After SCOTUS Decision, Abortion Providers Work to Secure Access

The Politics of Prevention

The Politics of Prevention is an occasional series on the effects of state policy on women's health services.

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Following the U.S. Supreme Court’s decision on Tuesday not to intervene in Texas’ ongoing abortion litigation, Planned Parenthood and other abortion providers are working to secure access to the procedure for women across the state.

“We’re working to help make sure that our patients and women across Texas can get the services that they need,” said Eric Ferrero, vice president of communications for the Planned Parenthood Federation of America. He said Planned Parenthood staff is predominantly working to secure hospital admitting privileges for physicians who don’t have them. Staffers are also helping women who must now travel long distances to access abortion; in some cases, they are helping to offset the costs of transportation and lodging.

Abortion providers in Texas have challenged the constitutionality of two laws that took effect in November: One requires doctors performing the procedure to obtain admitting privileges at a hospital close to the facility; another requires them to follow federal guidelines — rather than a common, evidence-based protocol — when administering drug-induced abortions.

On Wednesday, the U.S. Supreme Court ruled 5-4 not to intervene in the case or reinstate an injunction by a lower federal court that blocked implementation of the laws. The 5^th Circuit Court of Appeals in Louisiana overturned that injunction on Oct. 31, which allowed the law to take effect. The case on the law's constitutionality will still proceed in the 5^th Circuit, which has scheduled a hearing in January.

As the case moves through the courts, a dozen abortion providers — a third of those operating in Texas — have discontinued abortion services because they do not have a physician with hospital admitting privileges. Planned Parenthood was forced to stop performing abortions at four facilities in Texas when the new law took effect in November because those facilities do not have physicians with such privileges. Planned Parenthood facilities that offered abortions in Bryan, Midland and San Angelo have also recently closed.

Ferrero emphasized that there are still 50 Planned Parenthood centers open in Texas offering other women’s health services, such as contraception and cancer screening.

“The morning after all these headlines run, our health centers literally get calls from patients wondering if our doors are still open, wondering if they can still come get birth control,” said Ferrero. Although some facilities have discontinued services, he said, “it’s really too early to know if health centers will have to shut down permanently or just what will happen.”

Jeffrey Hons, president and chief executive of the Planned Parenthood Trust of South Texas, which has consolidated abortion services previously available at three locations in San Antonio to one location, said last week that the regulations have already had a dramatic effect on the facilities. For example, a patient must now visit the clinic four times for a drug-induced abortion and see the same physician, which requires more elaborate scheduling.

Meanwhile, abortion opponents are celebrating the Supreme Court’s decision to allow the law to remain in effect, and are optimistic that the 5^th Circuit will find the law constitutional when it considers the case in January.

“We never count chickens before they hatch, even though they are chickens because we do believe life begins at conception,” said Joe Pojman, executive director of the Texas Alliance for Life. He added that the justices’ 5-4 split on the decision not to intervene in the case shows that if the case was taken to the Supreme Court, the court “would likely uphold the constitutionality of our law in Texas, which is intended to increase the health and safety standards at abortion facilities.”

Additional regulations requiring abortion facilities to meet the same standards as ambulatory surgical centers remain unchallenged and will take effect in September 2014. Texas currently requires abortions after 16 weeks of gestation to be performed in such facilities. Although six abortion facilities that qualify as ambulatory surgical centers have been established since that law took effect in 2004, only three of them currently have a physician on staff with hospital admitting privileges.

Planned Parenthood recently opened a new ambulatory surgical center in Fort Worth, for example, but that facility cannot currently perform abortions because it does not have a physician with hospital admitting privileges.

Ferrero said there are "unquestionably parts of this state where it is nearly impossible to get hospital admitting privileges if you provide abortion.” He said that in some communities the politicization of abortion stops hospitals from granting abortion doctors admitting privileges.

“There’s definitely interest among the public in knowing which hospitals are refusing admitting privileges and which ones aren’t, and so I’m sure we’ll get to that point,” he said.

Proponents of the law argue the ambulatory surgical center requirements will improve women’s safety, and do not prohibit abortion, so long as providers are willing to raise the standards of their facilities. Texas Alliance for Life has also emphasized that abortion appointments are still easily available at the clinics that remain open.

“I don’t see it as putting anybody out of business; I see it as putting in safety standards that should have been there all along,” said Pojman. “They either choose to abide by those safety standards or they do not. And we know that it can be done.”

Abortion rights advocates are concerned that the heightened regulations could ultimately endanger some women, as more low-income women who cannot access the procedure may attempt to self-induce abortion.

In a 2012 survey of 318 women seeking abortion in Texas, researchers with the Texas Policy Evaluation Project found comparatively high rates of attempts to self-induce: 7 percent of Texas women surveyed, and 12 percent of women surveyed in the Rio Grande Valley, attempted self-induction before going to an abortion clinic, compared with 2.6 percent of abortion patients surveyed nationally in 2008.

“The confluence of extremely limited access to abortion in the context of poverty, access to misoprostol from Mexico, as well as familiarity with the practice of self-induction in Latin America, makes it particularly likely that self-induction will become more commonplace in Texas,” the researchers wrote in an article published in October in Contraception, an international reproductive health journal.

This story was produced with the support of the Dennis A. Hunt Fund for Health Journalism, a program of the USC Annenberg School of Journalism's California Endowment for Health Journalism Fellowships, and in partnership with Kaiser Health News, an editorially independent program of the Henry J. Kaiser Family Foundation, a nonprofit, nonpartisan health policy research and communication organization not affiliated with Kaiser Permanente.