Texas’ sweeping abortion law has already eliminated all abortion clinics south of San Antonio, and the last clinic west of the city is expected to close once the final piece of the law takes effect September 1. Under the new regulations, physicians who perform abortions must obtain admitting privileges at nearby hospitals and abortion facilities are required to meet expensive ambulatory surgical center standards, the final piece of the law, a requirement that medical experts nationwide have deemed unnecessary.
Since last November, clinics have closed left and right statewide because of these restrictions, and some of San Antonio’s three remaining abortion providers have increased hours to serve not only local patients, but also women from the Rio Grande Valley and far West Texas. However, high travel costs keep most potential patients from getting here.
Amy Hagstrom Miller runs the Whole Woman’s Health abortion provider network in Texas. Right now, the San Antonio location is the only facility in the city operating an ambulatory surgical center, and it will remain open after September 1. McAllen’s Whole Woman’s Health closed last year, and since then, Miller said her organization has purchased 15 gas cards and bus tickets for women to travel the more than 200 miles to San Antonio. The McAllen clinic used to treat about 45 women weekly, she said, so she knows more need help.
“We’re here and ready, but the vast majority of women can’t add those travel costs to the cost of an abortion or they can’t take off work,” she said. “There will be access in San Antonio, but abortion becomes out of reach for so many women.”
According to research by the University of Texas’ Texas Policy Evaluation Project and California-based Ibis Reproductive Health, more than 930,000 Texas women will live more than 150 miles from an abortion facility come September 1, and will consequently have to travel should they need an abortion. In Texas, women are also required to get a sonogram 24 hours before their procedure, so any trip to another city would require an overnight stay.
Women living along the border often barely make enough money to survive let alone afford an overnight trip to another city. According to the Texas State Data Center, the median income for women living in border counties ranges from about $12,500 to $17,000 annually, which is well below the poverty level for a family of three and lower than the statewide average. Filling up a gas tank or buying a round-trip plane or bus ticket from McAllen to San Antonio is out of the question for those who rely on every dollar they earn. The rising cost of childcare, advocates say, also plays a role.
Still, some women make the trip. Dr. Alan Braid, of San Antonio’s Alamo Women’s Reproductive Services, said more than half of the 150 patients he sees weekly are from McAllen, Corpus Christi and Midland-Odessa, all towns with no clinic.
“This law actually is going to make things more dangerous for women, because they will be putting off when they can come because of availability and distances that they have to travel,” he said. “If I sprained my ankle and I had to travel 300 miles round-trip to get treatment, I wouldn’t say that would be good medical care.”
A large percentage of women living on the border are Hispanic, uninsured and don’t have consistent access to preventive care or birth control. When the 2011 Texas Legislature cut more than $70 million from the state’s family-planning program, nine out of 32 family-planning clinics closed in the Valley and thousands of women lost services, leaving them especially vulnerable to serious health problems and unplanned pregnancies.
“This is and will disproportionately affect low-income women, and it’s just another example of Texas leaving behind people of color, poor people and people disproportionately impacted by income barriers,” said Lindsay Rodriguez, president of the Lilith Fund. Her volunteer-based organization runs a hotline for women seeking financial assistance for their abortions.
Wait times at the remaining clinics have also increased and Rodriguez said callers report that they have to schedule their appointments weeks out and further into their pregnancies, making the procedure even more expensive. And women who can’t afford it will turn to other, less safe options.
“Women will feel desperate and turn to unscrupulous providers, and there will be people who it doesn’t even occur to them that they’ll be able to afford it,” she said. “There is no way to quantify the number of people who never make it to a clinic.”
Two major provisions of the law are being challenged in court. Earlier this year, U.S. District Judge Lee Yeakel found the admitting privileges requirement unconstitutional, but a conservative three-judge panel of the federal 5th Circuit Court of Appeals in New Orleans quickly overturned his ruling, leaving the requirement in place while the full court decides whether to hear the case. A second lawsuit challenges the ambulatory surgical center requirement, and lawyers on behalf of Whole Woman’s Health and other independent abortion providers spent a week in Austin this month presenting evidence that the law imposes medically unnecessary restrictions on abortion facilities and creates an undue burden for women. The State contends the law promotes and improves the health and safety of women, and that traveling doesn’t present a “substantial obstacle.” Yeakel is also presiding over that case and had not issued a ruling at press time. (Follow The Daily blog at sacurrent.com for updates.)
The six or seven abortion clinics in Texas that are expected to stay open after the surgical center requirement takes effect are located in five major cities—Austin, San Antonio, Houston, Dallas and Fort Worth—leaving large swaths of Texas without a provider. Data already show that the need in other parts of the state isn’t going away and some women are already making the trip. According to UT and Ibis Reproductive Health, 4,034 abortions were performed in San Antonio between November 2013 and April 2014—roughly the same number as before the law took effect. During those same six months, 15 percent of women from the Rio Grande Valley seeking abortions in Texas got their procedures in San Antonio.
Whole Woman’s Health plans to increase its hours to see more women at its surgical center. In San Antonio, Planned Parenthood plans to rent space at another local surgical center so staff physicians can continue performing abortions while the organization raises money to build its own facility. Dr. Braid, of Alamo Women’s Reproductive Health, says it’s not an option for his clinic to be retrofitted to meet surgical center standards, which are largely construction-oriented and can cost millions of dollars to implement.
“We’re just keeping all our options open at this point. We haven’t committed to anything quite yet,” he said. Those options, he said, include buying an existing ambulatory surgical center or leasing space from one already open. “I see (abortion) as a part of women’s health, and I don’t see any other thing to do, but if we can’t overturn these laws, the only way to deal with it is to try to remain open and provide services as best we can for as many women as need these services in the safest possible way.”
(As of publication, the ambulatory surgical center requirement hadn’t taken full effect and Alamo Women’s Reproductive Services was still open and performing abortions at the clinic.)
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