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The Texas ban on most abortions had been in effect for a little more than a week when a staff email landed in Jeffrey Hons’ inbox.
Hons, CEO of Planned Parenthood South Texas, knew his staff was fielding calls from people seeking abortion care, even though the organization’s clinics had immediately suspended those services when the law went into effect Sept. 1.
Providing any abortion care could invite a deluge of lawsuits from private citizens who had been empowered to enforce the new restrictions. The risk was simply too high.
The email said most callers expressed “defeat and disappointment” when they realized an abortion in Texas was no longer possible.
Many of them accepted referrals to out-of-state abortion providers. A few did not.
“One mom called on behalf of her daughter and expressed outrage, stating that this was a horrible law,” the email continued. “And despite attempting to offer the mom information about where they could travel to and the financial resources that could help them, the mom gave up and said, ‘No, it’s just too far, so never mind.’”
In a matter of weeks, Senate Bill 8 — one of the most restrictive abortion laws in the country — has thrown reproductive health care services across Texas into disarray.
Like Planned Parenthood South Texas, which operates eight health clinics in San Antonio and the Rio Grande Valley, most providers are turning away all people seeking abortions for fear of costly litigation targeting anyone who “aids or abets” an inducement or procedure.
Those that are still providing abortions for women in the earliest weeks of pregnancy, including Alamo Women’s Reproductive Services in San Antonio, can now treat only a limited number of patients. The law prohibits abortions past the point at which cardiac activity can be detected in an embryo, typically around six weeks’ gestation. Many women do not become aware of their pregnancy until later in the first trimester.
And unlike most legislation limiting abortion access, SB 8 allows no exceptions for fetal abnormalities, rape or incest, stating that pregnancies can be terminated only in cases where a doctor identifies a “medical emergency.”
The law also has placed doctors and other health care providers in a precarious position.
Physicians who provide abortion care are unable to prescribe medications or perform procedures they know are safe — much safer than carrying a pregnancy to term — and that are endorsed as an “essential component of women’s health care” by the American College of Obstetricians and Gynecologists.
Other OB-GYNs, including those who do not perform abortions, are treading lightly during conversations with patients, wary that the law’s opaque wording could allow their medical advice to be misconstrued as assisting someone who may later end their pregnancy.
“We are in this window of uncertainty. All my colleagues are asking me, ‘What are we allowed to say?’” said Dr. John Thoppil, president of the Texas Association of Obstetricians and Gynecologists and a practicing OB-GYN in Austin. “And I don’t think any of us really know.”
SB 8 already has resulted in litigation against one provider. Dr. Alan Braid, a San Antonio physician, was sued by plaintiffs from other states after he disclosed in a Washington Post essay that he had provided an abortion Sept. 6, compelled by his “duty of care” to the patient.
On Friday, a federal judge in Austin will consider whether to grant the Justice Department’s request to temporarily block the ban while it is being challenged in court.
But providers and advocates do not expect a quick resolution to the case, and they fear it is a harbinger of further curtailment of abortion access across the country.
On Wednesday, a Florida legislator filed a bill modeled after SB 8, and lawmakers in other states are expected to follow suit. In December, the U.S. Supreme Court will hear arguments over a Mississippi law that would ban most abortions after 15 weeks of pregnancy.
To protect abortion rights, the U.S. House of Representatives passed a bill Friday to legalize the procedure. But the legislation is expected to fail in the Senate.
In the meantime, Texans with the ability to travel are flooding abortion clinics in neighboring states. But far more people do not have such privileges, experts say, forcing them to find another way to obtain an abortion or continue with an unwanted pregnancy.
“Restrictions impact those who have less means to circumvent them,” said Amanda Stevenson, a University of Colorado at Boulder sociologist who studies the effect of policies for abortion and family planning.
For those individuals, Hons said, “it just begins to feel insurmountable.”
A ‘frantic surge’
In the 22 years that Hons has led Planned Parenthood South Texas, he has been in the thick of the protracted, decades-long battle over abortion.
During his tenure, state legislators have passed increasingly onerous regulations on abortion care, including medically unnecessary requirements such as mandatory ultrasounds and 24-hour waiting periods. The number of Texas abortion clinics dwindled to two dozen, half as many as there were in 2013.
The building where he goes to work every day is a living reminder of that history.
Completed in 2015, the organization’s headquarters in the South Texas Medical Center meet the costly standards of a surgical center, in compliance with House Bill 2, which also required abortion centers to employ physicians with admitting privileges at a nearby hospital.
HB 2 was struck down by a landmark Supreme Court ruling the next year, rendering the need for the $6.5 million health center moot. But the damage was done — it had already triggered the permanent closure of about half the abortion clinics in Texas.
Despite all that, Hons was still taken by surprise when the justices allowed SB 8 to go into effect. Surely, he had thought, they would not allow enactment of a law that legal experts widely agree is unconstitutional.
But some women in San Antonio and South Texas saw the writing on the wall.
Before the introduction of SB 8, the volume of people seeking abortions was low enough that they were only performed a few days a week at the Planned Parenthood locations on Babcock and San Pedro, with 15 to 30 patients typically treated at a time.
During the last few days of August, Hons said, there was a “frantic surge” of abortion patients. His staff worked 12-hour shifts, sometimes providing more than 100 abortions on a single day.
When September arrived, the mad rush ended.
The calls for abortion services did not stop, but they decreased over time as the ban became international news and people encountered a message in bold font on the affiliate’s website: “Due to Texas’ SB 8 law, we are unable to provide abortion procedures at this time.”
Going out of state
While most abortions came to a halt in Texas, providers in Oklahoma, New Mexico, Colorado and Louisiana have been inundated with Texas patients. Some clinics are booked solid or are expanding their hours to meet the demand.
In its request to suspend SB 8, the Biden administration described the desperation fueling the patients. Clinics were receiving calls from sexual assault victims, minors and women who were carrying a fetus with abnormalities or experiencing medical problems themselves.
There was a mother who drove with her children for 15 hours to obtain a medication-induced abortion; a child who traveled from Galveston to Oklahoma after being raped by a family member; a woman who was trying to arrange out-of-state travel without her abusive husband finding out; patients who, by the time they arrived in another state, no longer qualified for a medication inducement and instead had to undergo a surgical procedure.
Even those in less dire circumstances had to contend with lengthy trips and logistical hurdles.
“Women are being forced to travel hundreds — and sometimes thousands — of miles to obtain an abortion under harrowing circumstances in the middle of a COVID surge,” the court filing said.
For many others seeking an abortion, going to such lengths is simply impossible.
For the millions of Texans who lived hundreds of miles from state borders, traveling to another state is costly and time-consuming. Even if their expenses were covered, a lack of child care or time off from work would still block many from leaving, said Stevenson, the Colorado researcher.
As a result, the restrictions deliver the biggest blow to the most vulnerable, including low-income women, those who already have children, people of color, immigrants and residents in rural areas.
Fear of lawsuits
Since abortion was legalized in the U.S., the strictest bans passed by states have been enforced only for a matter of weeks. If SB 8 is soon suspended, Stevenson said, it will still have affected an untold number of lives.
“A single person who doesn’t get the abortion that she seeks impacts the whole rest of that person’s life, as well as their family’s life,” said Stevenson, who previously researched the effect of Texas’ family planning policies.
In addition to unwanted pregnancies, Stevenson’s research indicates that SB 8 will likely lead to more maternal deaths.
In a forthcoming paper, she projected that if abortion was banned in the U.S., which has one of the highest maternal mortality rates among developed nations, pregnancy-related fatalities among Americans would increase by 21 percent in two years and 33 percent for Black mothers.
Patients with conditions such as diabetes and heart disease that increase the chance of pregnancy complications could have their lives “compromised” by the abortion ban, said Thoppil, the Austin OB-GYN. Such risks rise in the absence of prenatal care, which is already difficult to access for Texans on Medicaid, which many OB-GYNs do not accept, and those living in counties that do not have a single specialist for expectant mothers.
Physicians, meanwhile, are trying to navigate the confusion sparked by SB 8.
It is routine for OB-GYNs to offer screenings to their patients to identify inherited conditions or genetic abnormalities in a fetus, some of which may be fatal if the pregnancy continues to full term. In cases where a problem is identified, doctors would typically explain a patient’s options, including termination of the pregnancy. Similar conversations are customary in cases of unintended pregnancy, Thoppil said.
But some physicians are now reluctant to provide even basic medical information, he said, for fear of inviting “frivolous” lawsuits.
“This is affecting patient care, even outside of abortion,” Thoppil said.
Abortion alternatives
Along the Texas-Mexico border, many women were already living with the reality of no access to abortion services.
Kathleen Broussard, a sociology researcher pursuing her doctorate at the University of Texas at Austin, said that even before SB 8, Texas had one of the highest estimated rates of self-managed abortions, especially among Latinas in border cities.
For the greater part of the past two years, she has surveyed more than 150 of those people, whose reasons for operating outside the formal health care system varied. Some lived too far from a clinic. Others were undocumented and thus “in limbo,” prevented by immigration checkpoints from traveling north in Texas or south to Mexico.
So they took matters into their own hands.
The most reliable option was to receive mifepristone and misoprostol, medications that induce an abortion, by mail. The World Health Organization recognizes self-managed medical abortions in the first trimester as safe and effective.
Organizations such as Aid Access, a Europe-based nonprofit, mails pills to women around the world, including in the U.S. Its founder, Dr. Rebecca Gomperts, has said she will continue prescribing pills to Texans, regardless of the legality.
But Broussard found that people with the least access to resources turned to acquaintances or complete strangers, including connecting with people over social media to obtain pills. Others resorted to unproven methods — herbs, teas and supplements — as well as dangerous ones — abdominal trauma, starvation or insertion of items into the uterus.
When SB 8 came along, Broussard said, it felt like her work “was almost terribly encapsulated in this bill.”
“There are a range of things people try when they’re in a desperate situation where they can’t access abortion,” she said.
lcaruba@express-news.net
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