“The Last Rural Abortion Clinics In Texas Just Shut Down”: Back-Alley Procedures Are About To Become A Lot More Common
Since November, the last abortion clinics in East Texas and the Rio Grande Valley, some of the poorest and most remote parts of the state, have been hanging on by their fingernails. The two clinics, both outposts of a network of abortion providers called Whole Woman’s Health, stayed open with slimmed-down staffs while their owner, Amy Hagstrom Miller, struggled to comply with the first chunk of HB2—the voluminous anti-choice law passed by the Texas legislature last summer—which requires abortion doctors to obtain admitting privileges at a local hospital. Today, after weeks of failed negotiations with nearby hospitals, Hagstrom Miller announced that both clinics are closing their doors.
The clinics in Beaumont, about an hour east of Houston, and McAllen, just north of the Mexico border in the Rio Grande Valley, were the last rural abortion providers left in Texas. Between July, when HB2 passed, and November, when the admitting privileges requirement went into effect, nearly half of the state’s 44 abortion clinics folded, unable to comply with the new rules. The health center in McAllen stopped offering abortions and pared down its staff, providing ultrasounds and counseling to the women who continued to walk in the door and helping them coordinate travel to the nearest clinic, two hours north in Corpus Christi. The Beaumont clinic survived this initial purge because one of its physicians had admitting privileges, but he’s in his seventies and wants to retire. His colleagues couldn’t get privileges in his stead, leaving the clinic in a precarious position.
“I had to come to terms with the fact that those clinics had no future,” Hagstrom Miller says. She might have kept looking for a way to keep them open, if she wasn’t facing a much bigger threat. In September, the rest of HB2 will go into effect, requiring all abortion providers to conform to the same standards as ambulatory surgical centers (ASCs), outpatient care units that offer more complicated procedures, usually involving high levels of anesthesia. Only one of Hagstrom Miller’s remaining three clinics, the Whole Woman’s Health in Fort Worth, qualifies as an ASC. Updating the other two clinics to comply with ASC regulations—which include wider hallways and specialized heating and cooling systems—could cost $6 million.
The Corpus Christi clinic (which isn’t one of Hagstrom Miller’s) also has until September to renovate. If that clinic closes, Rio Grande residents will have to embark on a five-hour trek to San Antonio. Women in Beaumont won’t have as far to drive, but they will have to make multiple trips. Under Texas law, women seeking an abortion must obtain a sonogram from the doctor who will be performing the procedure at least 24 hours ahead of time. If you live more than 100 miles from the clinic, you’re exempt from the law. Unfortunately for Beaumont women, their town is a mere 90 miles from the nearest abortion provider in Houston.
For many women, a long drive, an overnight stay, and a few days off work are a substantial burden, but not impossible. For the residents of the Rio Grande Valley, though, these new hurdles could make abortion as difficult to obtain as if it were illegal. McAllen is one of the poorest cities in the country, second only to Brownsville, another town nearby. Last fall, Sarah Posner documented some of the barriers that keep women in the Rio Grande from accessing basic reproductive healthcare like birth control. Unpaved roads, erratic electricity, and poor sanitation are common in the surrounding communities. Few of the Rio Grande’s residents have jobs with sick leave. By Hagstrom Miller’s estimate, around one-third of her patients are undocumented immigrants who can’t drive beyond the border checkpoints north of McAllen without risking deportation.
Rather than waiting for months to scrape together the money for the procedure and the trip—a Sisyphean task in itself, since the price for abortion skyrockets from as little as $300 in the first trimester to several thousand dollars by the end of the second—more women may take matters into their own hands. The Rio Grande Valley already has one of the highest rates of self-induced abortion in the country. A 2012 survey found that 12 percent of women in clinics near the Mexico border said they had attempted to end their pregnancy on their own before seeking professional help. “They’re getting drugs from Mexico, drinking teas, eating herbs, falling down the stairs on purpose or convincing their boyfriends to beat them up,” Hagstrom Miller says. “Any of those methods could be fatal.”
The problem is compounded by the Texas legislature’s decision, in 2011, to slash funding for family planning services. Dan Grossman, the vice president for research at Ibis Reproductive Health, a pro-choice think tank, has been investigating the effects of these cuts as co-principal investigator of the Texas Policy Evaluation Project at the University of Texas-Austin. In a 2012 survey of women seeking abortions, nearly half of the respondents said they hadn’t been able to obtain their preferred form of birth control in the past three months. “The cuts in family planning are leading to a rise in unintended pregnancy and an increased demand for abortion,” Grossman says. “More clinic closures means that women will have to wait longer to get the procedure, which means a higher risk of complications.”
In 2013, 38 percent of people living in the Rio Grande Valley were uninsured. When state-funded family planning clinics in the region folded, poor women lost their only source of affordable birth control. Now, some may be getting access to contraception once again, thanks to the rollout of Obamacare. But Texas’s refusal to participate in Medicaid expansion means that many Rio Grande residents will fall into the “coverage gap”—earning too much to be covered under Medicaid but too little to qualify for insurance tax credits—and won’t be able to get the no-cost birth control promised by the Affordable Care Act. Others are undocumented and unable to buy insurance on the exchanges.
Long wait times for appointments will undoubtedly become the norm. By next fall, when the ASC requirement kicks in, six clinics in major urban centers—Houston, Austin, San Antonio, Dallas, and Fort Worth—could be responsible for performing more than 70,000 abortions each year. Hagstrom Miller and others are fundraising to help poor women pay for transportation to these cities, but for many, a trip to Mexico to buy illegal abortion drugs might seem like a better bet.
By: Amelia Thompson-Deveaux, The American Prospect, March 6, 2014
“A Particularly Cruel Joke”: Texas Lawmakers Celebrate “Achievements” In Women’s Health As Thousands Go Without Care
The consequences of Texas’ sweeping new abortion restrictions are now being felt across the state, but the status of reproductive healthcare in Texas had been dire long before conservative lawmakers passed the omnibus measure to shutter reproductive health clinics, restrict safe abortion services and leave thousands of women without access to necessary care.
Texas lawmakers passed a two-year budget in 2011 that cut $73 million from family planning programs; the following year, Rick Perry dissolved the state’s partnership with the federal Women’s Health Program, forfeiting millions in Medicaid funding for low-income women’s healthcare. Lawmakers restored some of this funding in 2013, but reproductive health providers like Planned Parenthood are barred from receiving it. That Perry has refused the Medicaid expansion has further compounded the crisis that has been building in the state, the blunt impact of which disproportionately impacts low-income women of color.
Republican “reforms” to the system have resulted in a 77 percent drop in the number of women being served by state health clinics at an additional cost of around 20 percent. The maternal mortality rate — particularly among women of color — is on the rise, and Texas has the highest uninsured rate in the nation.
It is in this context that the Texas Health and Human Services committee’s decision to hold a hearing on the “progress” the state has made in women’s healthcare seems like a particularly cruel joke. The committee intends to “build on previous legislative achievements in women’s healthcare,” according to a statement on the hearing.
Activists in the state, who have remained focused on challenging the rollback of reproductive rights in the months since Wendy Davis’ marathon filibuster, descended on Austin Thursday to provide testimony and protest the show hearing.
“When I heard about the hearing — well, I felt like if the Daily Show was going to create a parody, they couldn’t have done a better job,” Amy Kamp, one of the women providing testimony at the hearing, told ThinkProgress. “If Texas wants to protect women’s health, I have a helpful suggestion. Just reinstate the old program we used to have!”
“It’s laughable that the same politicians that have devastated Texas women’s access to healthcare — cancer screenings, birth control, and safe, legal abortion — are now touting their so-called achievements in women’s health,” said Cecile Richards, president of Planned Parenthood Action Fund. ”If that’s what they call help for Texas women, we’ve had quite enough of it.”
By: Katie McDonough, Assistant Editor, Salon, February 20, 2014
Women in Louisiana could lose all access to abortion services if the state succeeds in enacting a secretive overhaul of its clinic regulations. The requirements are so stringent that every one of the five clinics currently operating in Louisiana would have to close, according to a lawyer advising the clinics. The new regulatory framework would also impose a de facto 30-day waiting period for many women—an exceptional requirement.
“What it amounts to is a back door abortion ban,” said Ellie Schilling, a New Orleans attorney. “The way the [Department of Health and Hospitals] went about passing these regulations was in a secretive and undemocratic way. The public definitely doesn’t know what’s going on.”
DHH enacted the overhaul just before Thanksgiving, when it passed the rules as an emergency measure, effective immediately—exempting them from the normal comment period. None of the clinics were given notice; one heard about the declaration of emergency from anti-abortion protestors.
It isn’t clear what emergency the agency was responding to. There has been virtually no reporting on the new rules, and DHH did not respond to questions submitted Monday. The Declaration of Emergency states that the agency proposed the licensing standards in order to comply with two acts passed by the Louisiana legislature in 2013, but a complete overhaul goes well beyond their demands. DHH formally declared its intentions to make the emergency rules permanent in December.
According to Schilling, the law gives the agency the ability to shut down every existing clinic in Louisiana immediately, by imposing new space requirements that none of the existing clinics meets. Providers would lose some of their rights to appeal noncompliance citations, while new and complex documentation and staffing requirements create more opportunities for DHH to cite clinics for deficiencies. “Deficiencies are used to create this impression of clinics being repeat offenders, and that’s a basis for revoking their license,” explained Schilling.
The regulatory overhaul would also give the state tools to prevent new clinics from getting a license. Proposed facilities—like a $4.2 million Planned Parenthood health center on South Claiborne Avenue in New Orleans—would have to prove to DHH that their services are needed; it’s unclear what criteria the agency would use to determine need. “It certainly seems that one intention is to prohibit Planned Parenthood from entering the market,” Schilling said. (Planned Parenthood clinics in Louisiana do not currently offer abortion services. “We are evaluating all our options” in light of the regulations, a spokesperson said.)
The new rules place a significant, unjustified burden on women by requiring that they undergo blood tests at least a month before an abortion procedure. That means that unless a patient happens to have gone to the doctor previously and had those tests done by chance, she will face a mandatory 30-day waiting period.
“I’ve never seen anything like this. It’s pretty outrageous,” said Elizabeth Nash, state issues manager at the Guttmacher Institute.
Louisiana already has a 20-week cutoff, and so the waiting period could dramatically shorten the window in which women are legally allowed to have abortions. There is no medical rationale for conducting those particular tests so far in advance; they are routinely conducted by providers prior to an abortion, and legislation passed in 2003 that tightened the laws governing Louisiana’s abortion providers stipulated that they had to be done within 30 days of the procedure. To the contrary, forcing women to delay the procedures increases their expense, and raise the risk of complications.
Dozens of other states have passed waiting periods or regulations, known as Targeted Regulation of Abortion Providers, or TRAP laws, which single out abortion providers with burdensome rules. But Nash said that a de facto 30 day waiting period combined with requiring clinics to prove need for their services makes Louisiana’s law striking. “It’s a great way to eliminate access,” said Nash.
All that’s stopping the state from completing the overhaul, Schilling said, is going through the motions of a public hearing. One is scheduled for Wednesday morning in Baton Rouge, but bad weather threatens to cancel it. It isn’t clear if the state would hold another hearing, as it was already scheduled at the very end of the comment period. Legal challenges would surely follow, but as Nash warned, rolling back clinic regulations in the courts is challenging.
“As it is right now, you have to go to the major cities to have procedure done. If these clinics close, where will the patients go? Then what are we back to? Back street abortions?” said Missy Cuevas, who is fighting a legal battle with the state after her New Orleans clinic lost its license a little over a year ago. With more than two decades of work in women’s health, Cueva has seen the burden on Louisiana women grow as regulators clamp down. Five to ten women still call every day looking for services, even though she’s been closed for so long.
“If we make it any more difficult, where are the patients going to go—Houston? Atlanta? My patients can’t afford to go to Baton Rouge from New Orleans, much less to Houston or Atlanta. It’s going to force women to go back to what they used to do before, and women will die.”
By: Zoe Carpenter, The Nation, January 27, 2014
“Sending A Strong Message”: Oklahoma Judge Permanently Strikes Down State Restrictions On Emergency Contraception
An Oklahoma district court judge ruled late Wednesday to permanently strike down an unconstitutional state law restricting women and girls’ access to emergency contraception. Judge Lisa Davis found that the law violated the state’s “single-subject rule,” which prohibits legislators from addressing unrelated issues in one law.
Oklahoma politicians added a provision restricting women and girls’ access to a law focused on regulating health insurance benefit forms. The measure required women to provide proof of age in order to obtain emergency contraception, and required anyone under the age of 17 to have a prescription to access emergency contraception. Prior to the ruling striking down the measure, Oklahoma was one of nine states with laws restricting women’s access to Plan B One-Step and other generic emergency contraceptives.
“This unconstitutional provision was nothing more than an attempt by hostile politicians to stand in the way of science and cast aside their state’s constitution to block women’s access to safe and effective birth control,” said David Brown, staff attorney at the Center for Reproductive Rights, the group behind the legal challenge.
“We hope the court’s ruling sends yet another strong message to politicians in Oklahoma that these underhanded tactics are as unconstitutional and deceptive as they are harmful to women in their state.”
In November, the United States Supreme Court declined to hear Oklahoma’s appeal seeking to reinstate its law banning medication abortions, which was also found to be unconstitutional by a lower court.
By: Katie McDonough, Salon, January 24, 2014
Just days after Republican Ken Cuccinelli discovered that running as the transvaginal ultrasound candidate may have been a mistake in increasingly blue Virginia, three Republican women are launching a new effort to solve the GOP’s serious problem with female voters.
The Republican Party’s outreach to women — to the degree that it reaches out at all — has clearly not been working. Poll after poll shows that women favor the Democratic Party over the Republicans, and recent elections have confirmed it. President Obama topped Mitt Romney by 9 percent among women in 2012, and Terry McAuliffe beat Cuccinelli by an identical amount in Virginia in 2013. Among unmarried women, the gender gap is even more severe.
As Jonathan Martin reports in the New York Times, Republican consultants Katie Packer Gage, Ashley O’Connor and Christine Matthews hope to reverse the trend by launching a group called Burning Glass Consulting.
“We want to get smarter about how we communicate the Republican message specifically to women,” Gage told the Times. “Certainly there are challenges with other demographic groups, but women represent 53 percent of the electorate.”
According to the report, “The three strategists will undertake public opinion research, TV ads and general consulting for Republican candidates about how to better reach that majority.”
If this sounds familiar, it’s because the Republican Party has been down this road before. Just eight months ago, the Republican National Committee itself declared its intention to “stop talking to itself,” and improve outreach to minorities, the working class, and the same women that Burning Glass intends to target today.
“Instead of driving around in circles on an ideological cul-de-sac, we need a party whose brand of conservatism invites and inspires new people to visit us,” the Republican consultants who wrote the report optimistically suggested.
Ultimately, Burning Glass Consultants will encounter the same problem the RNC did. Sure, a more moderate tone couldn’t hurt the Republican Party’s efforts to win over women — it may even help them on the margins. But there is no message fix that could paper over the fact that elected Republicans are devoting their efforts to shuttering women’s health clinics, restricting access to contraception, and trashing the Affordable Care Act’s maternity coverage, among a long, long list of other policies that are genuinely hostile to women.
Yes, the Republican Party would benefit if far-right candidates like Richard Mourdock would stop telling women that they can’t undergo an abortion after being raped, because “God intended” for them to be attacked. But the GOP would be even better off if that wasn’t the party’s official platform.
Burning Glass’ effort to attract female voters is surely well intentioned. But as Republicans are finding out in their unsuccessful push to attract Hispanic voters, actions speak louder than words.
By: Henry Decker, the National Memo, November 12, 2013