Texas’ abortion-restrictive legislation, signed into law by Republican Gov. Rick Perry a year ago today, has caused a 50% reduction in abortion clinics and forced thousands of women to travel farther for care, reproductive rights leaders and members of Texas advocacy groups said on a conference call Thursday afternoon.
The first part of the omnibus legislation, which fully took effect on Nov. 1 last year, bans abortion after 20 weeks of pregnancy, forces women to follow outdated protocol and make more trips to the clinic when undergoing medication abortion and requires physicians to have admitting privileges at a hospital no further than 30 miles of where the abortion is performed.
The second part – set to be enforced on Sept. 1 – requires clinics to meet building code compliance that match the standards of ambulatory surgical centers, costly upgrades out of reach for the majority of remaining clinics. Opponents of the ASC rule see it as medically unnecessary and purposefully burdensome. Health leaders estimate the final provision will shutter 14 clinics, leaving no more than 10 abortion care clinics to serve the entire state.
In May 2013, 41 clinics provided abortion services; by Oct. 31 eight clinics closed or stopped offering the service. By Nov. 1, 2013, 11 more clinics shuttered or discontinued abortion services. As of June, only 20 clinics provide abortion care in Texas. The number, contend reproductive rights leaders, may fall to as few as six or seven facilities, located in just five major metro Texas cities – Dallas, Ft. Worth, San Antonio, Austin, and Houston.
Founder and CEO of Whole Woman’s Health, Amy Hagstrom Miller, described the abortion care landscape as “dire.” Miller’s network of five Texas clinics has shrunk to three; following the implementation of the final section of HB 2, only one ASC-compliant center located in San Antonio will survive. Miller said she has heard “harrowing stories of self induction” and seen several “attempts to travel hundreds of miles for care.”
Indeed, distance and travel time to clinics is steadily rising, said researcher Dr. Daniel Grossman, vice president of research for Ibis Reproductive Health and co-investigator for the Texas Policy Evaluation Project (TxPEP) – a multiyear study that tracks the impact of Texas legislation on women’s health care. Sharing new research, Grossman’s team estimates the number of reproductive age women living 50 miles or more from an abortion clinic increased from 800,000 in May 2013 to 1,700,000 in April 2014. When the ASC requirement goes into effect, that figure will increase to nearly 2 million. The number of women living 200 miles or more from a clinic similarly increased from 10,000 in April 2013 to nearly 300,000 in April 2014. When the ASC rule kicks in, the number of these women will jump to 750,000.
Grossman and researchers cast doubt on the ability of a handful of remaining ASCs to handle the influx of thousands of displaced patients: In 2012, only 21% of abortions were performed in ASCs, according to data from the Department of State Health Services. In the first six months after HB2 went into effect that figure has not substantially increased, researchers found. “We are very concerned that the small number of ASCs will not have the capacity to meet the demand for abortion services in the state,” said Grossman.
The result is predicted to yield longer wait times, delays in accessing care, higher costs, and the possibility of increased rates of unwanted births as well as a rise in self-induction.
Marva Sadler, director of clinical services at Whole Woman’s Health, calls the impact of HB 2 on her patients “absolutely maddening.” Sadler shared the story of a patient who made a 10-hour trek from Lake Charles, La., to the Whole Woman’s Austin clinic. The mother of three would have been able to access safe and convenient service at the network’s Beaumont location, had HB2 not forced the clinic to close in March. Unable to afford gas and hotel lodging for the two round-trips, the patient and her family – desperate for care – said Sadler, decided to park their RV in the Whole Woman’s lot. She also pointed to patients from nearby cities, like Ft. Worth, who have experienced long wait times for an appointment due to the rise in new patients, displaced in their local communities.
“We see women driving long hours and long distances, which adds unnecessary logistical and financial challenges just to get the health care that they need and deserve,” she said. “[...] We receive calls from many women who don’t understand the law and are shocked and irritated by all the barriers to accessing care.
“More often than not, we are realizing the practical efforts of this law are to prevent women from accessing safe, compassionate, and professional care,” said the health clinic director. “[HB2] is creating pointless barriers and dire situations that will ultimately create a health care crisis.”
This week, Planned Parenthood announced the construction of an ASC in Dallas and has plans to open up an ASC in San Antonio. However, even with these centers, reproductive rights advocates argue the network will be destroyed beyond immediate repair.
For more on the impact of HB 2, read our coverage in next week's issue (July 25, 2014) of The Austin Chronicle.
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