Texas abortion providers plan for Roe’s fall
Last October, as the U.S. Supreme Court prepared to hear a pivotal new abortion case, a survey quietly was emailed to abortion providers across the country, with an urgent goal.
It had been put together by a broad coalition of abortion advocates, funders and clinics, and it was looking for anyone “who may be willing and able to travel, relocate or provide medication abortion via telehealth” in case of tightening state or federal restrictions.
“While no one can predict the future,” the group wrote, “we can plan for it.”
The future they feared now looks more certain than ever. With the nomination of Judge Amy Coney Barrett to replace the late Justice Ruth Bader Ginsburg, a liberal icon, the high court is poised to solidify its conservative majority, opening the door to roll back abortion rights further in Republican battlegrounds such as Texas.
It is a watershed moment for activists on both sides of the abortion fight, and it comes at an especially precarious political crossroads in Texas, where Democrats have their first viable shot in nearly two decades to reclaim control of the state House next month.
For Texas abortion providers, the battle is no longer about simply surviving in a state where access already is greatly limited, but about building a network to help women legally access the procedure if and when it is no longer available here. They know they won’t be able to reach everyone. They also don’t see many other options.
“If we can provide care within our communities where they live, that’s best for our patients,” said Dr. Bhavik Kumar, an abortion provider at Planned Parenthood in Texas. “But if that’s not possible, for whatever reason, then we’ll do what we can for them.”
Should the Supreme Court overturn Roe vs. Wade, its 1973 decision that extended federal protections to abortion, the issue would return to state governments, creating a patchwork of access. The procedure likely would be banned across much of the South and Midwest, and states such as Illinois, California and New Mexico would become destinations for those who can afford to get there.
Getting care in ‘haven states’
Even with Roe left in place, conservatives on the court have signaled an openness to new restrictions from states, and there are several dozen cases in the federal appeals pipeline for them to choose from, including one over a Texas law that criminalizes a later-stage abortion procedure known as dilation and evacuation.
Abortion rights opponents said they see the most immediate opening for restrictions that center on the rights of a fetus, such as a discrimination law that would prohibit abortions that are based on a genetic abnormality or because of the sex of the fetus.
“Instead of looking at opportunities to regulate the industry that we want to be out of business, we think a wiser approach is to always keep focused on the unborn child,” said Elizabeth Graham, director of Texas Right to Life.
The state caught a glimpse of what life after Roe could look like this spring when Gov. Greg Abbott temporarily banned the procedure amid the coronavirus pandemic. Providers said they saw second trimester abortions rise as a result of the ban and that it appeared to most harm low-income women and women of color, many of whom lack private insurance or the resources or time to travel out of state.
Texas has the highest uninsured rate in the country, and lawmakers have declined to expand Medicaid under the Affordable Care Act, which would provide health care to more mothers after they give birth.
“We’re going to see people leaving to get that care in haven states, and people who cannot, which will disproportionately be Black people, indigenous people, communities of color, those with limited financial needs and those with disabilities,” said Dr. Ghazaleh Moayedi, a Texas abortion provider. “Those are going to be the people most impacted.”
Dr. Lauren Thaxton, an abortion provider and a researcher for the Texas Policy Evaluation Project, was in her medical residency in New Mexico in 2013 when Texas lawmakers passed House Bill 2, at the time one of the most aggressive anti-abortion laws in the country.
The law forced about half the state’s 40 abortion clinics to close and led to a drop in statewide abortions. Thaxton remembers treating women who had driven more than a dozen hours from Texas, some of them sleeping in their cars.
“To travel that kind of distance and then have a five-minute procedure and then travel back was just crazy,” she said, “And that’s of the people who were able to get to the clinic.”
Kamyon Conner, who runs an abortion fund in North Texas, said her organization gets about 6,000 calls every year from women requesting help to pay for abortions. The group usually can help about 1,000 of them.
“All abortions funds are underresourced,” Conner said.
Stakes rise in Texas elections
Clinics in some states are preparing for an influx of women from Republican-controlled states if they impose new restrictions. Planned Parenthood recently opened an expanded abortion clinic in Illinois. Amy Hagstrom Miller, who runs Whole Woman’s Health, said she is increasing capacity at her clinics outside Texas, as well as looking at ways to legally mail women the medications they need to perform home-based abortions — a method that is allowed and growing more popular in some states.
“Even if they have to travel into the other state in order to get the medication abortion, could it be less time, closer?” she said.
Moayedi began applying for out-of-state licensure earlier this year and now is authorized to perform abortions in Oklahoma. Others still are weighing what to do if they no longer are able to legally provide the procedure in Texas.
“There’s value in having people who know how to safely and respectfully care for people who have had abortions, even in places where abortion is inaccessible,” Thaxton said.
In the meantime, it is far from clear how the state’s abortion fight will play out, especially if Democrats retake control of the House this year. If Republicans hang on, abortion rights opponents see the coming legislative session as perhaps their best chance to enact lasting new restrictions, including a provisional ban on the procedure that would be triggered if Roe is overturned.
They also want to boost funding to Alternatives to Abortion, a state-run program that promotes childbirth and offers financial counseling and referrals to social services.
“I think we’re delusional if we don’t continue increasing our outreach to pregnant women so that they have options and they have real lifesaving help and they have people to walk with them and give them resources through unplanned pregnancy and after the child is born,” Graham said.
Abortion is supported broadly in Texas — much like the country as a whole — although some surveys have found more mixed feelings on specific restrictions. In a 2018 Quinnipiac poll, 60 percent of respondents said abortion should be legal in all or most cases. A more recent poll from the Texas Politics Project at the University of Texas at Austin found that nearly half of respondents supported a ban on abortions after six weeks.
The question now is whether there is enough political will among conservatives to take the kind of aggressive measures that may prompt blowback in future elections.
“As Texas got a little more competitive and the signs of competition were in some of these House races, you saw a sort of return to the abortion politics of the Laney years, where it got harder for people to see it in their interest to spend a lot of time arguing over these things,” Politics Project director Jim Henson said, referring to Pete Laney, a Democrat who served as Texas House speaker through 2003.
Newly emboldened, abortion rights advocates are now pushing to flip the script on opponents, whom they see as having controlled the conversation about abortion for too long.
“The statistic that always amazes me is that the anti-abortion side uses the word ‘abortion’ 4-to-1 more times than our side does,” said Aimee Arrambide, the director of NARAL Pro-Choice Texas. She said to succeed, the movement has to destigmatize the issue more and better humanize it through firsthand accounts.
“What the antis do is they introduce these ridiculous bills year after year, and finally they become normalized,” Arrambide said. “And we’re trying to do the same thing. We introduce proactive bills that will probably not pass under the current makeup of the Texas Legislature, but at least we’ll have an opportunity to talk.”