In Texas, going the distance for an abortion

SAN ANTONIO — None of the obstacles Texas placed in her way were going to keep Veronica from driving 125 miles to her appointment at Whole Woman's Health clinic Friday. With her 3-year-old and 1-year-old in tow, she was determined to get an abortion.

The state didn't make it easy. There used to be a clinic 50 miles away in Corpus Christi. But Texas — which she likens to a "big bully" — is more than halfway to its goal of reducing from 44 to 10 the number of licensed clinics in the nation's second-largest state.

In the end, Veronica — who did not want her last name used because of the personal nature of the procedure — came up short of money and postponed her trip. She doesn't blame the state for that, but she's concerned about the law's restrictions nonetheless.

"It is a hassle and a struggle," she says. "If we get rid of all the clinics, then what choice do you have?"

Texas' abortion law — which the Supreme Court this month agreed to review early next year — unquestionably has made abortions harder to come by.

The first round of closings put at least 300 miles between Lisa Marii Montes' home in Midland and the nearest clinics in El Paso, Fort Worth and San Antonio. En route to Whole Woman's Health last month, she had a change of heart.

"It's a costly procedure as it is, so adding on travel costs and accommodations is inconvenient," Montes says. "If it were more accessible, it may have made a difference in my decision."

The stories of both women illustrate the human stakes involved in the most important abortion case to come before the high court in a quarter century.

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Restrictions imposed by Texas legislators in 2013 and upheld by a federal appeals court in June will test how far states can go under a 1992 Supreme Court decision, which upheld the right to abortion but allowed limits that do not impose an "undue burden." Texas' limits require clinics to meet tougher building standards and doctors to have admitting privileges at local hospitals.

The law already has reduced from 44 to 19 the number of abortion clinics in a state where some 60,000 women seek abortions every year. Nearly 300,000 women live more than 200 miles from the nearest clinic. Unless the Supreme Court reverses the lower court's ruling, only 10 clinics will remain, and travel distances will increase. By comparison, California has about 160 abortion clinics, New York nearly 100.

The unassuming Whole Woman's Health clinic here, with walls painted a soothing mauve and each examining or consulting room named for a real or fictional iconic woman, would flunk the test and be forced to close. Its ambulatory surgical center around the corner — where state health department officials descended unannounced last Wednesday for an inspection — would survive, but patients would pay more and wait longer for an appointment.

That's a problem for low-income Latino women in the Rio Grande Valley, whose only remaining clinic could stay open but with just one semi-retired doctor licensed to perform abortions. A trip to one of San Antonio's abortion clinics would take four hours and include a Border Patrol checkpoint that undocumented workers fear crossing.

It's a problem for women who live in Texas' vast western frontier and Panhandle, whose choice would be driving hundreds of miles east to San Antonio or Fort Worth, or getting their abortions in neighboring New Mexico because the lone El Paso clinic would be shuttered.

And it's a problem even for women fortunate enough to live in or near the state's four major population centers, where nine clinics would stay open because they meet the required standards. Waiting lists would lengthen in places such as Houston, the nation's fourth-largest city, which would have just two clinics left, and Dallas-Fort Worth, where three-week waits already are the rule.

"It's difficult for patients to navigate this network of sham laws that Texas has created," says Bhavik Kumar, a 30-year-old doctor who shuttles from his Austin home to the Whole Woman's Health clinics in San Antonio and Fort Worth, sometimes performing as many as three dozen abortions in a day.

Even if lawmakers cheer decisions by women who choose to continue their pregnancies rather than deal with the law's restrictions, Kumar says, "What I think and what they think has nothing to do with it. Women should be given that choice, and politicians should stay out of it."

In recent years, state lawmakers across the country have not stayed out of it. They have passed nearly 300 restrictions since 2010, ranging from 24-hour waiting periods and parental notification laws, mostly upheld by lower courts, to bans on abortion after six or 12 weeks, which courts have blocked. Ten states have laws restricting doctors, and six have laws as strict as Texas's concerning operating standards, but courts have blocked several of those from taking effect.

Abortion opponents in the state dispute claims that their goal is to shut down as many clinics as possible, making it increasingly difficult for women to access legal abortions. "There is no evidence that women will experience any materially different travel distances to obtain an abortion," Texas argued in its brief opposing Supreme Court review.

"We realize that there's not a realistic way to ban abortions. They are going to remain readily available," says Joe Pojman, executive director of Texas Alliance for Life, which helped write the state law. Given that, he says, "we believe that the states should protect the health and safety of women who are undergoing abortions."

But Andrea Ferrigno, corporate vice president of Whole Woman's Health and former administrator of the McAllen clinic in the Rio Grande Valley, says requiring hospital-like settings isn't necessary for most early-term abortions. At the clinic here — where rooms are named after Indira Gandhi, Amelia Earhart, Wonder Woman and Rosie the Riveter, among others — patients can remain mostly dressed and are treated in relative comfort for a procedure that takes about seven minutes.

"An abortion experience doesn't have to be an ugly, awful experience," Ferrigno says. "It can be one of the most empowering experiences a woman has."

These days in Texas, the experience is more aggravating than empowering. Even so, Veronica says, with two small children already, she and her boyfriend have decided they are not prepared financially for a third child.

"It is a hassle and a struggle," she says of the cost, distance and time involved to navigate the new law, "that I'm willing to put up with."

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