The Politics of PreventionMore in this series
Editor's note: This story was updated twice, first to include a response from Texas Right to Life and Amy Hagstrom Miller, and then to provide details from a Thursday conference call with Whole Woman’s Health.
Whole Woman's Health announced late Wednesday that it is closing two abortion clinics — one in the already underserved Rio Grande Valley and another in Beaumont — as a result of strict abortion regulations passed by the Legislature last year.
"We are devastated to announce that we're closing our clinics in McAllen and Beaumont this week," a post on the abortion provider's Facebook account says. "After serving women in these communities for over 10 years, Texas politicians have forced us to shut our doors."
During a 2013 special legislative session, Republican lawmakers approved new regulations on abortion that require physicians who perform the procedure to have hospital-admitting privileges within 30 miles of the facility, and follow FDA standards, rather than common evidence-based protocols, for administering drug-induced abortions. The rules also ban abortions after 20 weeks of gestation. In September, additional rules take effect requiring abortion facilities to meet the regulatory standards of ambulatory surgical centers; only six of the existing abortion facilities in Texas currently meet those standards.
There were 44 abortion clinics in Texas in 2011; now, there are 24. Nineteen clinics have closed since this summer, said Amy Hagstrom Miller, the founder of Whole Woman's Health. She added that at one point, there were as few as 20 clinics open, but several reopened when doctors obtained hospital-admitting privileges.
By November, when the hospital-admitting privileges rule took effect, a dozen abortion providers — a third of those operating in Texas — had discontinued abortion services.
The Whole Woman’s Health clinic in McAllen stopped providing abortions as a result of that rule, but continued providing other women's health services until this week's announcement. Whole Woman’s Health is currently the only abortion provider in the Beaumont-Port Arthur area; the closest facility is in Houston, 90 miles away.
In an interview with MSNBC's Rachel Maddow on Wednesday night, Hagstrom Miller, the founder of Whole Woman's Health, said she was struggling with the closures because of the state's need for abortion services.
"It may have taken me a little too long to accept it," she said. "I don't back down easily because the need is still here. That's what's so heartbreaking."
But Melissa Conway, spokeswoman for the anti-abortion group Texas Right to Life, said the closures did not come as a surprise. She said she expects to see more abortion clinic closures, calling them a "reflection of the will of the people."
"It is clear Texans are no longer willing to accept the predatory practices of abortion providers who fail to place the value of a woman's health and safety or the life of a pre-born Texan in greater importance than their own personal financial gain," Conway wrote in an email.
In 2011, more than 2,600 women in the predominantly Hispanic Rio Grande Valley had an abortion. Currently, women seeking an abortion there must travel to San Antonio or Corpus Christi to gain access to the procedure — and the Corpus Christi clinic does not meet additional new "ambulatory surgical center" standards that will take effect in September.
The closest ambulatory surgical center that performs abortion is in San Antonio, 235 miles from McAllen.
Hagstrom Miller said Whole Woman’s Health is closing the Beaumont and McAllen facilities in order to maximize resources as they attempt to bring their Austin and Fort Worth locations in compliance with ambulatory surgical center requirements. “We’ve only got a few months here to see if we can work out a solution in either of those two communities,” she said.
On Thursday’s press conference call, Andrea Ferrigno, corporate vice president of Whole Woman’s Health, said the organization has struggled to obtain hospital-admitting privileges for its doctors in Beaumont and the Rio Grande Valley.
Whole Woman’s Health and other abortion providers in Texas have challenged the constitutionality of the hospital-admitting privileges and FDA-protocol provisions in federal court. The 5th Circuit Court of Appeals, which lifted a lower court’s injunction on the state regulations, held a hearing on the case in January, and has yet to make a decision. The U.S. Supreme Court has also rejected a request by abortion providers to intervene in the case.
Abortion rights advocates argue that the reduced access to legal abortion procedures has endangered women's safety and imposed on their constitutional right to an abortion. Proponents of the new regulations say they improve safety standards to protect women's health at facilities that perform abortions.
A Texas Tribune review of state inspection records for 36 abortion clinics from the year preceding the lawmakers’ passage of the new regulations turned up little evidence to suggest the facilities were putting patients in imminent danger. State auditors identified 19 regulatory violations they said presented a risk to patient safety at six abortion clinics that are not ambulatory surgical centers in Texas. None was severe enough to warrant financial penalties, according to the Department of State Health Services, which deemed the facilities’ corrective action plans sufficient to protect patients.
Among the violations auditors found at the facilities, which get surprise inspections annually, were expired or unlabeled medicine and instances in which medical staff failed to follow proper infection control procedures.
The Whole Woman’s Health clinic in Beaumont had the most violations of the records inspected by the Tribune. Auditors found that a sterilization machine was not working properly and that nurses were not trained to recognize the problem. Whole Woman’s Health took immediate steps to remedy the problems and had its correction plans accepted by the state.
Between 2000 and 2010, five women died in Texas from abortion-related complications; the most recent death occurred in 2008. More than 865,300 abortions were performed during that time period, making Texas’ abortion-related death rate, 0.57 deaths per 100,000 abortions, slightly lower than the national abortion death rate of 0.7 per 100,000.
Abortion rights advocates say that is 14 times lower than the risk associated with carrying a pregnancy to term; opponents argue that every abortion comes with a terrible cost, the death of a baby.
“We’re hearing from some women that they have not been able to have the abortion that they wanted and are being forced to continue a pregnancy,” said Dr. Daniel Grossman, vice president for research at Ibis Reproductive Health and a researcher with the Texas Policy Evaluation Project at the University of Texas, a three-year study evaluating the impact of the Legislature’s 2011 cuts to family planning. Since November, the researchers have been interviewing women who had their abortion appointments delayed as a result of the new regulations, and women who came to the McAllen clinic seeking an abortion.
“Both Beaumont and the Rio Grande Valley were hard hit by the cuts to family planning imposed by the 2011 Legislature,” Grossman said, adding that Beaumont lost 50 percent of its state funding for family planning, while the Rio Grande Valley lost two-thirds of its funding.
At the end of 2012, the researchers conducted a survey of women seeking abortions in six Texas cities. Forty-five percent of the women surveyed said they were unable to access their preferred method of contraception in the three months prior to becoming pregnant, often because it was too expensive. They also found women in the Rio Grande Valley were more likely than the national average to attempt self-induction of abortion. In the Valley, 12 percent of patients reported attempted self-induction, compared to a 2008 national survey that found less than 1 percent of women took a drug to try to end their pregnancy before going to an abortion clinic.
Dr. Joseph Potter, another researcher with the Texas Policy Evaluation Project, testified in federal court the demand for abortions in Texas would exceed providers’ capacity by 25,000, as a result of the reduced access created by the new rules.
“The implication is that 25,039 women will not be able to access abortion care in the state,” Potter testified in a court document, “even if they could travel the long distances necessary to access the nearest clinic with capacity to serve them."
Hagstrom Miller said the new abortion regulations could lead to a public health problem. "We didn't change the amount of women in the community who are still going to need the service," she said. "We just blocked their access to getting it safely."
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.