When the most extreme abortion ban in the country took effect in Texas on Sept. 1, every Texas abortion clinic had to change its operations to comply with the law. The majority curtailed their abortion services to the first six weeks or so of pregnancy, since the law imposes liabilities on providers who would terminate a pregnancy after fetal cardiac activity can be detected.
Planned Parenthood South Texas took a different tack. The affiliate of the national Planned Parenthood organization operates several health centers in San Antonio and the Rio Grande Valley, three of which regularly provided abortion care. But when the new abortion restrictions in Senate Bill 8 took effect at the start of this month, they stopped altogether.
Those who’ve been following Planned Parenthood’s aggressive advocacy for abortion rights in recent decades may be surprised to learn that three of its clinics would voluntarily cease all abortion care when faced with this outlandish law that seems explicitly designed to intimidate providers. The national organization’s motto is “Care. No matter what.” Its website expands on the meaning of the phrase: “Planned Parenthood will provide health care services, no matter who you are or where you live. And we won’t stop providing care—because that’s what every person deserves.” This rhetoric of tenacity—“we will never back down”; “we do not give up”—permeates Planned Parenthood’s messaging.
So why did the San Antonio clinics back down? It wasn’t that they were surprised by the law—Jeffrey Hons, the president and CEO of Planned Parenthood South Texas, had been preparing for the onset of S.B. 8 since it was discussed in the state Legislature this spring. By July, when Planned Parenthood’s Texas affiliates and other abortion providers in the state filed a class-action lawsuit challenging the measure, Hons and his board of directors already knew that they wouldn’t continue performing abortions, even the legal ones, if S.B. 8 was allowed to go into effect.
Hons refutes the suggestion that suspending legal abortion care is “backing down.” “To call it that is a mischaracterization,” he said. As he and his team see it, what they are doing is making a strategic, forward-looking choice: fighting for their patients by joining the lawsuit against S.B. 8 while creating the conditions for long-term sustainability at their clinics.
Their reasoning underscores how dramatic and confounding the law is. S.B. 8 allows any person, in or out of state, to sue anyone who performs or helps a patient obtain an abortion in Texas after the detection of fetal cardiac activity. Defendants of such lawsuits could be forced to pay $10,000 or more per case. The law sets no limit on the number of suits that can be brought against a single person, though only one complainant may recover damages from each violation of the law. Hons fears anti-abortion activists could use this provision to drown abortion providers in frivolous lawsuits and allegations of illegal behavior, even if they scrupulously keep their services within the parameters of the law. “We know that we are a risk-averse organization,” Hons said. “We had no way of predicting what right-wing actors would do in response to this law becoming enforceable.”
So far, Hons’ approach appears overly cautious. No one has yet sued any of the providers that have stood firm in the face of the law and continued performing legal, early-pregnancy abortions in Texas. The only two lawsuits that have been filed under S.B. 8 are both against Alan Braid, a San Antonio physician who admitted last week in a Washington Post op-ed to violating the law by performing an abortion on a woman whose pregnancy exceeded the legal gestational limit. Both of those lawsuits came from people who claim to support abortion rights and want to force a court ruling on the law.
Braid happens to own Alamo Women’s Reproductive Services, currently the sole provider of abortion care in the city of 1.5 million people. Since Sept. 1, Planned Parenthood South Texas has been referring patients to that clinic if they believe they’re early enough in pregnancy to receive legal abortion care.
When I first asked a national Planned Parenthood spokesperson why the South Texas affiliate had ceased performing all abortions, she didn’t know. Planned Parenthood, the national organization, does not dictate the operations of its affiliates, so she connected me with Hons. The other two Planned Parenthood affiliates in Texas, which operate clinics that provide abortion care in Austin, Houston, Dallas, El Paso, Fort Worth, and Waco, have continued performing abortions within the legal limits of S.B. 8.
Hons calls the three San Antonio clinics’ shift in operations a “temporary pause.” If a court strikes down the law, or possibly just enjoins the provision that allows private entities to sue abortion providers, the clinics will resume abortion care. But as a reporter who has covered the steadily rising barriers to abortion access for Texas residents over the years, I was frustrated to see three established clinics decide to stop providing legal abortions at this critical moment in the fight. If an abortion provider with the backing of one of the best-known advocacy groups in the country can’t stand the heat, who can?
I spoke to one independent clinic operator who feels the same way. Kathy Kleinfeld, the administrator of Houston Women’s Reproductive Services, said the San Antonio clinics’ pause presents an additional challenge to the already-strapped operations of independent clinics, which lack Planned Parenthood’s national reach and fundraising capacity. “I hate to see people bow down to these scare tactics,” she said. “It’s just unconscionable to me that there are so few providers to begin with in the state of Texas” due to previous abortion restrictions that forced dozens of clinics in the state to close, “so for another provider to cease providing abortion services—we’re already at a shortage.”
To Hons, ceasing abortion care is a way to play the long game, to make sure his health centers don’t end up shuttered like so many other Texas clinics. He fully believes that his affiliate will be able to resume full operations at some point, but that in order to do so, he cannot have the clinics financially and legally hobbled by potential frivolous lawsuits, even if he has the national organization to help. Last year, Planned Parenthood South Texas served 24,900 patients. A little more than 3,000 of those received abortion care. “In thinking about how to play with the risks of Senate Bill 8, we have to realize those other 21,000 patients—they are receiving mission-driven health care as well,” Hons said. “Planned Parenthood South Texas cannot deprioritize their health care needs.”
Kleinfeld understands that Planned Parenthood provides essential medical care—including STI testing, cancer screenings, and, crucially, contraception—that must continue in the face of restrictions on abortion rights. She points out that Planned Parenthood’s national profile has made it a primary target for anti-abortion activists, who have long attempted to drain the organization’s coffers and energies with defunding measures, false allegations of misconduct, and violent attacks. It makes sense, then, that Planned Parenthood affiliates might be extra cautious about potential legal distractions. But Kleinfeld worries about the extra burden on independent clinics—especially the one remaining San Antonio provider, which did not return a request for comment—that are already feeling the strain of the new law. Some clinics are already facing staffing shortages. And S.B. 8 has emotionally drained existing staff members, who must now spend their days turning away patients or attempting to finagle the financial and logistical support women may need to obtain an abortion in a neighboring state. “The stress of having to pick up the slack to accommodate more women that might have been able to be seen at additional facilities is just going to add to that,” Kleinfeld said.
Practical concerns aside, Kleinfeld and other abortion access advocates, who wished to remain anonymous to preserve their relationships in the reproductive rights community, told me they were disheartened by the symbolic implications of Planned Parenthood South Texas’ decision. Anti-abortion advocates have admitted that they were counting on the mere threat of civil liability to scare abortion providers into limiting their services. “I’m sorry to see that the opposition’s been successful in that regard,” Kleinfeld said.
For now, at the Planned Parenthood South Texas clinics, when calls come in from pregnant patients who are more than six weeks past their last menstrual period, staff members offer information about abortion clinics across state lines and help secure the financial assistance they may need to get there. The lucky few who are earlier in pregnancy get sent to Braid’s San Antonio clinic. But Hons said the phone lines have been “eerily quiet.” That may be due to the way people obtain information about abortion these days: Patients who find their way to the affiliate’s website will find a banner that says, “Due to Texas’ SB 8 law, we are unable to provide abortion procedures at this time.” The clinics’ pause in abortion care has taken “an emotional and psychic toll” on staff, Hons said. “Those staff are also risk-averse and understand the position that we’ve taken, but they are eager to get back to saying to our patients, ‘Yes, we can help you.’ ”
It is possible, even probable, that a six-week abortion ban will mean fewer legal abortions in Texas, requiring fewer abortion providers to meet the demand. But at this inflection point for abortion rights in the U.S., even seemingly symbolic gestures can have tangible consequences. Many Texas abortion clinics have added pop-up windows or eye-catching notices to their websites, reassuring viewers that abortion is still legal in the state. They worry that incomplete information about the law might lead abortion-seeking patients to assume the procedure has been fully outlawed in the state, rather than legally available in a very short window early in pregnancy, and give up hope. Texans who need abortion care are already facing unprecedented logistical barriers, a renewed fear of legal consequences, and shaming rhetoric from the political right. Abortion providers are in a unique position to ease some of that burden.
Each week, at a meeting of the Planned Parenthood South Texas senior leadership team, members revisit their decision to halt abortion care, taking into account any new information on the still-evolving landscape of liabilities, threats, and unmet needs S.B. 8 has wrought. “I fully expect we will resume abortion care as soon as reasonable,” Hons said, noting that multiple lawsuits contesting the law, including one filed by the Department of Justice and the one joined by Planned Parenthood, could still end in decisions that favor abortion rights. “Senate Bill 8 is not going to be left standing as it is now forever. I do not believe that’s going to happen.”