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JULY 25, 2014
a u s t
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All but Illegal
As the final provisions of HB 2 loom,
Texas abortion clinics brace for closure
B y M a r y T u M a
On a balmy Saturday evening, July 12,
reproductive rights activists, many with
tears in their eyes, took turns recounting
aloud their experiences fighting one of the
most draconian abortion laws in the coun-
try. Roughly 30 people donned orange (sym-
bolizing the pro-choice movement) or black
to gather at the Capitol, mourning the one-
year anniversary of the passage of House
Bill 2. The modest vigil, organized by local
activists, provided a space to reflect on the
wins and losses in solidarity with fellow
advocates. While less widely publicized than
the previous week’s celebration, attended by
hundreds, of the one-year anniversary of the
filibuster against the bill by state Sen. and
now gubernatorial candidate Wendy Davis,
D-Fort Worth, it was certainly heartfelt.
“The moment I realized the politicians
didn’t care about the truth; didn’t care about
our health; didn’t care if we lived or died – it
was both horrifying and liberating,” said
Geraldine Mongold, one of the thousands
who crowded the Capitol last summer to
protest HB 2. “It freed me from being con-
genial – from being awed by their authority,
and reminded me that this Capitol and this
government belong to me.”
The mixture of grief and hope among the
participants reflected the range of emotions
felt by those who are now coming to grips
with the bleak post-HB 2 reality. The first
part of the Republican-backed omnibus
legislation, which took effect last Nov. 1,
bans abortion after 20 weeks of pregnancy,
forces women receiving pharmaceutical
abortion to follow outdated and more expen-
sive protocols, and requires physicians to
have admitting privileges at a hospital with-
in 30 miles of the clinic where the abortion
is performed. The law has triggered a wave
of clinic closures, eliminated abortion care
in large areas of the state, and produced
severe disruption for vulnerable patients.
The numbers alone are chilling – in 2012
there were 44 abortion clinics in Texas; as
providers braced for HB 2, the number
dropped to 34. After the law was initiated,
by November 2013, 24 clinics remained.
Today, the number fluctuates
between 20 and 24, as a few
clinics have closed and then
reopened. However, the num-
ber is expected to dwindle to
fewer than 10 on Sept. 1 – when
the final requirement imposed
by HB 2 takes effect, forcing
clinics to make costly building
changes in accord with ambu-
latory surgical center (ASC) standards. Only
five Texas cities – Dallas, Fort Worth, San
Antonio, Austin, and Houston – have clinics
guaranteed to remain open. This in a grow-
ing state of 26 million people.
With about 75% of the population living
outside those metro cities, and, according to
the Department of State Health Services,
some 70,000 abortions performed annually
in Texas, reproductive health leaders say
that the state’s abortion care landscape,
already heavily beleaguered by restricted
women’s health funding, will become a
logistical nightmare and a (greater) public
health crisis.
Crafted to Close the Clinics
By September, after more than a decade
as a trusted Austin abortion care provider,
the Whole Woman’s Health clinic at the
intersection of I-35 and U.S. 183 will close
its doors. Over that time, the clinic has
offered full spectrum, holistic family plan-
ning and preventative health services –
annual exams, pap smears, birth control,
emergency contraception, and counseling,
in addition to abortion care (for roughly half
of patients served) – to some 60,000 women.
“Barring some miracle in the courts, we
really have no choice; the state is forcing us
to close,” says Amy Hagstrom Miller, found-
er and CEO of Whole Woman’s Health.
Miller’s network of five reproductive health
clinics in Texas is slowly disintegrating
under the weight of restrictions imposed by
HB 2. Following the hospital-admitting
privileges section of the law, Whole
Woman’s Health clinics in Beaumont and
McAllen ceased operations in March, and
the Fort Worth location is not an ASC; the
only surviving ASC-compliant clinic will be
in San Antonio.
While the rhetorical defense of the law,
declaimed by bill authors, conservative
public officials, and anti-choice supporters
on the chamber floors last summer, was
based on strengthening women’s health
and safety (albeit without medical evi-
dence), reproductive health leaders describe
the legislation as a thinly veiled attempt to
close clinics by drowning them in unneces-
sary costs and nonsensical regulations.
Overseeing both ASC and non-ASC centers,
Miller attests the requirements hold no
basis in science or medical fact and provide
no improvement to women’s safety. In fact,
the rule will have the reverse effect – it will
threaten the health of women due to the
inevitable shortage of providers.
“There is no medical reason for these
physical plant requirements; they have
nothing to do with safety,”
says Miller. “They are sole-
ly a barrier and a political
football.” Health leaders
point to the double stan-
dard set by HB 2 – while
abortion care centers must
comply with ASC rules, Texas law does not
require any other outpatient procedure to
be performed at an ASC. For instance, it
permits more complex and life-threatening
procedures like plastic surgery and outpa-
tient birthing (childbirth carries 14 times
the risk of abortion) to be performed in
non-ASC centers. Miller is far from the
only voice against the measure – major
medical organizations such as the Ameri-
can Congress of Obstetricians and Gyne-
cologists call the requirements “overreach-
ing” and “unsupported by scientific evi-
dence.” The facility changes – which
include widening hallways, increasing ceil-
ing heights, implementing HVAC system
requirements, and adding bathrooms, jani-
torial closets, and parking spaces – can cost
anywhere from $750,000 to $3 million in
construction fees, a price far out of reach
for largely independent, locally affiliated
abortion providers.
Despite receiving a record-breaking,
nearly 20,000 public comments, most of
them negative, regarding the ASC rule, the
Department of State Health Services
declined to change the regulation, conclud-
ing no comment “provides any basis to
believe that abortion providers would be
unable to make [the] adjustments and …
comply with the rule.” They noted that
“some licensed abortion facilities may not
be financially capable of complying” with
the new regulations, nevertheless, the
agency cannot “accurately estimate the
impact of the adopted rules on licensees.”
While DSHS “recognized these potential
consequences,” they also considered the
state’s “vital interest in preserving poten-
tial life and improving patient safety,”
ultimately concluding the ASC standards
would “not unduly burden a woman’s right
to an abortion.”
While Miller calls the ASC requirements
“ridiculous” and blatantly politically moti-
vated, she has sought funding to adapt.
Although Planned Parenthood recently
announced the creation of a new ASC-
compliant center in Dallas, as well as one in
San Antonio, in preparation for the contro-
versial rule, the mostly smaller, indepen-
dent abortion providers don’t have access to
the same resources. Miller has reached out
to several banks and funding organizations
to help underwrite the millions in building
costs – but no one is jumping to sign a
check. “Texas abortion
provision is not an invest-
ment that people are inter-
ested in at this point in
time,” says Miller. “It’s
seen as a dicey, high-risk
move – every time the
Legislature meets, a new
barrier is passed. So it’s
not something banks or
funders feel good about.”
Additionally, says Miller,
there’s no way to show in a
business model that their
centers could even afford
the hefty loan. “We don’t
have the revenue to sus-
tain that kind of lease payment,” she said.
“It’s impossible.”
Abortion clinic closure brought on by a
burdensome financial hurdle is precisely
the outcome anti-choice politicians sought
with the ASC rule, says Miller. Their wish is
becoming a stark reality. Across Texas, an
estimated 14 non-ASC centers will share the
same fate as the Whole Woman’s clinic in
Austin, leaving as few as six abortion care
centers to serve a population of 5.4 million
“There is no medical reason
for these physical plant
requirements; they have
nothing to do with safety.”
– Amy HagstromMiller
reproductive health
leaders estimate fewer
than 10 abortion clinics will
survive after September.
amy HagstromMiller, founder and
CEO of Whole Woman’s Health
p h o t o s c o u r t e s y o f
w h o l e
w o m a n ’ s h e a l t h