Thursday's decision, which will close about one third of the clinics that provide abortion care in Texas, will change the landscape of women's health care infrastructure in the state, maybe permanently.
We used to think change couldn’t happen overnight. That’s certainly not the case in Texas, where in the last 24 hours the landscape of abortion access has changed drastically. Many women who went to bed anticipating an abortion appointment today woke up to find their clinic closed thanks to yesterday’s U.S. Court of Appeals decision that the state’s draconian abortion regulations do not constitute an undue burden on women.
That decision immediately shuttered clinics whose abortion providers do not have hospital admitting privileges within 30 miles the clinic. We don’t know yet know the exact number of closures, but information from the Texas Equal Access (TEA) Fund and the Lilith Fund – important organizations that enable low-income women seeking abortion care to access it by helping to pay for the procedures – put that number at between 13 and 15 out of a total of 36 clinics across the state. Some parts of the state, such as the Lower Rio Grande Valley – home to two of the nation’s poorest counties – are left with no provider at all.
Of the clinics that remain open, many have some physicians on staff who have not obtained admitting privileges and as of today cannot perform abortions. Those clinics will be forced to serve fewer patients at the very time more and more women from across the state will rely on them for care.
The most recent decision is the latest in the never-ending onslaught on women’s rights in the state of Texas. It comes only three days after a federal judge blocked the law because he believed it would be deemed unconstitutional and found it to be “without a rational basis and place[ing] a substantial obstacle in the path of a woman seeking an abortion.” But, as The New York Times reported, the appeals panel came to the opposite conclusion, saying the admitting privileges rule is in fact constitutional because it serves a “legitimate state interest” by regulating doctors and does not impose an undue burden on the right to abortion.
Women seeking abortions just before the 16-week mark are especially in trouble today. There are currently only two facilities in Texas that perform abortions between 16 and 20 weeks. But the closure of so many clinics today and in the coming weeks will force women seeking abortions to traverse the state to access care, which will likely increase the number of procedures that have to happen in this window. This travel requires time and resources that many women simply do not have.
As part of the sweeping anti-abortion legislation passed this summer, Texas lawmakers today also implemented a ban on abortion after 20 weeks and a law that providers must adhere to out-of-date regulations for medication abortion.
For women needing an abortion at or after 20 weeks in Texas there are few options. Abortion at this stage of pregnancy is outlawed in neighboring Louisiana, Oklahoma, and Arkansas. Women could travel to Albuquerque, NM, but the city will soon hold a special election for a ban on abortion past twenty weeks, so that could be off the table too.
Abortions occurring after this gestational limit represent a small fraction of the total. Conservatives demonize women seeking later term abortions as being lazy, careless or irresponsible. This couldn’t be further from the truth. The reality is that the majority of women who seek an abortion this late in pregnancy do so because they learn of a fetal abnormality or are unable to afford one sooner; for those whose economic circumstances preclude them from accessing care when they first need it, traveling across or out of the state is just not possible.
The requirement that physicians use an outdated protocol on medication abortion is a blatant attempt to throw one more obstacle at women seeking the procedure. The original FDA guidelines require a higher dosage of medication than is necessary, carry higher risks of complications, require four visits to a clinic, and restrict the procedure to seven weeks. The more current protocol followed by nearly all providers in the U.S. and around the world calls for a lower dose and enables women to access it up to nine weeks of pregnancy. So on the one hand, anti-choice lawmakers chastise women for not seeking abortions early in pregnancy, and on the other they make it nearly impossible and less safe for women to access the procedure as soon as possible.
In Texas, conservative politicians and anti-choice activists have been maniacally focused on decimating the health infrastructure that serves as a point of primary care for hundreds of thousands of low-income women. Since 2011, 76 family planning clinics have closed. Now at least a third of the state’s abortion providers – the majority of which also provide a full range of women’s health services – are closed. This is nothing short of a crisis situation.
Lindsay Rodriguez of the Lilith Fund said, “All of these regulations disproportionately fall on low-income, rural women, and women of color. When lawmakers say a lot of women still have access, it’s not the people who need it most.”
Conservative lawmakers insist that all of the restrictions and regulations are in fact in the best interest of women. Nothing is more disingenuous. As my colleague Susan Holmberg and I wrote in August, restrictions on family planning and abortion do nothing but create more unintended pregnancies, more abortions, more sexually transmitted diseases, and push abortions into later stages of pregnancy.
Women’s health advocates are sure to appeal yesterday’s ruling. But in the meantime clinics are closed. Lights are shut off, staffs are let go, buildings are sold and women are just stuck. Conservatives have left their mark on the health of Texas women for the foreseeable future. You can tear down an infrastructure overnight, but building it back up will take far longer. Even if yesterday’s decision is overturned, women in Texas will be left without the care they need for years to come.