Abortion in Texas
One year after the Supreme Court decision we survey how hospitals and private citizens are responding to legalized abortion.
There are other options to an unwanted pregnancy, but none is so controversial. How available are abortions today, where are they done, and what has legalizing them meant?
“I was raped. I guess it was my own fault in a way, but I was passed out when it happened. It was my first time and I didn’t even know what was happening. I still feel bad about that.
“I knew I was pregnant and I just couldn’t tell my parents. I sneaked a urine sample out the window to a friend who worked in a lab. It came out positive. I was just desperate and I had to have an abortion, but it wasn’t legal then. I got my parents to let me visit a friend in St. Louis. She found this place in the slum section and I went down there—it was the whole back room thing. This guy inserted a catheter. When I went back to my friend’s house, the catheter fell out and I was bleeding, but I couldn’t say anything. I flew back home, still bleeding. The abortion hadn’t worked.
“My brother told my parents and they took me to a doctor who said the baby would be deformed. My father took me to a place in Mexico City. It was really insane. We had to go from one hotel to another and they picked us up on a street comer in this big car. They tried to induce a miscarriage but it still wouldn’t work.
“What was supposed to be a two-day stay ended up being two weeks. I finally miscarried naturally.
“I was screwed up for two years after that. I had a nervous breakdown. I was taking drugs—speed and the whole bit. I’m all right now, but it’s taken a long time.
“I don’t like to hear jokes about abortion—you know coat hangers and stuff. Maybe no one who hasn’t been through it will ever really understand.”
Jan is 22 now, and earning a degree in social work. Between school activities, she works with women who have problem pregnancies. She knows their fears and problems because she’s been through it—the hard way.
Jan’s story is not an unusual one. Before abortion became a legal alternative for a problem pregnancy, these experiences were a dime a dozen—women who were desperate enough and who wanted abortions got them, and in the process, some, like Jan, paid the price of mental and physical suffering. Then in 1973, the U. S. Supreme Court handed down a ruling which removed criminal sanctions against the performance of the procedure. This cleared the way for physicians to perform abortions for private patients and for agencies in many states to set up abortion clinics. In an effort to see what effect that decision has had in this state, Texas Monthly decided to look at the abortion situation in Texas. Is abortion a safe, legal, available alternative for Texas women with problem pregnancies? The answer is a highly qualified “yes.”
A middle-class white female Texas citizen living in Dallas, Houston, or San Antonio can now obtain a safe legal abortion without much trouble. Women who are young, black, or chicana, who are financially pinched, who do not have a private physician, and who live anywhere else in the state have a very good chance of having an experience like Jan’s.
Some women, out of desperation or ignorance, are going to the illegal abortionist. Some who would have chosen abortion are carrying unwanted children to term because they could not get to a doctor or an abortion clinic in time. Many don’t have the money. And many just can’t get access to the facts.
On January 22, 1973, the U.S. Supreme Court ruled in the case of Roe v. Wade—a case which came from Texas and was handled by State Representative Sarah Weddington of Austin. The seven to two ruling, written by justice Harry A. Blackmun, states that allowing abortion only as a life-saving procedure, without regard for the stage of the mother’s pregnancy and other interests involved, violates the due process clause of the Fourteenth Amendment. The court stated that a woman has a qualified constitutional right to terminate her pregnancy. The ruling overturned the Texas criminal abortion statute and left the state with no laws regarding abortion. The only rules now in effect are those set down by the court.
The court delineated three stages of pregnancy, allowing more state authority over the procedure as the pregnancy progresses. In the first trimester (12 weeks) of pregnancy, the decision to have an abortion lies with the woman and her physician. In this stage, the right is in full force and the state can make no laws abridging it. During the next six months of pregnancy, the court said that states may “regulate the abortion procedure in ways related to maternal health.” This means, for example, that the state can license and regulate the persons and facilities involved in doing the procedure. During the last ten weeks of that six-month period, the state can regulate or forbid abortions except when they are deemed necessary to preserve the physical life and health of the mother.
The court ruling did not give women the right to “abortion on demand.” Instead, it said that the decision “vindicates the right of the physician to administer medical treatment according to his judgment up to the points where important State interests provide compelling justification for intervention. Up to these points, the abortion decision in all its aspects is inherently, and primarily, a medical decision, and basic responsibility for it must rest with the physician.” In essence, the Supreme Court decision allows physicians to perform abortions without fear of criminal legal reprisals. It allows a woman to have an abortion up to a certain stage of pregnancy (in effect up to about 24 weeks), if she can find a physician who will do it.
Availability of a physician is not assured. Texas ranks last among the ten largest states in ratio of physicians to population. There are about 13,000 non-federal physicians in Texas serving 11,200,000 people, for a ratio of one MD to every 861 patients. The national ratio is one to 674. Obstetrics-gynecology is the specialty area which includes abortion, and the Texas Medical Association (TMA) says the state needs 400 more obstetrician-gynecologists to meet population needs. In addition to a doctor shortage, there is a distribution problem. Physicians are locating in the more populous counties of the state at a higher rate than the actual migration of the population, leaving a medical care gap in rural areas. There are 23 Texas counties with no MD. And the field is further narrowed by two other factors: Many physicians are opposed to performing abortions for any reason. Many hospitals do not allow abortions, or make it too difficult financially and bureaucratically to obtain one. Here, social, sexual, and religious attitudes are having an effect.
THE DOCTORS
In the March 1973 issue of Texas Medicine, Dr. Braswell Locker, former president of the 11,500-member Texas Medical Association, had an article about abortion. Titled “Ethics,” it said, in part:
There are many things that are legal that may not be right in the eyes of God. Let’s weigh our decisions very carefully, be sure we are right, and then go ahead and do every job as though it were for the Lord….
Medicine without an ethic; the law without a norm; and the religious community without a theology of life and death, man and nature; will leave people without a defense. This is particularly true in a world where so many are willing to sacrifice the other rather than sacrifice for the other.
Doctors may be reluctant to perform an abortion for many reasons. Some are Roman Catholic and thus forbidden by religion from terminating a pregnancy. Some fear that patients who want an abortion today will regret it tomorrow and blame the physician. Some still are not clear about the law; others fear extra-legal reprisals from peers who oppose abortion. And some physicians, because of their upbringing or their personal sexual attitudes, either refuse to think about the subject or have strong moral objections to it.
Private physicians who do perform abortions in Texas are often reluctant to admit the fact publicly.
The practice of medicine is a closed society. Physicians are under increasing pressure from outside the profession to provide better, cheaper, more accessible medical care; their only defense to what many doctors consider attacks on the profession is to band together into associations to protect their interests and uphold good standards of practice. These associations cannot make laws; they do, however, make policies to which most doctors are careful to adhere. For medical doctors (MDs), this association is the TMA. For osteopathic physicians (DOs), in addition to the TMA, there is the Texas Osteopathic Medical Association (TOMA).
TMA policy on abortion states that medical staffs should formulate local policies covering abortions designed to safeguard the patient’s health or to improve her family life. The TMA accepts that abortion may be performed at a patient’s request or upon a physician’s recommendation, but is careful to state that no doctor or other health care personnel may be required to participate in performing an abortion. The policy also states that the doctor must obtain the informed consent of the patient (in the case of a minor from her parent or guardian). TMA policy does not specifically prohibit doctors from performing abortions in their offices if emergency facilities are available.
TOMA policy, which governs DOs, is not as specific as that of the TMA. It says only that the bylaws of TOMA “do not prohibit a physician from performing an abortion that is performed in accordance with good medical practice and under circumstances that do not violate the laws of the community in which he practices with the understanding that no physician shall be obligated to render such treatment against his will or in violation of his good conscience.”
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