Abortion access still strained even after landmark US supreme court ruling

Clinics including Whole Woman’s Health, the plaintiff in the case, face financial obstacles and infrastructure problems after years of crippling anti-abortion laws

Moments after the supreme court struck down a law threatening to close half the abortion clinics in Texas, a banner appeared outside the Austin headquarters of the lead plaintiff, Whole Woman’s Health. “We won!” the sign boasted in big block letters. “Our clinics stay open.”

Only this clinic did not.

The building, a low-slung facility just off the highway, is a symbol of how profoundly anti-abortion activists have reshaped abortion access in the US, even as they reel from a setback in the supreme court of historical proportions.

Until two years ago, this building was an abortion clinic. Then a new law – one of the nation’s harshest – required all Texas abortion facilities to meet expensive, hospital-like building standards, compelling all providers to have patient admitting privileges with a nearby hospital. The clinic was unable to satisfy either regulation and forced to close in July 2014.

Monday saw the supreme court strike down these requirements as unconstitutional. The decision emphasized the lack of medical evidence showing that such laws make abortion, a simple outpatient procedure, safer.

But Amy Hagstrom-Miller, the Whole Woman’s Health CEO and founder, is not sure if the former clinic in Austin, which Whole Woman’s Health and local reproductive rights groups use as an office suite, can ever again serve as an abortion clinic.

“Just because you have a legal win doesn’t mean you can restore the infrastructure and rebuild immediately – or maybe ever,” she said. “It’s not just a matter of will or gumption or desire on my part. It breaks down to: how would we be able to afford this?”

Abortion providers are making these same calculations across the country. During the three-year battle to strike down Texas’s law, House Bill 2, copycat laws emerged in more than half a dozen states, devastating abortion access.

“It is beyond rational belief that HB2 could genuinely protect the health of women,” and was not simply aimed at closing clinics, Justice Ruth Bader Ginsburg wrote in her opinion to strike the law down.

Amy Hagstrom-Miller
Amy Hagstrom-Miller, president and CEO of Whole Woman’s Health, smiles as she walks from the US supreme court on Monday. Photograph: Kevin Lamarque/Reuters

The ruling was a huge victory for clinics, but many women are still traveling farther, and spending more money to have abortions than any time in recent memory. Today, there are still one million Texas women who live more than 100 miles from the nearest abortion clinic.

Texas, Arkansas, Alabama and Tennessee in the south, and states like Wisconsin, Michigan and Ohio in the midwest have lost around 40 clinics to hostility and new restrictions in the past five years. Huge parts of Mississippi and Louisiana are also without providers.

“The impact of these laws could last for decades,” Miller said.

In the three years that Whole Woman’s Health fought the Texas law to the supreme court, HB2 forced the group to shut down clinics in Beaumont, Austin, McAllen and Fort Worth. Only two of those, in McAllen and Fort Worth, reopened. And at each location, it cost several hundred thousand dollars to reopen, Miller said – to renegotiate contracts with vendors, turn on the utilities, restock the medical supplies, hire a security firm and new staff and buy new equipment. “You can’t just turn the lights back on,” she said.

Other providers have voiced the same concern. “This ruling was huge in a lot of ways, but women are still in a position of scrambling to even get through our doors,” said Willie Parker, the chair of Physicians for Reproductive Health and the only abortion provider in the state of Mississippi.

One way of looking at Monday’s ruling, Parker said, was that it left things the way they were. “And none of us are satisfied” with the way the map reads now.

Nowhere is this legacy more apparent than in west Texas, where clinics closed from Amarillo to Odessa to San Angelo. There are no abortion clinics for the 550 miles between San Antonio, in the center of the state, and El Paso at the border with New Mexico.

Among the other closures was a Planned Parenthood clinic in College Station, the site of Texas A&M University. Desirae Embree had an abortion there as an undergraduate, and she remembers driving past the building after its new owners had toppled the Planned Parenthood sign in the parking lot. The building now belonged to an anti-abortion crisis pregnancy center.

Today, the nearest clinic to College Station is two hours away, in Austin. Only one clinic is operating anywhere south of San Antonio. That includes the Rio Grande Valley, which is home to more than a half a million mostly low-income, Latina women.

“Nineteen is not enough clinics for a state with 5.4 million women of reproductive age,” said Jessica González-Rojas, director of the National Latina Institute for Reproductive Health. “It won’t be enough until abortion access is available in your language, in your community.”

HB2 shut down Reproductive Services of El Paso in June 2014. That October, citing the dearth of providers in west Texas, an appeals court gave the clinic permission to operate once again.

But it would take another full year for the clinic to actually reopen. By the time of the court’s ruling, said Marilyn Eldridge, the clinic’s owner, Reproductive Services had dismantled much of its operation. Its license had lapsed, the furniture had been donated, and its medical equipment was now in use at a sister clinic in Tulsa. The landlord had sold the building. The staff had found new jobs, and in one case, retired.

It cost Reproductive Services $50,000 to restock its medical and office supplies alone. When finally the clinic was ready to reopen, the Texas health department refused to rule on its licensing application. It required intervention from the Center for Reproductive Rights, the legal group whose lawyers challenged HB2 before the supreme court, before the department would issue the license. Miller wonders if the department will do the same for other prospective clinics.

US supreme court abortion
Abortion rights activists celebrate on the steps of the US supreme court on Monday. Photograph: Pete Marovich/Getty Images

“There were times we didn’t think we were going to reopen,” said Gerri Laster, Reproductive Services’ administrator.

Miller and others fear that most of the 20-some clinics shuttered by HB2 are gone for good.

“Routh Street Women’s Clinic will never reopen,” said Ginny Braun, the former clinic’s director.

The clinic, one of about a half-dozen to disappear around Dallas, closed for two weeks in 2014 when a court briefly enforced HB2’s hospital-like building requirements. In June 2015, with the law temporarily enforced again, the clinic closed for good. The uncertainty she and her staff experienced during that first closure, Braun recalled in an email, was just too punishing.

“The phones never stopped ringing and it was a terrible time for all – patients and staff. We had dismantled much of the clinic and were prepared to begin the process of emptying the building.” Then a lawyer called to say that the HB2 had been blocked again. Staff spent all night reassembling the clinic. “The pace and demand was unsustainable,” Braun recalled. “Some of the longtime staff simply could not go through this nightmare again, and did not return.”

Routh Street saw its last patient on 13 June 2015. Wait times for women seeking an abortion now stretch up to 23 days in the Dallas–Fort Worth area.

Miller has thought seriously about opening an abortion clinic in a city that no longer has one, but a giant roadblock is money.

“I have the willpower and the resilience, but I don’t have the capital. The only way I could rebuild, reopen, and sustain my business in Beaumont, or try to help Corpus Christi – I would need to raise money,” Miller said.

It can also be difficult to establish a new clinic. Reproductive Services of El Paso, for instance, is struggling to get health care providers, a large source of referrals, to realize that the clinic exists.

But the clinic has found itself attracting a new stream of patients. They hail from towns – Odessa, Midland, and Lubbock – where HB2 saw local abortion access blown off the map. “We didn’t even see them coming,” said Laster, the clinic’s administrator. “But where else would they go?”

Additional reporting by Tom Dart in Austin


Molly Redden

The GuardianTramp

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