Abortion Clinics, the Law & Texas

April 30, 2016

In 2013, Texas passed HB-2. HB-2 is a law that increases regulations on abortion. The law’s stated purpose is to increase women’s health and safety. Opponents of the law challenge that assertion. They argue that the law places places an unconstitutional limitation on women’s access to abortion.

The United States Supreme Court recently heard arguments on both sides. They will address the constitutionality of the provisions, which require that (1) providers have admitting privileges from a hospital 30 miles from the clinic where they perform abortions, and (2) facilities that perform abortions must be upgraded to render themselves equivalent to ambulatory outpatient surgical centers, which are essentially mini-hospitals. They have to have hallway widths a certain length, a janitor’s closet, as well as male and female locker rooms.

Before the 2013 law, Texas had more than 40 legal abortion providers throughout the state. Just two weeks after the first requirement went into effect approximately half of Texas’s abortion clinics closed. In addition, the second provision requiring clinics to meet the outpatient surgical center is scheduled to take effect. Unless the law is overturned, this provision will further reduce the number of clinics serving the 5.4 million women of childbearing age in Texas. The legal question is whether having 10 clinics to serve all these women or making a woman travel 200 miles to the nearest facility, represents an “undue burden” on women’s right to terminate a pregnancy.

Opponents of the law say that it does place an undue burden on a woman’s ability to terminate her pregnancy under the guise of increasing safety standards for one of the safest office-based medical procedures. Women in East Texas or the Rio Grande Valley now have no local clinics. Proponents of the law celebrate the 9,000 fewer abortions performed in Texas since HB-2’s passage. However, lengthy waiting lists for appointments have driven some Texas woman to travel to neighboring New Mexico, which permits abortion at any stage in the pregnancy. HB-2 included a ban on the procedure after 20 weeks of pregnancy and changed the rules for how doctors can prescribe abortion-inducing drugs. New Mexico’s Department of Health estimates that about 20% of the abortions performed there are done on out-of-state women, including 681 from Texas in 2014.

There are two types of early abortion. One is a medical abortion. During a medical abortion, a doctor prescribes two pills, and the women take the pills at home. Under Texas law, a woman has to take them at the abortion facility. This means she has to come back on two separate days (and perhaps travel hundreds of miles or stay in a hotel) just to take both pills.

A related procedure (often associated with miscarriages) uses the medical procedures of dilation and curettage. In this case, the cervix is dilated and a doctor surgically removes of part of the lining of the uterus and/or contents of the uterus. The procedure can only be performed in a doctor’s office. In Texas, the same procedure done as an abortion must be performed in an ambulatory surgical center. However, if it is performed for a miscarriage it can be done in a Doctor’s office (and the office does not need to meet ambulatory surgical standards).

All eyes will be on the Supreme Court’s ruling as their decision will affect the lives of women in Texas and throughout the United States.