The Difficulty of Getting an Abortion in Texas

Can pro-choice groups prove that the state has made it too hard to terminate a pregnancy?
Lucy Maude Ellis/flickr

AUSTIN, Texas — In October, Susan, a woman who lives in Willacy County in Texas’ southernmost tip, found out she was pregnant. She is married and has three children, and for a few weeks last fall, she couldn’t afford her birth control. Her condition, to her, was not entirely good news.

“I weighed out the pros and cons,” she said. “But I didn't want to have another baby.”

Susan asked her gynecologist about getting an abortion, but the doctor said she didn’t perform the procedure. For women in her area, there was only one place to go: Reproductive Services of Harlingen, where Dr. Lester Minto has been providing abortions since 1990. She made an appointment, sat anxiously in the packed waiting room, and got it over with quickly, she said.

By the time she came back for a follow-up visit two weeks later, Minto was no longer offering abortions. In fact, the entire Rio Grande Valley—an area with 275,000 women of reproductive age—is now without a single abortion provider.

What happened in the interim was the implementation of one of the provisions of House Bill 2, a state law that pro-choice activists called one of the harshest anti-abortion measures in the nation. It prohibited abortion after 20 weeks, added restrictions to medicated abortions, and mandated that abortion providers have hospital-admitting privileges at clinics within 30 miles of where they practice.

Starting in September of this year, it will also require all abortion clinics to conform to the standards of ambulatory surgical centers, which include specifications on everything from the spacing of the hand-sanitizer dispensers to the flooring of the janitor’s closet.

In a state where a person can drive for hours without encountering much more than cattle and brush, just 27 percent of Texas’s 630 hospitals are located in rural areas. Of the 34 abortion clinics that were open in the state in October 2013, 12 closed in November because their doctors weren’t able to secure admitting privileges. (Three of them have since reopened to at least partial capacity). Of those 25 clinics, only three are currently licensed surgical centers that are staffed by a doctor with admitting privileges.

Now, women who live in Willacy County must drive 120 miles to Corpus Christi, where the nearest physician with admitting privileges struggles to keep up with a torrent of new patients. Starting in September, they will have to drive 250 miles, to San Antonio, to visit the nearest abortion clinic that’s also a surgical center. And because a 2011 Texas law required women to first get an ultrasound, then wait 24 hours before getting an abortion, they would likely have to stay overnight.

“I know I'm a good mother and I provide for my children, but I see a lot of kids who aren't wanted, and I think it's going to be even worse now with this law,” Susan said. “I remember it cost me $1,000 just to give birth to my last child. And the abortion was $550.”

The new law has been embroiled in a bitter legal war since its passage last summer—a vote that itself was famously filibustered for 13 hours by the pink-sneaker-clad state Senator Wendy Davis. In October, a panel of judges at the Fifth Circuit Court of Appeals in New Orleans said the law requiring doctors to have admitting privileges can take effect while the case works its way through the system. The court acknowledged that the provision “may increase the cost of accessing an abortion provider and decrease the number of physicians available to perform abortions,” but said the state’s goals were ultimately aligned with the public interest.

Last week, a coalition of abortion providers argued before the Fifth Circuit Court of appeals that Texas’ expansive terrain—and the capriciousness of hospitals’ decisions—means not every abortion doctor will be granted admitting privileges, and desperate women will suffer as a result. They say that more than 22,000 women would be left without any meaningful access to abortions.

Throughout the legal back-and-forth, the state has maintained a persuasive counter-argument: Abortions would still be available in the state, after all, and the pro-choice groups so far haven’t been able to offer proof that specific women would be hurt by the new restrictions. “Aggregate information from providers,” they said, doesn’t constitute demonstrating an “undue burden” on women’s abortion rights, as would be required for the law to be unconstitutional.

I discovered a similar problem when reporting on reproductive laws in Texas. Though countless abortion clinics and providers made themselves available to me, they could not put me in touch with a single woman who has so far been affected by the new law. Even Susan, though she squeaked in just before the deadline, was ultimately able to terminate her pregnancy. When I asked roughly a dozen pro-choice groups for examples of patients who had suffered under the law, they responded either that nobody wanted to come forward out of privacy concerns, or that it’s hard to know when someone isn’t able to do something. Without standing in the living rooms of newly pregnant women as they attempt to make appointments or scrounge for gas money in order to trek to far-away clinics, it’s impossible to determine when an obstructed abortion results in an unplanned birth.

"Susan" is a pseudonym—she asked to remain anonymous because, as she told me, “I would be judged for my decision.” In a place where few women want their names associated with the “a” word, long drives and overnight stays are powerful deterrents. The question for the courts is, do they make for an “undue burden?”


An abortion clinic exam room in Austin. (Olga Khazan)

HB2 is in good company: More state abortion restrictions were passed between 2011 and 2013 than in the entire previous decade, from 2001 to 2010, according to the Guttmacher Institute, a pro-choice nonprofit.

The story of Texas’s own abortion-limiting thrust begins in 2011, with a law that required women to have an ultrasound 24 hours before an abortion and to hear both the fetus’ heartbeat and a description of its body.

Writing in the Texas Observer, Carolyn Jones recalled her doctor describing her own sonogram: “Here I see a well-developed diaphragm, and here I see four healthy chambers of the heart…,” he said, as Jones sobbed.

A friend of mine recently went to one of the few clinics in Dallas where an OB-GYN still has admitting privileges. After her sonogram, the doctor read a required script on the health dangers of having an abortion, which included scientifically disputed information on the procedure’s negative psychological consequences and its link to breast cancer.

“You know this is all b.s., right?” my friend said the doctor told her. “It’s just that I have to tell you this.”

Women who live in remote towns sometimes stay overnight near their clinics to avoid making two trips. Local abortion funds, which normally help subsidize the costs of the procedures themselves, have started raising money to cover gas and hotel expenses, as well.

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Olga Khazan is a staff writer at The Atlantic, where she covers health.

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