What is HB2? (from fundtexaschoice.org)
The current Texas law has four main requirements:
- Abortion doctors must have admitting privileges at a hospital within 30 miles of the abortion clinic and must meet ambulatory surgical center (ASC) standards.
- Abortions after 20 weeks post-fertilization are prohibited, except in cases of a severe fetal abnormality. The 20-week ban also does not apply in cases where the post-20-week abortion is necessary to “avert the woman’s death or a serious risk of substantial and irreversible physical impairment of a major bodily function, other than a psychological condition,” in which case the abortion shall be performed “in the manner that, in the physician’s reasonable medical judgment, provides the best opportunity for the unborn child to survive.”
- Abortion-inducing drugs must be used according to FDA regulations (with the exception that dosages can be given according to American Congress of OBGYN Practice Bulletin). FDA regulations require that women visit the doctor in person for each of the two doses of the abortion pill, resulting in two separate doctor’s visits.
- After taking abortion-inducing drugs, there must be a follow-up appointment within 14 days. This brings the total of pill-related appointments to three. Additionally, the Texas 24-hour waiting period law requires that women living within 100 miles of their nearest abortion clinic wait 24 hours between her mandatory ultrasound and her actual abortion, meaning four doctor’s appointments for most women seeking the abortion pill.
As of September 1, 2014, Section 245 of the Texas Health and Safety Code was amended to require that all abortion clinics to be ambulatory surgical centers (ASCs). This change resulted in the closure of most clinics in the state.
Access to abortion clinics particularly difficult for West Texas women
By Erin Stone
When Planned Parenthood closed in Midland in 2013, there were in fact two clinics that shut their doors—Planned Parenthood of West Texas, which provided only family planning services, and Planned Parenthood Choice, which was the abortion clinic.
When the Texas Legislature cut funding to any women’s health care facilities providing abortion care in 2011, Planned Parenthood clinics across the state had to make a choice.
To maintain their ability to continue providing family planning services for free, Midland’s Planned Parenthood created a legally and financially separate abortion clinic, dubbed Planned Parenthood Choice, which was a fee-for-service clinic. But soon, the state enacted another law not only cutting funding to those who provided abortions, but also cutting funding to those who referred to or even provided education about abortion.
“If you had devised a way to shut down small, rural healthcare that was providing family planning that was it,” said Carla Holeva, former CEO of Planned Parenthood of West Texas. “Of course the political atmosphere at that time was pretty hot and heavy and Governor Perry had vowed very publicly to close Planned Parenthood down.”
The Texas Women’s Health Program was created by the state to take the place of programs like Planned Parenthood. Though Holeva said it’s a “wonderful program” that provides the services Planned Parenthood did to most of the working poor population PPWTX served, it still cut off women’s right to know about abortion. The referral rule was what really clinched “the perfect storm” that shut down the Planned Parenthood programs in Midland, Holeva said.
“We could have a woman come in that was paying cash for her family planning services and in the course of her family planning we found out she was pregnant,” Holeva said. “Because she’s paying cash, I could tell her all of her options, whether it’s continuing with the pregnancy, adoption or if she's choosing to end her pregnancy. I can give all three to her. Same thing if the woman was on Medicaid, a federally funded program.”
“But if that third woman came in and she was on the Texas Women’s Health Program, I could not even discuss with her one of her options,” Holeva continued. “And if she asked me about abortion, I would have to tell her that I was not able to discuss that with her. So you think about it and you've got three women, two of them get full access to their options but the third one doesn’t. You're treating your patients very differently. It was crazy.”
For a while, PPWTX and Planned Parenthood Choice, housed in the same building on Secor St., managed to stay open and financially and legally separate. But in the end, lack of staff and money, and a loyalty to the Planned Parenthood belief of all-women’s options care forced them to close.
“We could have stayed open and just been an abortion provider, but there weren’t enough patients here for that,” said Karen Hildebrand, who served as CEO from 1991 to 2012. “It just wasn't feasible to stay open and retain employees. We could've stopped doing abortions, but we would have also had to stop doing pregnancy testing and all-options counseling. It’s just sort of question of integrity and belief and faith in women as intelligent beings capable of making their own medical decisions. We believe that they should have access to complete, medically accurate information about all their options when they're faced with an unintended pregnancy and to not do that was not something we couldn’t move forward with.”
Considered an “attack” by some and a “safety measure,” by others, House Bill 2 has been the most recent state law that targets abortion access.
Though Texas legislators created the bill for the purpose of making abortions safer, the requirement that clinics meet the standard of ambulatory surgical centers was in fact what wiped out the majority of providers in the state, making such centers inaccessible to rural areas—particularly West Texas.
Since HB2 went into effect, though whether or not it will be upheld is expected to be decided by the Supreme Court this month, the abortion clinics in Texas closest to the Midland-Odessa area that have remained open are four to five hours away. After the bill went into effect, the American Congress of Obstetricians and Gynecologists (ACOG) released a statement in response to the Texas bill stating:
“The bills would require physicians who perform abortions to have admitting privileges at a hospital within 30 miles, allowing abortions only in surgical clinics and setting a higher standard than for other procedures with similar low risk such as colonoscopy. The fact is that abortion is one of the safest medical procedures. The risk of complications from abortion is minimal, with less than 0.5% of abortions involving major complications.”
Reasons for abortion are varied
The variety of reasons women seek abortions is sometimes lost in the pro-life vs. pro-choice narrative that dominates the discussion across the nation.
Nancy Tarleton, 24, moved to Midland from California five years ago. In 2013, during the height of the defunding of Planned Parenthood, she became pregnant, but later found out the child was stillborn. She decided to go through with a medical (nonsurgical) abortion.
Working a waitressing job and without insurance, Tarleton went to Midland Health Center, where Midland’s Planned Parenthood and Planned Parenthood Choice were housed at the time.
She entered the building surrounded by yelling protestors, she said.
“At the time of my abortion, they were in the process of defunding, so (for anesthetic) I literally got about 400 mg of ibuprofen,” Tarleton said. “That’s all they had because they were being defunded. People don't understand. They hear ‘Planned Parenthood’ and they think ‘abortion’ because (a woman) was irresponsible, or because of this and that. You don't know everybody’s circumstances.”
In 2011, 401 women living in the Midland-Odessa metropolitan area obtained an abortion, according to a study from the Texas Policy Evaluation Project. The activism of pro-life groups in this area was particularly high as compared to other areas of the state.
“Our primary goal was to give information to potential clients coming in or anybody else about abortion, about alternatives, about The Life Center or other alternatives, to provide sidewalk counseling for those who wanted to talk,” said Mike Banschbach, coordinator of Pro Life Midland. “But the goal was to inform and engage in discussion and to get them over to The Life Center. There is a lot of free stuff over there.”
The Life Center is a non-medical clinic that provides pregnancy tests, limited ultrasounds, prenatal classes, parenting education, consultations with an RN, adoption information, and referrals for clinics that do STI/STD testing or birth control.
They don’t promote the use of the birth control pill or other forms of birth control other than abstinence, but they do provide education on all options, said a clinician there in a phone interview.
As part of their activism, Pro Life Midland would also often take down license plate numbers of those who were parked in the Planned Parenthood parking lot and send letters labeled with Planned Parenthoods address but with information about The Life Center inside. Banschbach confirmed this practice.
For some women, this practice could have resulted in death.
Both Holeva and Hildebrand cited in separate interviews an instance of a woman who received one of these letters after being seen entering Planned Parenthood Choice.
A woman called them, sobbing over the phone, saying that she had a received a letter from Planned Parenthood stating that she didn’t have to go there, but she should go to The Life Center.
“She said it was just a fluke that she checked the mail today, that her husband is very abusive and he won’t allow her to get the mail,” said Hildebrand, who is now the Executive Director of Odessa’s Crisis Center. “She said, ‘he will kill me and you don't understand that I came this close to dying today. I would have been dead if I wouldn't have gotten this.’ This is what the impact this practice has. You hear about people being pro-life but it’s really about being pro-birth. Once the baby is born, this is the same group that wants to cut off funding for Head Start, food stamps and everything else that helps these families when they're struggling after an unintended pregnancy.”
Though this woman’s situation is not typical, it does happen. Reproductive coercion (be that denying them access to birth control or impregating them to force further economic reliance) is often a method used by abusers to control their partners, said Hildebrand.
Many of the Texas abortion funds the Reporter-Telegram reached out to stated they have seen multiple clients who are in such abusive situations. SafePlace has also seen the occasional client in this situation, said Tracy Black, victims advocate there.
A matter of belief
The Pro Life Midland group protested Planned Parenthood as a whole primarily because of its abortion services, but also because of its providing affordable access to the birth control pill, said Banschbach.
“Friday for the most part was abortion day so we would certainly have a presence there on Fridays,” Banschbach said. “We would talk about birth control and contraceptives and their abortive natures. It’s not a perfect world, but is the answer, oh gee, people can’t help themselves so we’re gonna lower the bar. They're only glorified animals, they can’t control their impulses so we’re gonna lower the bar. Personally, I don't think thats the answer.”
However, most women who seek abortions do not do so because of the stereotypical notion they were promiscuous or using abortion as a birth control method, according to abortion clinics that have been serving Midland-Odessa women since the Planned Parenthood shutdown.
West Fund, founded by Alyssah Roth and Raquel Ortega in part as a response to HB2, was the first abortion fund to serve El Paso, specifically. About 12% of the clients they fund now are from Midland, said Roth.
“On average, the folks we’re funding (from Midland) are 25 years old and about 50 percent of them already have children, and the majority are white,” said Roth. “Women from this area are some of the people who have to travel further. They are the ones being most affected by this clinic shut-down bill as well as people who just tend to not know that clinics are still open let alone that abortion is still legal. When you hear what they're saying on the news, you just get bits and pieces and make assumptions and don't realize that there are options.”
Many of the women who used the facilities that were shut down by HB2 for general women’s health care and abortions were low-income and uninsured, which is why these abortion funds have sprung up throughout the state.
“Obviously women are smart enough, for the most part educated enough, and now they have the (technological) resources, so if they wanna find stuff out they can,” Banschbach said. “It’s not like they’re incapable or inferior to men. Then where that goes is well, can a woman make decisions for her own body? Well of course she's capable of making them and should, but if they're having sex with somebody, those two people need to be having this discussion. The man is afraid of commitment normally and doesn't wanna step up. He's getting his sex and he can get up and leave at any time and thats 75 percent of the problem, that attitude. But should she make the decision in a vacuum? Probably not. Particularly if she's considering an abortion, that’s serious business. You've got to talk to people about this, lots of health considerations, emotional considerations. just getting the abortion doesn't mean the problems are over.”
Most of the women who seek funding for their abortion procedures are supported by their partners or a close family member or friend, said Roth. Almost none of them arrive at the decision alone, she said.
However, people specifically from the Panhandle and West Texas are increasingly needing help with funding for travel and lodging costs, said Nan Little Kirkpatrick of the Texas Equal Access (TEA) Fund, particularly due to the fact that HB2 requires a 24-hour waiting period between a women’s mandatory ultrasound and sonogram viewing and her actual abortion procedure.
The lack of options is also causing women to get abortions later in their pregnancies, which leads to a higher cost procedure.
“The need just seems to keep growing all across the board,” said Amanda Williams of the Lilith Fund in a phone interview. “There are longer wait times at clinics because people are going to the same places now. It’s a constant battle because once you procure money over a week, then you're one week more in your pregnancy so the price goes up again. Many of our clients are low income, head of households, already have kids and can’t take time off work or pay for childcare for the time they take off.”
Of the abortion clinics that remain open in the state, the closest to Midland-Odessa are Austin Women’s Health Center, Whole Women’s Health of Fort Worth, Whole Woman’s Health of San Antonio, and Hilltop Women’s Reproductive Clinic in El Paso.
There are a few ASCs that remain as well: Alamo Women’s Reproductive Services and Planned Parenthoods in Austin, El Paso, Dallas and San Antonio.
Gloria Martinez, Nurse Administrator at Hilltop Women’s Reproductive Clinic, says they see many women from Midland and that “there’s a great need out there.”
To Banschbach, that need will continue to grow if the access remains.
“What’s gonna keep people from coming back in a few months for another abortion? At some point people have to come to grips with whether they are God or whether there is a God,” Banschbach said. “Wehave eight kids. My wife gave birth to number eight when she was 45. at some point you've gotta say look, if there is a God, he made the universe and he's a lot smarter than I am and if I exhibit some trust and faith, I'm not gonna be left in the gutter, homeless with nothing to eat. God does not want that for people. We have so many resources here. Are you telling me that if you have another mouth to feed no one is gonna step in and help? C’mon. that’s just not real. I’m sure there are plenty of people around here who would be happy to adopt.”
However, Midland has a huge shortage of foster care families. Nearly 60% of foster kids in the Midland-Odessa area get sent to foster homes out of region, according to CPS data. Additionally, due to the fact that nearly half of all pregnancies in the United States are unintended, taxpayers spend about $12 billion annually on publicly financed medical care for women who experience unintended pregnancies and on infants who were conceived unintentionally, according to a study by the Brookings Institution, a non-profit public policy organization based in Washington, D.C.
“We know that access to abortion has a huge impact on someone’s life and that it has a huge impact on their access to other kinds of opportunities,” said Kirkpatrick. “So if a person is already in poverty or extremely limited income, we know that if they are unable to access an abortion they want then they are three times more likely to fall into poverty than if they were able to access that abortion. I worry not only that people will be forced to carry their pregnancies to term that they don't want and don't feel are right for them, that terrifies me, and so does the thought of people being forced to take matters into their own hands and possibly pursue underground methods of abortion, which we know from history happens.”
With West Texas and Panhandle families being some of the furthest from abortion clinics in Texas and New Mexico, they are being forced to have abortions later in their pregnancy. They are on average a week and a half further along than more local clients, said Roth.
West Fund, Texas Equal Access (TEA) Fund, based in Dallas, Fund Texas Choice, based in Austin, and the Lilith Fund, also based in Austin, all have seen an increase or stable numbers in their clients from the Midland-Odessa area since HB2 passed.
Unlike Texas, New Mexico has no required 24-hr-waiting period between ultrasound and actual abortion procedure and there's no required parental consent for minors. Both are big reasons why these funds send clients to out-of-state to New Mexico, said Natalie St. Clair of Fund Texas Choice.
Tarleton said she wouldn’t have known where to go if Planned Parenthood had been gone at the time of her abortion, she said. This is the case for many Texas women.
“Like it or not, the woman is the child bearing one and she has the most pain,” Banschbach said. “She enticed Adam and as a result we fell. So that was part of the punishment, that there would be pain in childbirth. Women sacrifice some health, rearing children, nursing, all that business. But the man has to pitch in too. He can’t go drinking with the buddies, he's gotta come home after work and relieve his wife. The greater culprit is the man. There’s a much greater sex drive in a male. If men treated women like they should be treated, they wouldn't be pressuring them to have sex outside of marriage, they wouldn't be treating them like glorified prostitutes.”
However, Banschbach admitted that because of the role of the man in unintended pregnancy, the Pro Life group should be providing education not only for women, but also for men—something that currently is not happening.
To those who work in the field of women’s health care, on the other hand, that is a given.
“Our belief is that children are a treasure and they need to be brought into this world, they need to be loved and wanted, and when that can’t happen, that’s a tragedy and all of society pays a price,” Hildebrand said. “Almost every single social problem that we have can be traced back to somebody being born unloved and unwanted. And that’s what Planned Parenthood was all about—having the ability to decide when and if you have the ability to become a parent, and every child thats brought into this world being loved and wanted and treasured. So it is just a different way of looking at the world.”