This story is part of a partnership between MedPage Today and VICE News.
The Supreme Court just struck down restrictions on abortion clinics in Texas, setting a national precedent in a major victory for pro-choice groups.
In a 5-3 ruling on Monday morning, the eight-member court overturned a 2013 Texas law that would have forced 10 abortion clinics in the state to close.
More than 20 abortion clinics in Texas closed in October 2013 as a result of the state's House Bill 2, which requires, among other things, that doctors have admitting privileges at a hospital within 30 miles of the clinic. The measure passed even with then-State Senator Wendy Davis's filibuster, which captured national attention.
A delayed part of the bill would have required abortion clinics in the state to be ambulatory surgical centers, which have strict building requirements, such as wider halls. If it had taken effect, it would have forced another 10 clinics to close on July 1, 2015, but the Supreme Court stepped in at the last minute, issuing a temporary block of the law until it could decide whether to take up the case. The justices began to hear arguments in March.
The case, which is now called Whole Woman's Health v. Hellerstedt, determined the definition of "undue burden" in Planned Parenthood of Southeastern Pennsylvania v. Casey. That 1992 ruling upheld most of Roe v. Wade, but allowed states to pass abortion restrictions as long as they didn't create "undue burden" for women, which the court never defined.
"If this law goes unchallenged women are going to be harmed," said Andrea Ferrigno, a vice president at Whole Woman's Health, an abortion provider with a clinic in Texas. She says the clinic has been telephoned by women who need abortions and don't have access to them because of HB2.
"'What if I tell you what I have at home in my kitchen cabinet and you can tell me what I can take?'" Ferrigno recalled one woman asking her. "That was the level of desperation she had."
The American Congress of Obstetricians and Gynecologists (ACOG), the largest organization of physicians specializing in women's health in the United States, says "induced abortion is an essential component of women's healthcare."
"ACOG opposes unnecessary regulations that limit or delay access to care," the 58,000-member organization says in its official policy on abortion. "The intervention of legislative bodies into medical decision making is inappropriate, ill advised and dangerous."
The organization, along with with the American Medical Association, filed an amicus brief to the court in December 2013, stating that there was no medical or scientific reason for HB2's restrictions. During the arguments in March, justices discussed how evidence filed in other briefs to the court showed abortions are no more risky than colonoscopies, which are outpatient procedures that don't need to be done in ambulatory surgical centers.
"Texas law expressly authorizes other surgical procedures, including those performed under general anesthesia — which early abortion is not — to be performed in the physician's office," attorney Stephanie Toti argued to the Supreme Court in March in her rebuttal. "And even other physicians that operate at an [ambulatory surgical center] aren't required to have admitting privileges... So these regulations target one of the safest procedures that a patient can have in an outpatient setting for the most onerous regulations."
Although Texas attorney Scott Keller argued the law would protect women's health, Justice Ruth Bader Ginsburg quipped that abortion wasn't riskier than child birth. At one point, Justice Stephen Breyer asked for evidence of women who had complications because the abortion doctor didn't have admitting privileges at a hospital.
"Which were the women? On what page does it tell me their names, what the complications were and why they happened?" Breyer asked.
"Justice Breyer, that is not in the record," Keller said.
A 2014 study published in the medical journal Contraception found that the state abortion rate in Texas decreased by 13 percent when the number of clinics went from 41 to 22.
In November, the Texas Policy Evaluation Project (TxPEP) released its 2014-15 survey following the initial clinic closures and estimated that at least 100,000 of 18- to 49-year-old women in the state attempted to self-induce abortions.
"They didn't do this because this was their ideal form of health care, but because they felt that they had no other option," lead TxPEP researcher Daniel Grossman, a professor of obstetrics and gynecology at the University of California at San Francisco, told VICE News at the time.
Advocates for women's health say the clinic closures have not only forced some women to drive hours to get abortions — possibly twice because of the 24-hour waiting period. They'll also likely need to arrange and pay for child care and miss work, making it an expensive endeavor.
On top of this, Grossman said that the remaining clinics have waiting periods as long as 23 days because of the shortage, meaning women are further along in their pregnancies when they are able to obtain abortions, which are then more complicated and more costly. On average, a first trimester abortion is $397, but a second trimester abortion is $854, said Michelle Batchelor, deputy director of In Our Own Voice: National Black Women's Reproductive Agenda, citing a Guttmacher Institute study published in the journal Women's Health Issues.
"Black women make $0.60 for every $1.00 white men make," she said, stressing that the earnings discrepancy is even more pronounced than it is for women in general. "That really affects her access [to abortion.]."
She said she's also worried because women of color often rely on clinics that provide abortions for other health needs, such as family planning and sexually transmitted infection testing.
Miriam Yeung, executive director of the National Asian Pacific American Women's Forum said Asian Americans would also be hit hard if the Supreme Court doesn't rule against HB2, driving them to "desperate circumstances."
Yeung mentioned Purvi Patel, who induced her abortion at her home in Indiana because she said she thought she was only 10 to 12 weeks pregnant, and was convicted of feticide and "neglect of a dependent," where prosecutors argued her fetus was born alive, though this has been contested. Patel is serving 20 years behind bars.
"Women are always going to need abortions and will do what they have to do," Yeung said. "The other side likes to argue that they don't want to criminalize women and don't want to punish women. Women are already being punished for having abortions."
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