Two abortion clinics in Texas are closing, bringing the state's total down to 20 as abortion providers struggle to stay open under new state laws.
The two clinics—located in McAllen and Beaumont—are the last remaining providers in rural areas. Those that remain are clustered in major cities, leaving low-income women in rural Texas without nearby access to abortion.
More closures are likely to follow: Under House Bill 2, an antiabortion bill passed last November, all clinics are required to close by Sept. 1, 2014, unless they have on-site ambulatory surgical centers. Of the 20 remaining clinics, only six meet that standard and are likely to remain open.
There were 44 abortion clinics in Texas in 2011.
House Bill 2—the most restrictive in a recent wave of state-level antiabortion laws—gained national attention last summer when Democratic state Sen. Wendy Davis filibustered the bill for 11 hours. It nevertheless passed the Legislature shortly after during a second special session called by Republican Gov. Rick Perry in July 2013.
Along with the surgical-center clinic requirement, the bill bans abortions after 20 weeks; bans medical abortions after seven weeks and requires women to visit the clinic four separate times to complete the procedure (one visit for a sonogram, a second and third for doses of a drug, and a fourth for a follow-up); and requires all physicians conducting the procedure to have hospital admitting privileges within a 30 mile radius.
The first three provisions went into effect Nov. 1, forcing a wave of clinics to close immediately. The surgical-center requirement will go into effect Sept. 1.
The two clinics whose closings were announced this week are operated by Whole Woman's Health. McAllen stopped providing abortions in November when the bill went into effect, while Beaumont ceased procedures a week and a half ago. Both have technically remained open while the owner tried to find a solution.
Company CEO Amy Hagstrom Miller says the medical-abortion limitation has been the hardest part of the law for patients, but admitting privileges and ASC requirements have been most difficult for clinics.
"I've been a little more stubborn or a little more stupid," she told National Journal. "I've tried to keep them open and lost a lot money."
Neither clinic has an ASC, and Hagstrom Miller says she doesn't have the budget or patients to build a multimillion-dollar center. The Beaumont clinic does currently have a physician that has hospital admitting privileges, but he is 75 years old and trying to retire. Attempting to get hospital admitting privileges has proven a fruitless process; the stigma against abortion is too great in Texas, and Hagstrom Miller has not been able to get responses from any doctors or hospitals, despite calling them all.
"I have trouble getting a vendor for bottled water," she says.
Both Beaumont and McAllen are border communities with predominantly low-income residents. According to data from Whole Woman's Health, 22 percent of the Beaumont population is below the federal poverty level. Patients at this clinic are 40 percent African-American, largely single and uninsured, and between 19 and 35 years old. The facility sees 1,200 patients each year.
In the McAllen community, just over 27 percent of residents are below the poverty level, and only 15 percent have insurance. Clinic patients are largely Hispanic, married, uninsured, and about 30 years of age. The clinic sees 1,700 patients annually.
Beaumont is the only abortion facility between Houston and New Orleans. The next closest is in Houston, which is 90 miles away.
McAllen is currently the only abortion provider remaining in the Rio Grande Valley. The closest alternative is in Corpus Christi, 150 miles away, but this clinic lacks an ASC, and faces closure in September. The next closest is in San Antonio, which is 230 miles away.
The difficulty in travelling these distances—an impossibility for many women who lack the funding to do so—is compounded by the fact that Texas law requires multiple visits for a single procedure. A 2011 law requires women to see the doctor twice—first for an ultrasound, and again for the abortion. This disproportionately affects rural clinics, which often fly in physicians who don't live in the area. For some women in these areas, needing to cross the border adds an additional obstacle.
Hagstrom Miller says women who have the means to travel will, but women who don't will try to find other ways to terminate their pregnancy.
"The law didn't do anything to prevent need," she says. "Under any kind of prohibition like this, you'll see clandestine operations come up—the need is still there."
Advocates of H.B.2 maintain it is beneficial to women's health, by holding providers to higher standards. "This is an important day for those who support life and for those who support the health of Texas women," Perry said upon signing the bill into law.
Opponents argue it is purely political. A lawsuit filed by Planned Parenthood, the American Civil Liberties Union, the Center for Reproductive Rights, and a Texas law firm challenged the admitting privileges provision of the law, saying it restricts access and endangers women's health. Whole Woman's Health is involved in the lawsuit. An injunction was originally granted that would stop the provision from going into effect, but it was appealed by the state. The case is currently held in the 5th Circuit Court, with a ruling expected any day.
However, even if lawsuits against the bill are successful, it could be very difficult to reopen clinics once they have already been closed.