We already know that about half of Texas's abortion clinics were forced to close as a result of the omnibus anti-abortion bill HB2 — a bill that will face a major Supreme Court challenge in March. And we have some research about what happened to abortion access after that: women forced to delay their abortion procedures due to longer waits for appointments at overburdened clinics, fewer women getting clinical abortions overall, and at least some women taking matters into their own hands by self-inducing at home.
Now, for what researchers believe is the first time, we have a study describing what some women actually go through when restrictive new laws close abortion clinics. And it comes at a time when abortion rights supporters are working to share real women's stories to reduce the stigma associated with abortion, and to convince the Supreme Court to overturn provisions of HB2.
The study found women had to wait and have a later abortion, or couldn't get an abortion at all
The study, conducted by the Texas Policy Evaluation Project (TxPEP) and published in the journal Contraception, consisted of qualitative interviews with 23 women who had trouble making an abortion appointment after HB2 was passed. Most were Latina and under the age of 25, and about half already had at least one child.
Five of these women had abortion appointments that were abruptly canceled after the clinic closed, 15 tried to make an appointment but were turned away because the clinic had recently closed, and three were Texas residents who ultimately crossed the border into Albuquerque to have their procedure done.
It's not possible to make broad statistical judgments about what happened to Texas women seeking abortion based on this small sample, and that's not the study's intent. Due to the often stigmatized, private nature of abortion, it can be difficult for researchers to find women who are willing to talk extensively about it. But the women's stories represent a range of experiences that previous research has already found evidence of.
Of the 23 women interviewed, two couldn't overcome the financial and logistical obstacles it would have taken to get an abortion somewhere else, so they continued their unwanted pregnancy.
Eight women were delayed more than one week. Two sought abortion care in the first trimester, but were delayed so long that they couldn't get an abortion until the second trimester — which is a more expensive and riskier procedure. (Second-trimester abortions still only have a 1.3 percent risk of major complications, but that's more than 20 times higher than the risk for a first-trimester abortion.)
Most of the women surveyed had to pay more out of pocket and travel greater distances to get their abortion than they would have if the nearby clinic had stayed open. Some started driving at 3 am for their morning appointments so they wouldn't have to pay for a hotel; others forked over the $60 to $200 for a hotel room because they were worried about cramping and bleeding during the four-hour drive back.
Others had their privacy compromised: One 18-year-old woman didn't want to tell her parents about her abortion, but realized she had no option of being discreet when she had to figure out how to get to San Antonio.
More than half of the women surveyed said they were confused about where to go for abortion services, and were frustrated by conflicting information about which clinics were still open.
"It was pretty scary," one 22-year-old woman from Austin told researchers. She said her appointment was supposed to be on a Thursday, but she got a call Wednesday night that her appointment was canceled.
"They said that they would give me the number to the Dallas location that I could go to," the woman said. "But, I mean, Dallas is four hours away, so I just knew it was going to be a little bit more difficult for me. ... 'Is that clinic going to be booked up? Was I going to get in, in time? How was I going to pay to get there? How was I going to get there?'"
Texas laws created a nightmare for one woman with a doomed pregnancy
Valerie Peterson, who has a PhD and two children, spoke with reporters on a call this week about the misery that anti-abortion laws in Texas helped inflict upon her. She found out her unborn child would die either before or shortly after birth when an ultrasound at 16 weeks found a hole between her son's brain and spinal cord. The diagnosis was alobar holoprosencephaly, and Peterson's doctor told her the condition was 100 percent incompatible with life.
Her doctor referred her to an abortion provider in Austin, but high demand for appointments after HB2 meant she would have to wait three weeks. "I broke down crying," Peterson said. "I didn’t know how I was going to make it that long. Every day that I had to remain pregnant was so emotionally painful."
Her doctor used his personal connections to help Peterson find an earlier appointment, but it would still be a four-day process because of Texas laws, including a mandatory waiting period.
"The process just seemed so cruel and emotionally grueling on top of everything else I was dealing with at the time, and I just couldn’t do it," Peterson said.
She finally flew to Orlando for her procedure, after confiding in a friend who knew a health provider there who could get her in immediately.
Abortion providers tell harrowing stories of what happened after HB2 passed
On the call with reporters, Texas abortion providers and patients described the chaos, confusion, and heartbreak for both patients and staff in the days after HB2 passed.
One patient, who had driven 90 miles to the clinic with her daughter, was "inconsolable" when she found out her appointment had been canceled, said Ginny Braun, CEO of the Routh Street Women's Health Clinic in Dallas, which permanently closed in June 2015 after the Fifth Circuit Court upheld HB2.
"Had she made the trip one day earlier or not had to make two trips to the clinic because of HB2, we could have helped her," Braun said. "All I could do was cry with them, give them some phone numbers, and refund her sonogram fee so at least they had enough money to drive back to Oklahoma."
Anecdotally, providers also saw an increase in women trying to self-abort. "The first week after the law changed, we started seeing an increase in patients who had tried something to end their pregnancy before coming to the clinic," said Tenesha Duncan, administrator of the Southwestern Women's Surgery Center in Dallas. "That week, a doctor found parsley in a patient’s vagina. I’ve also talked to patients who were distraught and suicidal because they couldn’t access the abortion care they needed."
For providers, it was exhausting and unsustainable to seesaw between opening and closing depending on which court ruled in their favor — and even if the Supreme Court rules to overturn HB2, some clinics may never reopen.
Before Braun's clinic closed permanently, it closed for briefly two weeks in October 2013. Closing and reopening a clinic is no small logistical feat, Braun said: You have to either lay off or try to rehire your staff, and you still have to deal with expenses like insurance or taxes. That's why Braun doesn't think it's likely that her clinic will ever reopen.
The clinics that haven't closed are overburdened with patients, providers said. Sometimes people have to sit on the floor of the waiting area because there's no room. And if the Supreme Court upholds HB2 and Texas is reduced from 19 open clinics to 10, with no protection against new laws that might close even more clinics, this problem will only get worse.
"Even now, the remaining clinics cannot keep up with current patient demand," said Vicki Saporta, president of the National Abortion Federation. "And there is no way they could take on the additional patient volume if more clinics are forced to close because of HB2."