Thanks to a federal appeals court decision handed down this week, it’s about to be much harder to get an abortion in Texas. The U.S. Court of Appeals for the Fifth Circuit ruled that Texas may implement a sweeping anti-abortion law known as HB2 that threatens to shutter dozens of clinics in the Lone Star State.
Among other things, HB2 will force clinics to make expensive upgrades to bring their buildings in line with the standards for “ambulatory surgical centers” (ASCs). Under this particular portion of the law, all abortion providers in the state will need to implement costly renovations to their buildings — like widening their hallways, building janitor’s closets, and installing sophisticated air filtration systems — to make their facilities more analogous to a hospital than a doctor’s office.
Some abortion providers have estimated that these renovations will cost them upwards of a million dollars. Planned Parenthood, a national organization with considerably more resources than independent abortion providers, is currently spending $5 million to construct a sophisticated surgical center in San Antonio to comply with HB2. Other providers don’t have that kind of money, and will now be forced to close.
Significantly, the Fifth Circuit decided that this portion of Texas’ omnibus abortion law applies even for the provision of medication abortion, the non-surgical method of ending an early pregnancy that involves taking two rounds of pills.
“We conclude that the record and district court’s opinion do not justify statewide invalidation of the ASC requirement in the context of medication abortions,” the panel of judges wrote. “The ASC requirement in the context of medication abortion is rationally related to a legitimate state interest and has not been shown to have an improper purpose or impose an undue burden on a large fraction of women for whom it is relevant.”
In practice, this means the state of Texas will require abortion clinics to make hospital-style upgrades to their buildings to legally allow their patients to swallow pills.
Even when it comes to surgical abortion procedures, there’s no evidence that patients would receive safer or better care in ambulatory surgical centers. Abortion is already a very safe procedure with an incredibly low rate of complication; clinics have been providing this particular service for decades without major issues. It’s also a procedure that doesn’t require a high level of anesthesia, unlike the outpatient surgeries that are typically handled in ASCs. Medical experts point out that there’s no good rationale to regulate abortion more stringently than other procedures currently offered outside of hospitals, like colonoscopies.
But specifically in terms of the abortion pill, the argument in favor of HB2 becomes particularly strained. It’s unclear why patients would need to be in an environment resembling an operating room in order to swallow pills that global health experts have confirmed are actually safe enough for women to take alone.
Plus, making abortion clinics look like hospitals isn’t necessarily the best strategy for putting patients at ease. The staff members at Whole Women’s Health, a group of reproductive health clinics with several locations in Texas that has served as the lead plaintiff in the legal challenge against Texas’ law, say there’s a big issue with ASCs that often gets overlooked in the debate over HB2: These facilities feel cold, impersonal, and a little scary.
The other clinics run by the organization look more like cozy gynecologist offices, with purple paint and Audre Lorde quotes on the wall. But at the Whole Women’s Health clinic that meets the standards for a surgical center, the atmosphere is quite different. Patients wear hospital gowns and have their abortion performed on an operating table. An NPR reporter toured that facility two years ago and described it as looking like an emergency room, right down to the “bright red line that divides the sterile surgical suites from the rest of the center.”
In an interview with Cosmopolitan, Fatimah Gifford, the communications director for Whole Women’s Health, explained this environment can feel intimidating for some people seeking a pregnancy termination. When patients enter the ASC, Gifford says they sometimes ask, “Why do I feel like I’m going into a hospital? I thought you said this was safe?”
Imposing tight restrictions on medication abortion — which is involved in about a quarter of all pregnancy terminations in the U.S., according to 2008 figures — is becoming increasingly popular on the state level. Many states are moving to require patients to take abortion pills in the presence of a doctor, rather in the comfort of their own home.
The rest of the global community, meanwhile, is taking the opposite approach. In an attempt to reduce maternal mortality from unsafe abortions and births, other countries have been moving to expand access to abortion-inducing medication — including, in some cases, making it available on pharmacy shelves.
Reproductive rights advocates estimate that HB2 will leave just eight abortion providers operating in a state with nearly 27 million people. The law will take effect on July 1 unless the Supreme Court steps in to intervene.