“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
“When Women Have Options”: Obamacare, The Greatest Pro-Life Victory Ever
A new report finds that between 2008 and 2011, the abortion rate hit its lowest point since 1973, when Roe v. Wade declared access to the procedure a Constitutional right.
The rate fell 13 percent to 16.9 per 1,000 women in 2011, down from its peak of 29.3 per 1,000 in 1981.
While conservatives want to claim credit for the decline with onerous restrictions on a woman’s right to choose, the availability of contraception and family planning deserve most of the credit, according to the Guttmacher Institute’s Rachel Jones, the lead author of the study.
“The decline in abortions coincided with a steep national drop in overall pregnancy and birth rates,” she said in a statement. “Contraceptive use improved during this period, as more women and couples were using highly effective, long-acting reversible contraceptive methods, such as the IUD. Moreover, the recent recession led many women and couples to want to avoid or delay pregnancy and childbearing.”
Use of contraceptives has become near-universal and more common among married women than single.
Obamacare’s birth control mandate obligates all insurers to cover contraception without a co-pay, as it does all preventive care. Before the law 28 states already had such mandates in place and 85 percent of large firms offered coverage as part of their plans. Since August 1 of last year, that coverage is now standard for women no matter where they live or how they acquire health insurance.
A Washington University study released last year showed that providing birth control at no cost reduced the rate of abortions by 62 to 78 percent compared to the national rate. Meanwhile the right’s strategy of reducing abortions by requiring sonograms has had no effect on a large majority of women, according to a new study in Obstetrics and Gynecology.
Instead of encouraging the pro-life benefits of Obamacare, conservatives continue to try to minimize them. Republicans want to give employers the ability to opt out of the mandate, asserting falsely that some of the birth control options available induce abortion.
By opposing the mandate, the right reveals that its goal has always been to reduce women’s options, not unintended pregnancies. Obamacare will reduce thousands — if not hundreds of thousands — of abortions and could reduce even more if the Republican-led states that rejected Medicaid expansion would agree to provide subsidized care to approximately 4 million Americans.
Instead, so-called “pro-lifers” enable politicians who deny health insurance to those who need it most, threatening the lives of thousands. If only they were as pro-life as Obamacare is.
By: Jason Sattler, The National Memo, February 4, 2014
“Back Street Abortions?”: New Law Could Force All Of Louisiana’s Abortion Clinics To Close
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
“Poor Pitiful Persecuted Bullies”: From A Position Of Feigned Weakness, Conservatives Portray Themselves As Victims
On the 41st anniversary of Roe v. Wade, it seems the antichoice movement is focused less on extending its recent state-level gains than on denying their significance as a rollback of basic reproductive rights. Sarah Posner captured their rhetoric nicely at Religion Dispatches yesterday:
What with autopsies and rebrandings, and a new Pope decrying “obsessions,” you would think that tomorrow’s March for Life might not be such a big event. But on the anniversary this week of Roe v. Wade, the Pope is still Catholic, and the GOP is still Republican. The rebranding, if there is one, is to portray anti-abortion absolutism as mainstream, not extreme.
This effort at rhetorical but not substantive repositioning is the GOP’s big message today, notes Posner:
When the RNC convenes for its winter meeting, it will take up a proposed resolution, CNN reports, “urging GOP candidates to speak up about abortion and respond forcefully against Democratic efforts to paint them as anti-woman extremists.” The “Resolution on Republican Pro-Life Strategy” calls on the party to only support candidates “who fight back against Democratic deceptive ‘war on women’ rhetoric by pointing out the extreme positions on abortion held by Democratic opponents.”
Antichoice pols are the victims here, you see. That’s why they’ve seized on comments by New York Gov. Andrew Cuomo about the consensus in his state supporting abortion rights as evidence they are poor pitiful refugees against intolerance (an act Charlie Pierce aptly calls “driving nails into their own palms”).
It’s all a shuck, though, as Posner concludes:
The March for Life is still a big deal. One of the nation’s two major parties supports it, and will later in the week that party will consider whether its candidates should be punished for being too weak in response to “deceptive” charges they are waging a war on women. Rebrandings, truces, lamentations about singular obsessions–none of that changes the Republican and the conservative movement commitment to making abortion illegal, and, barring that, to making it inaccessible.
The silly foot-stomping over Cuomo’s comments are from a defensive posture, but it would be a mistake to engage in much schadenfreude about the conservative position being weak. The foot-stomping is strategic: an opportunity to portray themselves as victims strengthens the resolve of their followers. (See, there is no war on women, only an elitist war on conservatives!)
Interesting, isn’t it, that from this position of feigned weakness the antichoicers are gearing up for another election cycle of bullying Republican politicians into doing their will, all in the broader cause of bullying women to give up control over their reproductive systems.
By: Ed Kilgore, Contributing Writer, Washington Monthly Political Animal, January 22, 2014
“Why Wendy Davis Terrifies The GOP”: Fighting For Women To Have Their Choice
The National Rifle Association didn’t just stop the effort to close the loopholes in background checks, even though that effort was supported by more than 8 in 10 Americans. It has crushed academic research on gun violence to the point that we don’t even know how many people commit suicide at gun ranges each year.
Some say the gun rights movement has learned from what happened to the tobacco industry, as decades of denial gave way to legislation that has increasingly diminished the ability of their product to be consumed in public.
But smoking tobacco laced with nicotine isn’t a Constitutional right, unlike the right to bear arms or a woman’s right to choose. If firearms advocates want to search for an example of effectively legislating away a right, they can look at what their allies in the anti-abortion rights movement have achieved.
Exactly 41 years after the Supreme Court ruled that a woman’s right to privacy via the “due process” clause of the Constitution gave her a limited right to end a pregnancy, 87 percent of counties in the United States lack an abortion provider. The right’s effort to use local and state control to enact laws and regulations make it impossible to provide the procedure in most of the country. And they’re far from done from trying to make abortion rights “a thing of the past,” as Governor Rick Perry vowed last year before signing legislation that will force dozens of clinics to close.
State Senator Wendy Davis (D-Fort Worth) rose to speak for 14 hours against laws that were clearly designed to close as many clinics as possible, making an abortion far more difficult to obtain, and then ban the procedure earlier than the Supreme Court had previously ruled was Constitutional.
Imagine if you couldn’t purchase a gun in 87 percent of the country. Imagine if nearly every day in some state a new piece of legislation was being considered that didn’t close gun shops but made it impossible for them to operate, forcing buyers into the black market. Gun owners may not mind that because buying a gun from a private individual is less of a hassle. But the industry, which finances the NRA, would never let that happen.
Despite what Republicans want you to believe, there is no “abortion industry.” We know this because an “industry” would never let the march against women’s rights proceed as rapidly as it has in the last few years.
Knowing that abortion is actually more common where it’s illegal, the right is pushing women into a black market that could cost them their health and their lives. The only hope women have is the courts, politicians and activists willing to stand up for the right to choose.
Wendy Davis did just that in a way that captured the country’s attention. It infuriated those against abortion rights who brand their opponents as murderers, or with the more stinging “infanticide.” And now that Davis is raising lots of money in her effort to become Texas’ governor, they’re seizing on every inconsistency in her story to shame her as a bad mother and craven opportunist.
Shaming women who attempt to exercise their right to have an abortion is an effective tactic. One of the women who went to Kermit Gosnell’s vile clinic, where actual crimes were committed, reported that she avoided the local Planned Parenthood because “the picketers out there, they scared me half to death.”
Even politically, Democrats have at times adopted the talking point that abortion should be “safe, legal and rare” because that’s what people say in polls that they want. In a CNN/ORC poll last May, 42 percent said abortion should be legal in few circumstances while 25 percent were in favor of “all,” 11 percent said “most” and 20 percent said “none.”
The “none” is the official opinion of the GOP in its party platform, even as Republicans oppose the family planning and sex education that are the best hopes for actually reducing unintended pregnancies. And the “none” position is winning, with just one vote on the Supreme Court threatening to end more than four decades of choice.
Wendy Davis is a threat to those who feel their position for “life” is on the march. She says, “I’m a mother who made the choice to keep my child and I will fight for you to have your choice.” Her life story and courage are inspiring and embolden others to speak out. She’s even redefining being “pro-life” in a way that holds conservatives responsible for the care of children after being born.
So Republicans must destroy her.
The anti-abortion movement — like the gun rights movement — sees any hope for its opponents as something to be destroyed before it can make actual progress.
One conservative said the recent attempts to undermine Davis’ life story remind him of Rush Limbaugh’s pyrrhic attack on Sandra Fluke. But they bear more resemblance to the way the right tried to undermine now-Senator Elizabeth Warren (D-MA), another singular voice from the left who enrages the right with fear.
Republicans kept trying to call her out for mistakenly saying she had Native American ancestry. But in the end all they did was reveal their own dizzying hate and the emptiness of their arguments.
By: Jason Sattler, The National Memo, January 22, 2014
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