When Texas' House Bill 2 was signed into law in July 2013, the bill's offered a clear example of just how badly Texas lawmakers wanted to eradicate abortion in the state. One of the bill's subchapters, the "Preborn Pain Act," states that life begins at conception, repeatedly refers to an embryo's "post fertilization age," and states — as if by universally accepted medical fact — that an embryo is capable of feeling pain 20 weeks after sperm hits egg.
But the overtly anti-abortion tone of the bill wasn't so much the problem. It was the way that the bill's tangled list of complex rules made it nearly impossible to get an abortion. Just short of making abortion illegal, the bill heavily restricted abortion medication, ruled that abortion doctors must have admitting privileges at hospitals within 30 miles of their clinic, and mandated that all existing and future abortion clinics meet the hospital-like standards of an (ASC).
"When the Texas law went into affect, about half of the abortion clinics closed due to the admitting privileges requirements alone," Julie Rikelman, the litigation director at the Center for Reproductive Rights told VICE News.
The Center, along with a group of local abortion doctors and clinics, began fighting the Texas law as soon as it was passed. In August, Judge Lee Yeakel of the US District Court in Austin ruled that forcing abortion clinics to meet hospital-like ASC requirements is unconstitutional. Yeakel's stated that most clinics would have to spend $1 million or more to meet stringent new building codes, and said that the new law constituted "a scheme that effects the closing of almost all abortion clinics in Texas that were operating legally."
But even though Yeakel's ruling allowed the shuttered clinics to reopen, they were forced to close again when the Fifth Circuit Court shot down the District Court ruling last Thursday. On Monday, the Center for Reproductive Rights asked the Supreme Court to intervene, and they are currently awaiting a decision.
Fatimah Gifford, communications director at the Whole Woman's Health abortion clinic, told VICE News that four of their five clinics ceased operating due to the law. One of those clinics, in McAllen, was there for 40 years and was the only abortion provider in the Rio Grande Valley. Now there are no abortion services at all south of San Antonio.
"Before the law, there were 44 providers," Gifford said. "By around July of 2014 there were 20 clinics. Now there are only eight abortion providers, all of which meet both ASC and admitting privilege requirements and meet all of the four provisions in HB2."
Gifford said it was a shock to local communities that nearly all of the state's abortion clinics rapidly shut down over the course of just a year.
'Women who don't have the means to travel hundreds and hundreds of miles have been doing self-induced abortions, using medication over the Internet, or traveling across the border to Mexico.'
"A lot of women don't understand what the law is, and that they lost access to the clinic," Gifford said. "We find ourselves educating a lot of our callers right now. And they're either astonished or they're frantic because they're not sure what they're going to do."
The Whole Woman's Health clinics in Austin and Beaumont closed entirely, but until last Friday, the clinics in McAllen and Beaumont were still performing abortions. Those clinics are still seeing patients for post-operative care.
According to Rikelman, the Texas law is unusually extreme in its detailed attack on clinics. But it's only the most extreme example of several similar moves by other state legislatures in recent years.
Abortion rights advocates call them "TRAP" laws, an acronym that stands for Targeted Regulation of Abortion Providers. Rather than outlawing abortion outright, states have imposed impossibly strict standards on building codes and required that abortion providers have admitting privileges at nearby hospitals.
"The ASC requirements contain building code requirements that have nothing to do with women's health," Rikelman said, referring to the Texas law. "The types of faucets in sinks, the kind of paint you have on your walls, and the amount of parking spaces."
In a 2013 Guttmacher Institute of TRAP laws, Planned Parenthood of Western Pennsylvania CEO Kimberlee Evert complained that some of the local facility compliance regulations applied not only to abortion providers, but also to every tenant that shares their building. For Planned Parenthood, that would mean other tenant in the same building — even those who had nothing to do with abortion services — had to replace dimmer switches with new light fixtures, inspect fire extinguishers monthly rather than annually, and meet other seemingly arbitrary requirements that could not reasonably be enforced.
There are currently laws designed to bury abortion clinics under red tape in 27 states, according to the Guttmacher Institute.
Several of those states now face legal challenges. District Courts are hearing cases in Kansas, North Dakota, and Oklahoma, while battles over TRAP laws in Texas, Mississippi, Louisiana, Alabama, and Wisconsin have moved on to federal courts.
In 2013, the American Congress of Obstetricians and Gynecologists issued a condemning regulations that single out abortion clinics, including "facility regulations that are more stringent for abortion than for other surgical procedures of similar low risk."
Meanwhile, the 13 Texas clinics forced to close last week will likely close permanently if the Supreme Court doesn't intervene. That means wide swaths of the state will have no access whatsoever to legal abortion services.
"There are no licensed abortion providers in the Rio Grande area that borders Mexico," Rikelman said. "Women who don't have the means to travel hundreds and hundreds of miles have been doing self-induced abortions, using medication over the Internet, or traveling across the border to Mexico."
'We certainly have been hearing anecdotal stories in our surveys about women attempting to self-induce by anything from taking herbs to throwing themselves down the stairs or getting punched in the stomach.'
Dr. Dan Grossman, vice president for research at IBIS Reproductive Health, told VICE News that he has been surveying Texas women to determine whether self-induced abortion rates will rise in response to the state's near-eradication of abortion services.
"In 2012 we found that, overall, about 7 percent of women coming into a clinic for an abortion said they tried to end their pregnancy on their own before coming in," Grossman said. "It was higher in the Rio Grande Valley, about 12 percent. And that's compared to about 1 percent nationwide. I imagine that's only becoming more common now that all of the clinics have closed."
Grossman said he expected to have new quantitative data on self-induced abortions in Texas by the end of this year.
"We certainly have been hearing anecdotal stories in our surveys about women attempting to self-induce by anything from taking herbs to throwing themselves down the stairs or getting punched in the stomach," Grossman said.
And, as panicked Texas women continue to call Whole Women's Health, abortion rights resource groups are scrambling to meet demand for travel assistance.
This July, the Texas Policy Evaluation Project estimated that, since the clinic closures went into effect, 752,000 female Texans now live more than 200 miles from an abortion provider.
Gifford said her clinic refers callers to groups like Fund Texas Choice, which helps women with transportation costs and plane fares, and to abortion cost-assistance through Lilith Fund and the National Abortion Federation.
Whole Woman's Health even started its own non-profit to help shuttle would-be patients to its sole remaining clinic in San Antonio.
"Even after the first wave of clinic closures, we had women coming and saying, 'I had to use $100 of the money for my procedure to cover travel expenses and now I'm short,'" Gifford said. "It's too early to tell, but we are diligently tracking how many women we are referring to San Antonio from McAllen. It's 300 miles one way."
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