Last year, Governor Rick Perry called the Texas Legislature to Austin for two special sessions, both focused on passing one of the country's most restrictive abortion laws. The new law, HB 2, put Democratic gubernatorial candidate Wendy Davis on the map after an 11-hour filibuster. It also began to unravel the ability for women across the state to access safe, legal abortion.
That pace of that unraveling is quickening. Last week, The Austin American Statesman reported that over a third of the state's abortion clinics had closed following the passage of HB 2, leaving only 24 clinics (and counting) in the entire state. And the Rio Grande Valley region made national news last week as the final two abortion clinics for the area, located in McAllen and Beaumont, closed their doors.
"Thousands of women will be denied local access to safe and professional abortion care for the first time since Roe v. Wade. For far too many, abortion continues to be legal in the state but in reality is simply out of reach," said Amy Hagstrom Miller, CEO of Whole Woman's Health, the organization that operated the two clinics.
Whole Woman's Health also operates a clinic in North Texas, where HB2 is rapidly making access to abortion is more difficult. The Fort Worth-based Whole Woman's Health Clinic performs between 80 and 100 abortion procedures per week, and even that isn't meeting the demand. Whole Woman's Health Clinic is one of only two abortion clinics in Fort Worth, and there are a total of only six clinics serving North Texas' 2.5 million women.
Fort Worth's Whole Woman's Clinic may also be in danger of closing. HB2 requires doctors who perform abortion procedures to have admitting privileges at a nearby hospital, and mandates that abortion clinics meet the standards of ambulatory surgical centers. The Fort Worth Planned Parenthood abortion clinic is an ambulatory surgical center, but Whole Woman's is finding it much more difficult to receive that designation. In order to continue services, they will need to find an ambulatory surgical center that will allow them to perform procedures there, or make costly upgrades to their facilities.
"The costs for ambulatory surgical centers are significant," said Whole Woman's Health spokeswoman Fatimah Gifford. "This means that clinics will have to pass these costs onto patients. Waiting times have increased, and the demand for abortion procedures means that not everyone will get an appointment. It also means that some clinics will close because they weren't able to find or become an ASC."
People far and wide need to come to Dallas-Fort Worth to access abortion care, along with the thousands of women living just a few hours north, east, or west of the city. Merritt Tierce, executive director of the Dallas-based Texas Equal Access Fund, said she fields calls from cities as far as Lubbock, Amarillo, Odessa and Midland.
"Women get online to find an abortion clinic, and they don't find one in their area. They've all closed. They find that Dallas is the closest place for them to go," said Tierce. For patients as far away as Lubbock or Brownwood, this means spending money on travel and hotels, and missing a lot of work.
Getting an abortion in Texas means several trips to a clinic, most of which critics of HB2 and other restrictive abortion laws consider unnecessary. If a woman needs a medical abortion, commonly referred to as "the abortion pill," she can expect to visit a clinic four times. Surgical procedures require two visits with a physician, and all abortion procedures are subject to a statutory 24-hour waiting period.
With women's options dwindling, clinics are busier and more thinly stretched than ever. Some are open seven days a week. In Dallas, both Abortion Advantage and Southwest Women's Choices, two of the city's four clinics, are open six days a week.
Someone women opt not to have an abortion at all.
"They can either figure out how to pay for the procedure and jump through the hoops, or they can carry a pregnancy to term that they don't want," Whole Woman's Health's Gifford said. "You also never know what desperate measures people will take if they are in desperate situations."
Merritt Tierce's group, TEA Fund, helps women deal with some of the financial burden caused by HB2. Through private donations, TEA Fund provides financial assistance to women who are unable to pay for abortion procedures. Like the clinics, TEA Fund is also struggling to meet the need.
"Our hotline is only open three hours a day, and in that time we field 30 calls. We try to call everyone back, but most days we can only help two or three people because our financial resources are extremely limited," Tierce said. "We're doing extreme triage out here. It's bleak."
The new rules also have been difficult for the doctors who provide abortion services. Most abortion providers also maintain busy obstetrics practices, which makes shouldering an increased workload at the abortion clinic difficult. Clinics are struggling to recruit new doctors to come to Texas because of the restrictions on providing abortions. Many providers fear that they could be putting themselves and their families at risk of violence by moving themselves to Texas. "You'd have to be a crazy, radical pro-choice activist to come provide abortions here," Tierce half-joked. "If there are any out there, though, we need you."
Whole Woman's Health, Planned Parenthood, and other clinics joined together to sue the State of Texas after the passage of HB 2. District Judge Lee Yeakel ruled parts of the law unconstitutional, but the 5th Circuit U.S. Court of Appeals immediately issued a stay that allowed the law to go into effect after an appeal from Attorney General Greg Abbott.
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For now, the clinics play a tenuous waiting game with their budgets and the courts while trying to provide abortions to Texas women. When the ambulatory surgical center requirement takes effect in September, there could be as few as six clinics in the entire state of Texas. In Dallas, only Southwest Women's Choices meets the law's requirements, along with the Planned Parenthood clinic in Fort Worth.
The fate of HB 2 sits in the hands of the conservative 5th Circuit Court of Appeals. Many reproductive rights activists predict that the law will be upheld, and ultimately head to the Supreme Court. The bill's champion in the courts, Attorney General Greg Abbott, could also end up in the Governor's mansion come November.
Meanwhile, Tierce and TEA Fund are working to educate the women who call them for help about the political circumstances that have made abortions so difficult to obtain.
"Most people don't know about HB2," Tierce said. "It's a result of decades of work by the anti-choice movement to make these procedures impossible. I can't give someone the full history in a phone call, but we do think it's important to make those connections with women between the political and ideological movements and their personal circumstances."