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.
