Texas' Latest Assault on Women's Rights

Human Rights

All eyes were on Texas last July, when Democratic State Sen. Wendy Davis’ day-long filibuster and activists’ chants temporarily blocked a bill containing some of the most restrictive abortion regulations in the country. But after the spotlight faded and the bill — House Bill 2 (HB2) — ultimately passed, Texas was left with 24 clinics to serve the whole state of 26 million as 14 abortion clinics were forced to close. In September, when the law fully takes effect unless blocked by court challenges, Texas may be left with only six abortion clinics.

Outside the Lone Star state, the political world is weighing Wendy Davis’ campaign for Texas governor, which was propelled by her courageous defense of reproductive rights. But inside Texas, a scramble has ensued among a small community of women’s health organizers to help women needing abortions.

“People aren’t really interested in focusing on these issues when there aren’t hot button legislation things or riots happening at the Capitol, but there are literally lives at stake every day here,” said Noreen Khimji, a member of the Cicada Collective, a group of volunteers who provide travel services as well as informational and emotional support to North Texas women.

“Everyone who contacts us is definitely in a lot of need and under dire circumstance,” she said. “There are people who can’t access clinics at all.”

These dire circumstances brought about by HB2 have changed how Texas women can find and get abortions. The bill’s strict regulations on medication abortions, for instance, are making some women choose to have in-clinic abortions instead. Meanwhile, several grassroots groups have formed to offer transportation and money, while those already in place have faced extra burdens. HB2 also has put more burdens on abortion providers. Fewer doctors are now allowed to perform abortions, and the clinics that have remained open are swamped with additional patients.

“We’re just doing triage at this point,” said Merritt Tierce, executive director of Texas Equal Access Fund, a volunteer-based, non-profit that has helped low-income women fund abortions for nearly a decade. They receive 30 calls each day, she said, but can only afford to help three or four women.

This disastrous state of affairs is just the beginning. Matt Angle founder of the Lonestar Project, a Texas political research organization that encouraged Davis’ run for governor, emphasized that the closure of these clinics go beyond restricting access to abortion, but also cuts access to basic healthcare, family planning services, cancer screenings and pre-natal care. He is hoping the real-world impact of anti-abortion Republicans will translate into votes for Wendy Davis when she runs against Gregg Abbott for the state governor seat come November.

“There’s no question that by Republicans aggressively moving to withhold access to healthcare to millions of Texas women that it creates a motivating factor for them,” Angle said.

The State of (Abortion in) Texas

Texas, which was a Republic before it became the 28th state, has always been its own world. Today, with more than 26 million residents, it’s the second most populous state in the country. It’s also the second largest state in the country, so vast that if it were a nation, it would be the 40th largest in the world. Those distances come into play when women needing abortions look at their options.

Currently, with just the 24 clinics left in the state after the first part of HB2 went into effect in November, access to abortion has been extremely hard to come by, especially for low-income women. Not only do they have to find the means to pay for the procedure, which typically costs $300-$1,000, they have to travel extra distances multiple times.

This hurdle is what inspired Lenzi Sheible to create Fund Texas Women, a volunteer group that funds low-income women’s travel costs to clinics. Sheible was a volunteer at an organization that helped fund abortions, but knew that after HB2 passed, women would also need help with funding their transportation. Since last November, Fund Texas Women has spent $12,000 funding 37 women’s trips to abortion clinics.

In one striking example, Fund Texas Women spent $1,200 on one woman alone, Sheible recounted. The woman, who lived in a rural area, didn’t have a ride and her nearest Greyhound bus station was an hour from her home. Taking the train would drop her off hours away from the nearest abortion clinic. The group gave her the funds to take a taxi four hours to the clinic and back. Her child had to go as well because her family refused to help by watching him, as they did not approve of her abortion.

“Our job is to help those people who have nowhere else to turn,” Sheible said.

Another consequence of HB2 is that Texas women are now avoiding medication abortion, the easiest abortion procedure, because that means they have to visit a clinic four separate times —first to get a sonogram, one time for each of the two pills used, and then a mandatory followup. Prior to HB2, women only had to make the first two clinic visits because they could take the second pill in the privacy of their home. The bill also banned medication abortions from after nine weeks to after seven weeks. 

As a result, more women are choosing surgical abortions, said Sean Mehl, a patient advocate at one clinic. He said medication abortion means the woman has to “be there close to four days in a row, and that often changes their minds.”

The law has also made delivering reproductive care “chaotic,” Mehl said. First, his clinic had to shut down and scramble to secure the one doctor they worked with who had hospital admitting privileges, a requirement of HB2. Working with the doctor’s schedule, they had to cut down offering the procedure from five days each week to three. On those days, Mehl said, they try to schedule as many procedures as possible, sometimes upwards of 60 to 70, and work for about 12 hours.

Waiting times have increased. While they try to schedule women the same week they call, Mehl said sometimes they can’t make an appointment until two weeks from the call, forcing some patients to find a clinic elsewhere. One woman told him she was going to fly to Baltimore to get the procedure instead.

But not everyone has that ability—which underscores how HB2 especially hurts the poor.

“What we’ve always seen and the reason we exist is that low-income people are much more penalized by these restrictions than people who have any resources,” Tierce said, adding that immigrant women living in the Rio Grande Valley have absolutely no access to abortion.

Those who are undocumented would have to pass through checkpoints to get to their nearest abortion clinic as the Valley’s last clinics have closed due to the law. Even those who are documented usually only have visas that restrict travel past these checkpoints. A report from the Center for Reproductive Rights and the National Latina Institute for Reproductive Health found that many of these women are forced to get abortion pills on the black market or risk going to Mexico to obtain them.

The report stated:

While the informal market is an important source of low-cost reproductive health medicines and contraception, these goods can be ineffective, inappropriate to women’s individual health care needs, more likely to be used incorrectly because women do not receive proper instructions, and, in some cases, dangerous to women’s health.

Texas Equal Access Fund helps low-income women who need somewhere between $100 and $400. But Tierce said once they reach their funding cap each day, they can’t do more. They return many of the calls to tell women they are out of money and to call the next day. When it comes to deciding whom to help, Tierce said that while the fund tries to help callers in the order they are received, in the end the process is often random.

“When there’s so many people who need so much, sometimes it can start to feel arbitrary,” Tierce said. “And it’s hard to make a judgment call, and it’s hard to try to categorize people based on their experiences.”

Tierce said that women they are able to help are extremely thankful and some even imply they almost did what women did pre-Roe v. Wade — attempt to self-induce an abortion.

“So many times people will speak in these euphemisms like, ‘I was thinking about doing something,’ meaning, ‘I was to the point where I would have harmed myself in order to not continue this pregnancy and because you gave me 50 bucks, I didn’t have to do that,’” she said. “It’s really heartbreaking to hear that over and over, to hear people being so grateful. They’re put in a position where they have to beg for help, and they feel so indebted to someone just for giving them their human right and what should be part of standard health care.”

It Was Easier to Get An Abortion in Texas Decades Ago

It wasn’t always like this in Texas. Native Heather Busby, executive director of NARAL Pro-Choice Texas, remembers a time in the 1990s when abortions were much easier to access and teens got free contraception at a family planning clinic close to her high school. But when Republicans increasingly began getting elected as state officials and legislators, restrictions began rolling in.

In 2003, the "Women’s Right to Know Act" was passed, requiring all abortion doctors to tell women about adoption options as well as scientific falsehoods like abortion increases the risk of breast cancer and infertility. Women then had to take 24 hours to “reflect” on the procedure. The same year, the state also ruled that any abortion occurring after 16 weeks would have to be performed in an ambulatory surgical center — a hospital-like center unnecessary for the abortion procedure that takes five to 10 minutes, Busby said. Requirements for these centers include certain hallway widths, a certain number of parking spaces, both men and women’s locker rooms, and even certain landscaping requirements.

It took two and a half years to build abortion clinics that met ambulatory surgical center standards. During this period, women seeking abortion after 16 weeks were forced to go out of state. The six clinics built to meet the requirements were then able to offer abortions to Texan women 16 to 24 weeks into their pregnancies. HB2, however, banned abortions in Texas after 20 weeks when it partly went into effect. When it goes fully into effect in September, these six clinics will be the only clinics left. In 2011, 73,200 women obtained abortions in Texas — hardly an amount six clinics could manage.

Mehl said his clinic is in the process of looking for a new space that would serve as an ambulatory surgical center. “As much of a strain as it is on all of us personally, we’re all doing everything we can, and we will continue doing everything we can to remain open,” he said. “We would be devastated to close.”

HB2 also began requiring all abortion doctors have admitting privileges at their nearest hospital, meaning the doctor would have permission to use equipment in the hospital’s emergency room. Without privileges, a woman would still be able to receive emergency care at hospitals, a rare occurrence anyway — for one Texas abortion clinic, two times in 10 years. These privileges are hard to obtain, and hospitals, which are mostly affiliated with religious institutions, do not have to explain why they decide not to grant them.

Throughout the past decade, Texas has also passed laws requiring every woman to receive an ultrasound before an abortion and minors to receive adult consent for contraception from non-federally funded clinics. It also lost federal funding for its Medicaid waiver program for low-income women’s reproductive care and cut family planning funds by two-thirds, forcing 60 family-planning clinics to close. A 2012 survey by The Texas Policy Evaluation Project found that 45 percent of Texan women seeking abortion were unable to access the birth control they wanted to use, while 23 percent reported “at least one structural barrier such as cost, lack of insurance coverage, and inability to find a clinic.” Meanwhile, it has spent more than $1 million on abstinence-only sex education projects,

Busby said it’s “going to be a long road” to restore adequate women’s healthcare in Texas. “But I’m optimistic logic and commonsense will prevail,” she said.

The Hope and Odds of a Wendy Davis Win

Perhaps the first step in that long road is removing power from the radical right-wing in Texas.

Tierce said Texas Republican Representative Jodie Laubenberg, HB2’s sponsor, was a straw woman carrying the bill — created by other anti-abortion legislators — and knew little about how the bill worked and how it would supposedly improve women’s health. 

“I observed a lot of the proceedings over the summer,” Tierce said. “And it would have been possibly humorous if it weren’t so devastating that she couldn’t answer any questions about her own bill.” But in the Republican-dominated Texas statehouse, that incompetence didn’t matter. “The Republicans have such a chokehold on the legislature that she didn’t have to answer. She sort of fumbled around to find an answer. But she can just have said ‘I table’ and moved on. There’s nothing we can do.”

These frustrations have drawn national attention, as Davis runs against state Attorney General Gregg Abbott for governor. Abbott has a hard-core, anti-abortion position.

When Planned Parenthood, the ACLU and other groups filed a lawsuit against HB2 and a federal district judge found the hospital admitting privileges unconstitutional and issued an injunction the day before Nov. 1, Abbott filed an appeal and an emergency motion to stay the injunction so the law could go into effect as planned. And when an anti-abortion, three-women judge panel recently voted to overturn the district judge’s injunction, Abbott celebrated. (Now, the Supreme Court may pick up the case. In the meantime, the Center for Reproductive Rights has recently filed a second lawsuit.)

“You couldn’t have more of a stark contrast between the candidates,” Busby said.

Knowing that lack of reproductive services is deeply troubling to women, Abbott has yet to clearly answer if he supports abortion in cases of rape or incest. And his hostility toward women’s rights extends further than abortion. He’s stated he would veto an equal pay act for women, and female attorneys in his office are paid less than men on average.

“Gregg Abbott is basically Ted Cruz without the sneer,” the Lonestar Project’s Angle said, adding that Texas Republicans have become more extreme in recent years, not less. “Very few people would challenge the notion that, right now, George W. Bush couldn’t get nominated in the Republican Party in Texas because he’d be seen as too liberal.”

Angle said the challenge will be getting women hurt by HB2 to vote next fall, especially in the state’s communities of color. The lack of access to healthcare has been a motivating factor for voting among Hispanics and women, he said. But the Hispanic vote continues to lag— down into the 20-30 percent range of eligible voters compared to more than 50 percent for whites and blacks.  

“The real challenge for anybody running statewide in Texas is to do the type of organizational work it takes to increase participation among Latino and African American voters,” he said.

Texas’ restrictive voter ID laws, however, obstruct a lot of these voters from taking part in the electoral process. Texas Rep. Marc Veasey (D-Fort Worth) has sued the state of Texas over these voter ID laws, and a trial is set for Sept.

“Republicans in Texas — they get the joke,” Angle said. “They understand that as participation in elections increases, that it reduces their ability to hold onto power. So they made a very cynical decision that rather than try to win the votes on the support of Hispanic, African American, women or young voters, that it’s easier to suppress their vote.”

Meanwhile and Beyond

For now, the political activists and women’s health advocates who stood with Wendy Davis a year ago are gearing up to get out the vote while still providing needed reproductive healthcare.

“What happened last summer in Texas was truly unprecedented. We saw thousands of people come out to the Capitol … to testify in front of committee hearings and participate in the process in a way that I’ve never seen in the state,” Busby said. “Now they’re getting involved in becoming deputized to register voters, they’re working in their communities, they’re showing up for events, they’re getting educated, they’re getting activated. It breathed some new life into our movement in a way that I would have never expected a year ago.”

Tierce, like other reproductive rights advocates, knows this is a long and uphill fight. “Even if the legislation were overturned tomorrow and everything went back to the way it was before HB2 — it was still really hard to get an abortion before HB2,” she said. “We have a long way to go before abortion is accessible the way that it should be. And yeah, we do have to change the laws, but we also have to change the public consciousness. And that takes a lot of time, a lot of effort and a lot of people talking about abortion like it’s normal — and it’s a word you can say and it’s a procedure you can have.”

Meanwhile, on the frontlines, the right-wing war on Texas women continues.

“It’s scary that we’re definitely facing a lot of really terrifying opposition here,” Khimji said. “There are a lot of people who really want to control people’s bodies. And even if it didn’t happen, it’s still a real threat I think because a lot of lengths people go through to try to prevent people from carrying out their autonomy. ”

Pro-life protests have grown outside clinics, Mehl said, and they have turned women away.

“Sometimes, I’ll call people that don’t show up for the day, and it’s really heartbreaking when I speak with someone and they tell me, ‘Well, I talked to someone outside, one of the protesters, and they changed my mind,’” he said.

For now, the tens of thousands of Texas women seeking abortions every year are facing increasingly ugly obstacles and being forced into ever more desperate choices. Whether Davis and other Democrats win in fall’s election is an open question, just as it’s unclear how quickly a change in political power can reverse Texas’ statewide lockdown for reproductive care. The only thing that’s certain is HB2 has rolled back the clock for Texas women.  

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