The Long Road to a Safe and Legal Abortion

Women in the South could have to drive up to 600 miles to get a procedure that is their legally protected right.

Pro-choice protester Julia Ann Nitsch, center, chants during a rally at the Texas state capitol over controversial abortion legislation in July 2013 in Austin, Texas
Pro-choice protester Julia Ann Nitsch, center, chants during a rally at the Texas state capitol over controversial abortion legislation, in July 2013 in Austin, Texas.

Photo by Erich Schlegel/Getty Images

That there is an abortion access crisis in Texas is beyond doubt. With the number of clinics in the vast state cut drastically in the past year, many have noted that Texas women are having to travel to other states to get the abortions they need. But a close look at the entire region shows that even crossing into a neighboring state does not guarantee a woman the procedure. In fact, for many Texas women trying to legally and safely end a pregnancy, a map of the entire South is quickly becoming a required tool.

Over the past year, Texas has begun enforcing HB2, a multipronged anti-abortion bill that closed nearly half the clinics in the state by requiring the doctors providing abortions to have admitting privileges to local hospitals—privileges they can’t get either because hospitals are religious entities that don’t want to be “complicit” in abortion; have standards regarding the minimum number of patients a year a doctor must admit, which abortion providers can’t meet; or are afraid to get caught up in the public outcry over the abortion debate. While the Supreme Court recently said that an additional 13 clinics that had closed under HB2’s provision that all clinics meet ambulatory surgical center, or ASC, standards could reopen, that is only a temporary reversal. Although a handful of those clinics say they will reopen based on the Supreme Court’s stay, others will not. And most of those that are reopening aren’t bringing providers closer to those who need them but instead giving more capacity to areas where abortion was already available. While it is good news for the long wait times that are already piling up in cities like Houston and Dallas, the Supreme Court­–mandated pause in closures does nothing for the many Texas women who live hundreds of miles from a clinic.

So where are they going? After the abortion provider in Lubbock was forced to close earlier this year, the women in the panhandle of Texas had two options within a 250 mile radius: take Interstate 40 east to Oklahoma City, or west to Albuquerque, New Mexico. Because Albuquerque has three clinics, and New Mexico doesn’t have a waiting period like the one in Oklahoma, west makes more sense.

“We have seen an increase after the first HB2 disaster went into effect,” Dr. Susan Robinson, a provider at Southwestern Women’s Options in Albuquerque told me. “Since the injunction was turned over in the [5th Circuit Court of Appeals], though, we had a lot more calls, mostly about getting a medication abortion. Of course the answer is yes, but unfortunately, we are required to say ‘You must come back for a follow-up.’ We can’t say, ‘Oh, I know you traveled here for 10 hours; you can go see someone at home. You have to tell them they must return for a follow-up and that discourages a lot of people.”

According to Robinson, Southwestern never turns a patient away, regardless of how crowded it gets. “We are never ‘full,’ ” she said. “We may have a wait in the waiting room, we may have to stay as late as 8 o’clock at night, but we do not put people off because we are ‘full.’ ”

If a patient can handle the waiting period, she may choose to go north to Oklahoma, though capacity will become an even bigger issue there in November, when the state’s own admitting privileges law finally goes into effect. From 2002 to 2012, the most recent year data was available from the Oklahoma State Department of Health, an average of 5,000 abortions per year were performed in Oklahoma. Dr. Larry Burns in Norman, Oklahoma, provides approximately half of them, according to his attorneys at the Center for Reproductive Rights, which is representing him in court. If Burns is forced to close on Nov. 1, that will leave about 2,500 pregnant women per year seeking a new place to terminate. Their options? Head down Interstate 35 to the already-crowded clinics remaining in Dallas and Fort Worth; follow I-40 east to Little Rock, Arkansas, and that state’s only abortion provider; or follow I-35 north, up to Wichita, Kansas, where South Wind Women’s Center is already preparing to take extra patients from Missouri, because that state’s sole abortion clinic has just been forced to enact a mandatory 72-hour waiting period between when a woman first sees a doctor and eventually gets the procedure.

Then there is Louisiana, where, tucked into the northwestern-most corner, are two of the state’s five open clinics (two fewer than just three years earlier) and the only two clinics north of Baton Rouge, which is located pretty far south in the state.* Those clinics serve all of northern Louisiana, much of southern Arkansas, and now, due to the rapidly disappearing clinics in Texas, some Texans as well.

“We started to see an uptick with the original clinics closing in Texas,” the owner of Hope Medical Group in Shreveport, Louisiana, told me recently. “With the continued enforcement of HB2 moving into the ASC requirements, we’ve definitely seen more women from Texas and from other points beyond. Even though this is recent, there was enough of a change for us to notice.”

According to Hope’s owner, the clinics in Texas that had been remaining open prior to the ASC enforcement were already seeing so many patients from closed clinics within the state that wait times were growing too long to consider. “What is happening is women would call from Oklahoma, they would call in to Dallas, and Dallas would say, ‘We can’t see you for another month.’ So we have seen patients coming in from that far. They just keep heading down the highway.”

“In an abortion, sooner is better,” he added.

Unfortunately, like the other states in the area, Louisiana, too, is in the middle of a court case over admitting privileges mandated by HB 388, which was signed into law in September. Soon that state’s own capacity to provide care could be dramatically cut, depending on the outcome of that case.

“When HB 388 passed, there was only one doctor with admitting privileges in the state,” Hope’s owner said, referring to one of the two providers at his clinic. “And he made it clear that he would not be the only physician providing abortions.” Since the bill became law, one other doctor in southern Louisiana has been able to get privileges, but that is all. “What we are faced with is a situation where we will have two doctors who can provide abortions in Louisiana. That is our reality.”

Louisiana’s admitting privileges rule has not been enforced yet because the local court has granted a reprieve until all of the doctors get responses from all of the hospitals where they have applied.  A court date to argue the constitutionality of the law has been set for March 30, 2015.

If the courts uphold the law, that may cause Hope to have massive waits resembling those that patients are trying to avoid in Texas. It not only will have to take in the patients that would have gone to other clinics in the state, but its own capacity will also be cut in half, as only one of its two doctors currently has privileges. “We’re going to be in the same situation Dallas is in,” said the clinic’s owner.

These are not far-fetched scenarios. It is becoming increasingly realistic to envision women following the interstates, moving from one overflowing city to the next, to obtain a safe and legal abortion, which is their right. Depending on how many different Targeted Regulation of Abortion Provider, or TRAP, laws finally are in effect by the time next spring arrives, a patient who finds the wait too long in Dallas would have to keep heading east on I-20 for 185 miles to get to Shreveport, only to learn it’s full, too. After another 200 miles she would hit Jackson, Mississippi, the only abortion provider in that state, and one being held open by the courts, as its own admitting privileges law is currently blocked by a 5th Circuit panel. Another 185 miles after that takes her to Tuscaloosa, Alabama, one of the four clinics left in that state. Alabama too has an admitting privileges law held up in the courts that could close two of its four clinics.

That’s nearly 600 miles, more than nine hours, just in one direction, all for a legally protected, safe medical procedure she could have had close to home. For women in the South, getting an abortion increasingly means a car or a bus and a few days on the road—often away from work and family obligations. How long until this woman has nowhere to go?

Correction, Oct. 21, 2014: This piece originally misstated that two of Louisiana’s five clinics are located in the northeastern corner of the state. They are located in the northwestern corner. (Return.)