August 13, 2014 / 2:45 PM / 5 years ago

Texas emblematic of national battle against abortion providers

AUSTIN (Thomson Reuters Foundation) - Conservative state legislatures are waging an effective fight to close down the nation’s abortion clinics, and nowhere is that battle more evident than in Texas, with one of the most restrictive abortion laws in the country.

If a challenge to the state law fails in federal court, as of Sept. 1, there will be seven abortion providers left in Texas, the country’s second largest state by population and area, with 26 million people in an area about three times the size of the United Kingdom. That is a plummet from 41 providers in May 2013.

“This has been an ongoing, unprecedented level of attacks on access to women’s health services,” said Sarah Wheat, vice president for community affairs at Planned Parenthood of Greater Texas, which operates in the northern and central regions of the state.

Currently there are 19 abortion providers, according to the Texas Policy Evaluation Project (TxPEP). The ongoing study, based at the University of Texas at Austin, analyzes the impact of laws affecting reproductive health passed since 2011 by the state legislature, which meets in odd-numbered years.

In the 2011 session, lawmakers cut two-thirds of funding for family planning programs, denied funding to family planning clinics affiliated with abortion providers, and set off an initial wave of clinic closures.

Further whittling down the number of abortion providers in Texas is House Bill 2 (HB2) - which supporters argue protects the health and safety of women, and critics maintain imposes unnecessary, burdensome regulations on abortion providers and obstructs access to abortion services.

Passed in July 2013, HB2 has four requirements, variations of which are seen in many similar state laws around the country:

The first three parts of the law became effective in November 2013 and resulted in a cascade of more clinic closures. The ASC requirement, which, along with the admitting privilege mandate in two south Texas clinics, is part of the current legal challenge in federal court, is slated to take effect Sept. 1.


For a variety of reasons, the admitting privileges provision has spurred the majority of clinic closings, according TxPEP. Many doctors come from out-of-state. Eligible rural hospitals may not be close enough to clinics, and many hospitals, especially those affiliated with religious groups, are reluctant to associate with abortion providers.

Supporters of the admitting privileges rule argue that it provides continuity of care for women who have abortion-related complications. Opponents point out that complications are rare — less than 1 percent in the first trimester, during which period 89 percent of all abortions take place — and that admitting privileges have no bearing on whether a woman is admitted to an emergency room.

Furthermore, building new facilities or updating existing structures to meet rigorous hospital-like ASC standards can cost up to $3 million and are beyond the means of many existing clinics.

Supporters say ASCs also enhance women’s safety. Critics call them unnecessary for providing safe abortions, more than 60 percent of which occur in non-ASC clinics nationally, according to the Guttmacher Institute, a nonprofit organization that works to advance reproductive health through research and policy analysis.

If the ASC requirement is enacted, the surviving providers would be in major cities, leaving women in vast swaths of the state, particularly rural areas, up against significant barriers, including up to 500 miles (800 km) round trip, to access abortion services.

For rural Texan women, many of whom are low-income, the distance, lost wages and expenses for travel, lodging and childcare may make access to abortion virtually unattainable.

“This is an issue that people don’t care about until they need it, and most believe they won’t,” said Amy Hagstrom Miller, founder, president and CEO of Whole Woman’s Health.

In 2011, 73,200 women in Texas believed they did need an abortion and got one, according to the Guttmacher Institute.


Hagstrom Miller, who operates clinics in Texas, Maryland and Minnesota, is the lead plaintiff in the current legal challenge being argued by lawyers for the Center for Reproductive Rights.

She has closed three of her five clinics in Texas since the abortion law took effect in November 2013 and will be left with one - an ASC in San Antonio - if the final provision of the law takes effect on Sept. 1.

Having seen years of efforts to overturn Roe v. Wade - the 1973 Supreme Court decision that upheld a woman’s right to abortion - anti-abortion activists recently took their legal battle to the state level.

It has been an effective strategy. Six states currently have only one abortion provider each: Arkansas, Missouri, Mississippi, North Dakota, South Dakota and Wyoming.

Between 2011 and 2013, states passed 205 abortion restrictions, compared to 189 laws passed in the entire previous decade, according to Guttmacher.

Critics argue that these TRAP laws (Targeted Regulation of Abortion Providers) do nothing to enhance women’s safety – as supporters say – and simply aim to curtail access to abortion.

The current battle over HB2 may eventually be taken up by the U.S. Supreme Court. Meanwhile, the state faces the prospect of a dozen more clinics closing in a few weeks.

“I think a lot of states are looking to see what happens in Texas,” said Brook Randal, an emergency room doctor at a hospital without obstetric and gynecological services. Randal stopped doing abortions at Whole Woman’s Health after the admitting privileges requirement went into effect.

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