Amy Hagström Miller thought it would be over in four to six weeks.
That was an estimate she gave last August of how long it would take to close abortion clinics like hers as Texas leaders prepared to impose the country’s first effective six-week abortion ban. “That’s if we can’t block it ahead of time,” said Miller, president and CEO of Whole Woman’s Health.
“It’s hard to stay hopeful in situations like this in Texas, but we’re still winning,” she said. “We’ve won before.”
Within a year, that optimism turned to horror as abortion rights providers and supporters watched as the U.S. Supreme Court not only upheld the six-week ban in Texas, but also went much further, revoking Roe v. Wade on Friday and repealing federal protection against abortion five decades ago.
Resistance: Some Texas prosecutors say they will not prosecute abortion cases after Roe. But it probably won’t matter.
Like other providers, Whole Woman’s quickly announced that it would stop providing abortions at its four Texas clinics.
“Rowe has been canceled,” Miller tweeted when the decision was dropped. “All the extreme times.”
While Friday’s Dobbs v. Jackson Women’s Health Organization ruling included a Mississippi law, Texas has been offering nationwide test sites for months after Rowe, and it has shown that the court’s conservative majority is willing to take radical steps to allow states to regulate abortion.
“SB8 laid the groundwork for this,” said John Taylor, a professor of political science at the University of Texas at San Antonio, on Texas law, Bill 8 of the Senate. “It was a huge signal from the court where they were going to rule with Dobbs.”
Republican-led states have been trying for years to ban abortions after six weeks of pregnancy or when doctors first detect cardiac activity in the fetus. But each of those efforts failed when it was challenged in court. Friday’s ruling allowed more than two dozen states with Republican leaders to start criminalizing all or almost all abortions.
FIRST ARREST FOR ABORTION IN TEXAS: Texas woman faces murder after “self-induced abortion”
Texas broke the blockade last fall by imposing its six-week ban exclusively through private cases. The Conservative majority of the Supreme Court said it was helpless to intervene because the law was not enforced by government officials.
The Texas law was new because it not only attracted private citizens to sue each other, but also clearly arranged the cards against abortion clinics. The parties could file their cases in any state court, which gives them the right to seek sympathetic judges. And even if abortion providers win, they are barred from reimbursing court costs.
“I think the fetal heart rate law made Dobbs’ decision much more likely,” said Josh Blackman, a professor of constitutional law at the South Texas School of Law in Houston. “This basically illustrates what the world would look like after Dobbs before Dobbs.”
Travel, pills in the mail
The picture that emerged was one of the huge new struggles for women seeking the procedure. Between September and December last year, more than 5,500 Texans traveled to abortion clinics in nearby states, according to an analysis by the University of Texas at Austin. This is a tenfold increase in monthly visits since before SB8 took effect on September 1 – and the survey includes data from only six neighboring countries.
Meanwhile, Aid Access, a global nonprofit that supplies abortion pills to women in the United States, saw three times as many requests in Texas under the new restrictions.
The law “did not reduce the need for abortion care in Texas,” said Carrie White, a lead researcher at the University’s Texas Policy Evaluation Project. “Rather, there is reduced access to the state.”
Almost every aspect of reproductive health care in Texas is entangled in SB8 and the accompanying SB4 bill, which restricts access to abortion pills until after seven weeks of pregnancy.
This drug – mifepristone and misoprostol, often taken in tandem – can also be used to manage miscarriage, and some pharmacies are hesitant or refuse to give it to patients who have already lost a pregnancy, said Dr. Kimberly Pilkinton, the newly elected president of the Texas Association of Obstetricians and Gynecologists.
She said some patients also had problems receiving methotrexate, the most common drug used to treat ectopic pregnancies, in which a fertilized egg is implanted outside the uterus and cannot survive. SB8 allows doctors to eliminate ectopic pregnancy, but the language in SB4 is less clear.
Exceptions can be difficult to interpret, Pilkinton said.
“There is so much fear about some of these laws that some people just don’t want to commit to something that could be interpreted as something to do with abortion care,” she said.
“Everyone is going crazy”
The confusion has also spread to major medical institutions, which need to weigh civil liability and criminal sanctions when considering how to treat pregnancy complications.
Although the new restrictions allow doctors to intervene to save a woman’s life or prevent “significant impairment of basic bodily function,” some hospitals are delaying care for women with potentially life-threatening conditions that require early termination.
When Dr. Judy Lewison, a 72-year-old midwife in Houston, first learned about SB8, she “thought we were entering some kind of anti-utopia.” She felt that this was “flying in the face” of progress in civil rights in the 1960s and 1970s, but she still did not understand how profoundly this could affect her field.
Then her colleagues started telling her that they could not cause a pre-pregnancy or have an abortion to keep the mother healthy.
“Suddenly they realized they couldn’t go on the way they were trained to do – what is medically right,” she said. “For them, they had an early dawn. I think it took some time for others to realize the impact. “
Dr. Lee Bar-Eli, a family doctor in Houston, was surprised early on by what she thought was a lack of national outrage against the law in Texas. She knew that this would do the most harm to black and low-income women, who face discrimination and may lack the time and money to travel to a country where the procedure is still available.
Women who have the resources to travel are now facing declining opportunities outside the state as more southern states, including Oklahoma, move to ban abortions following Roe’s decision. New Mexico will probably be the closest option, and obstetricians in Colorado have already noticed an increase in patients in Texas.
“It was a little disappointing to have this nine-month period in which we live this reality,” Bar-Eli said. “And now that Rowe is falling against Wade, everyone’s going crazy.”
julian.gill@chron.com
jeremy.blackman@chron.com
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