WWS Reacts

WWS Reacts: Who is Most Affected by the Texas Abortion Law?

Jun 17, 2015
B. Rose Huber
Woodrow Wilson School

UPDATE: As of June 29, the Supreme Court is refusing to allow Texas to enforce these restrictions. The order will likely remain in effect until fall 2015, when the court will decide whether to hear an emergency appeal from the clincs of the lower court ruling.

Last week, a federal court upheld provisions from a 2013 Texas abortion law, which may close down 11 of Texas' remaining abortion clinics.

We discussed the decision and who it will affect most with James Trussell, the Charles and Marie Robertson Professor of Public and International Affairs, Emeritus at Princeton University's Woodrow Wilson School of Public and International Affairs; and Abigail Aiken, a postdoctoral research associate at the Office for Population Research, which is based at the Wilson School.

Q. What is the overall impact of this decision?

Answer: The U.S. Court of Appeals for the Fifth Circuit ruling on the 2013 law requires that abortion clinics in Texas meet the requirements of ambulatory surgical centers. Conservative estimates of the impact of the law indicate that only 10 abortion clinics will remain open in Texas. This number is down from 41 clinics in 2012 and 18 clinics that are presently open. These 10 clinics are located in only six cities: Austin, San Antonio, Dallas, Fort Worth, Houston and McAllen, leaving no clinics at all in West Texas.

The enforcement of another aspect of this law back in 2013 – the requirement that clinic doctors must have hospital admitting privileges – already forced all of Texas’s rural abortion clinics to close, including both in the Rio Grande Valley. One clinic in McAllen subsequently re-opened. As a result of this measure, many women in Texas must already travel hundreds of miles to a clinic and must make up to four visits with the same doctor to obtain a medication abortion.

If the second provision of the law – that clinics must meet the same requirements as ambulatory surgical centers – goes into effect, women will have to travel even greater distances to access abortion care, with those seeking abortion in West Texas or rural areas forced to travel the farthest distances. The overall impact of this law would be to disproportionately restrict abortion access among low-income women, women living in rural areas and undocumented women.

Q. The statute calls for abortion clinics to meet certain building standards. Can you explain these? How do they affect women's health and safety? 

A: The new law requires that abortion clinics meet the same requirements as ambulatory surgical centers, meaning that they must comply with federal and state regulations stipulating how the facility must be designed and set up. Examples include regulations governing the dimensions of corridors; the type of plumbing, heating, lighting and ventilation the clinic must have; and the types of surgical and emergency equipment that must be available. While these requirements might make sense for many ambulatory surgical centers – where patients are undergoing day surgeries that require transport on a gurney or that carry more than a negligible risk of major complications – they make no sense for abortion clinics.

Abortion is already a very, very safe procedure. Major complications occur less than a quarter of a percent of the time, making abortion much safer than carrying a pregnancy to term. Conforming to ambulatory surgical center requirements will not make abortion any safer. Rather, women’s health will be impaired by not having access to safe abortion.

Q. Attorney General Ken Paxton of Texas said the law protects unborn children, calling it a "victory for life and women's health." What is your response to this?

A: The claim that this law represents a “victory for women’s health” is an appalling and disingenuous misrepresentation of fact. This law has the potential to seriously harm women’s health in Texas by denying access to abortion in a timely and safe fashion. In truth, the law is a victory only for those opposed to abortion.

Q. The Texas law is part of a nationwide effort to reduce abortions around the country. For example, other states, like Tennessee and Florida, plan to increase the time women must wait before going through with the procedure. What else might we see going forward?

A: As in Texas, states will attempt to require that doctors performing abortion have admitting privileges to a hospital located nearby. We are already seeing increases in legislation mandating waiting periods for procedures, requiring doctors to provide certain written information, and to oblige women to undergo fetal heart auscultation. Laws requiring narrated ultrasounds have also increased, such as the measure that was recently permanently blocked in North Carolina after the Supreme Court refused to review it. There are also likely to be laws attempting to limit the maximum gestational age or how far along a woman is in pregnancy. For example, the Texas law imposed a maximum limit of 20 weeks in 2013. And requirements that 600 milligrams of mifepristone – a drug that ends pregnancy less than seven weeks along – be used for medication abortion as approved by the FDA, even though evidence-based medicine has shown that 200 milligrams is safe and effective. The 600 milligrams regimen is more expensive, which is a cost that falls upon the woman seeking the abortion.

Q. Overall, who do these decisions affect the most? Is there another policy solution?

A: One of the most egregious aspects of these decisions is that they disproportionately affect poor women, socially disadvantaged women and women of color. For those who create them, such laws are tantamount to expressing a complete lack of concern for the lives of these women, or for their ability to exercise their legally protected rights. Moreover, the consequences of these decisions affect not only women but also their partners and families, who will live the everyday realities too.

As to another policy solution, one option is to reduce the need for abortion by making all methods of contraception universally available to women and men. However, those opposed to abortion are often the very ones also opposed to enhanced contraceptive access. Better access to contraception and promotion of those methods that are highly effective because they do not require regular action on the part of the user (such as IUDs and implants) could go a long way. Yet even so, one only needs to look at other countries where contraception is already universally available to know that there will still be a need for timely access to safe abortion.

WWS Reacts is a series of interviews with Woodrow Wilson School experts addressing current events.