More than one hundred patients at Whole Woman’s Health facilities in Texas were turned away on March 31 for appointments that some had scheduled the day before. The morning of the 31st, the U.S. Fifth Circuit Court of Appeals had ruled that an executive order banning abortion during the coronavirus outbreak could remain in place, reversing a federal judge’s block of it, meaning that many who hours before thought they could go through with their appointments now could not. According to Amy Hagstrom Miller, CEO and president of the organization, patients were begging, often in desperation, to see the clinicians. But with the order back in place, there was nothing doctors could do except provide funds for some patients to fly to get their abortions out of state, increasing their risk of being exposed to the coronavirus or unwittingly exposing others.
“One of the things that’s so frustrating for me and all of the staff at Whole Woman’s Health is just being put in the position to have to carry out orders like this that we don’t agree with, that we think are harmful and disrespectful to the patients we’re here to serve,” Hagstrom Miller told me. “But we’re put in a position of carrying that message from the governor and the attorney general to our patients.”
And that message was to stop providing abortions. On March 22, Governor Greg Abbott issued an executive order halting “procedures that are not medically necessary” in response to the shortage of hospital capacity and personal protective equipment in Texas. The next day, Texas attorney general Ken Paxton specified that clinics in the state must stop providing abortions unless a person’s life or health are in danger. Providers in violation faced “penalties of up to $1,000 or 180 days of jail time.” The order was blocked by a federal district judge on March 30, but less than 24 hours later the Fifth Circuit issued the temporary stay, allowing Texas to prohibit most abortions through at least April 21.
Neither Abbott’s nor Paxton’s offices responded to requests for comment.
The state’s rationale for banning abortions—to avoid overwhelming hospitals or using up scarce medical masks and gowns and gloves—does not match the reality of how the procedure typically occurs in Texas. According to Texas Health and Human Services, in 2017 fewer than 100 of about 52,000 abortions were performed at hospitals. And about 90 percent were done when the patient was ten weeks or less along in her pregnancy, when it’s still legal in Texas to receive a medication abortion that terminates the pregnancy by pill. According to Hagstrom Miller, medication abortions require a minimum of personal protective equipment, and then only in cases requiring blood work.
Nonetheless, many clinics that offer medication abortion are operating as if they are subject to the ban. Some have closed. Others, like Whole Woman’s Health, remain open on a case-by-case basis to provide medication abortions they believe are consistent with the exemptions in the executive order.
But clinic closures don’t stop pregnant Texans from going to great lengths to obtain abortions. Patients calling Texas clinics are now looking for alternatives. “Not a single woman has said then I’ll just go ahead and continue this pregnancy,” Kathy Kleinfeld, who runs Houston Women’s Reproductive Services, said.
In response, clinics are referring patients to facilities in other states where they can legally obtain abortions, but this can come at great cost and can subject women to potentially fraught travel during a pandemic.
“It puts callers in a difficult situation where they’re having to choose between their reproductive health needs to be met immediately and their health or safety from coronavirus,” said Sahra Harvin, a board cochair at Clinic Access Support Network. “And I think it’s been really stressful and scary for our callers having to choose between endangering their health in one way and endangering their health in another way.”
According to Kari White, lead investigator at the Texas Policy Evaluation Project at the University of Texas, most of the 24 clinics in Texas that operated before the recent executive order were concentrated in metropolitan areas. Prior to the order, nearly half of Texas’s counties were more than one hundred miles from the nearest U.S. facility providing abortion care. But now with the ban, that distance has grown considerably: 94 percent of counties are more than one hundred miles away, and 72 percent are more than two hundred miles away from an out-of-state facility.
Patients choosing to go out of state face added anxieties: going to a place they’ve never been before, incurring additional travel costs, and possibly having to self-quarantine after crossing state borders.
An occupational therapist in her late twenties and her partner, a financial analyst, both from Houston, told me they had two appointments canceled in Texas and were referred to the nearest facility with the earliest availability: a clinic thirteen hours away in New Mexico. They had found out about the pregnancy just as the coronavirus outbreak in Texas was worsening, and believed it was not the right time to become parents, so they decided to make the trip. Fearing travel restrictions might be set in place to control the COVID-19 outbreak, the couple booked an Airbnb ten days ahead of the appointment and drove overnight so that they could work remotely the next day.
The couple told me that there were plenty of other patients from Texas at the New Mexico clinic—doctors in that state also report seeing an influx of patients—and that a $50 discount was offered to those coming from places such as Texas and Ohio with abortion bans in place. The abortion itself was $450, but after adding in gas, the Airbnb, and groceries, the trip ended up costing upwards of $2,500.
For others, the process of rescheduling their abortions has been even more arduous. According to Harvin, some callers have made an appointment at a clinic in another state only to find out a few hours later that that state was also shutting down operations. In Oklahoma, for example, lawmakers halted abortion services, eliminating that state’s clinics as an option for Texans, before the move was subsequently blocked by a federal judge. And in other cases, clinics that are still accessible are now booked through mid-April because of the influx of patients they’re receiving from out of state. This has led to significantly increased wait times for a procedure that’s time-sensitive.
Practical support organizations that help with the costs associated with getting an abortion—such as transportation, childcare, lodging, and other fees that aren’t for the abortion itself—report they are receiving an overwhelming volume of calls from clinics in Texas. Clinic Access Support Network in Houston, which typically has seventy-plus volunteers who drive people to their appointments or pays for travel to bring people into the city, is now paying for patients to travel out of state. Fund Texas Choice, which receives all of its funds from private donors, has doubled its typical weekly spending limit of $1,000 since the executive order took effect, and it has been blowing past it, according to Rebecca Dreke, the treasurer. In March alone, 27 of the 40 pregnant women Fund Texas Choice assisted, about half of whom would otherwise be eligible for medication abortions in Texas, traveled to states including New Mexico, Colorado, Mississippi, and Kentucky.
According to White, many patients seeking abortion are low-income, adding to the stress of finding a provider during this time. “What’s concerning in this current situation is the latest unemployment rates came out and millions of people in the United States are now without jobs—there’s a lot of economic uncertainty in people’s lives,” White said. “They may be working fewer hours or may not be working at all. That adds to the complication of them trying to find the money that they need in order to be able to pay for a procedure and travel elsewhere in order to get it.”
Kamyon Conner, executive director of Texas Equal Access Fund, an organization that provides funding to low-income women in the northern region of Texas who are seeking abortions, said she had heard from Texans in situations where both adults in a household had lost their incomes. “They are angry at the people who enacted these restrictions on abortion at this time,” Conner said, “and are pretty upset that it’s happening at a time when they’re already going through so much other stuff.”
Both partners in the Houston couple I talked with still have their jobs and are working remotely, though one had to take a pay cut recently. “This was definitely an undue expense. I mean, we had to rent this place to live out of the state,” they said. “It’s definitely been financially stressful in a time when you’d hope you wouldn’t have to face that as well.”