There were already women in the waiting room when the clinic’s lawyers called to deliver the news: Until further notice, abortion was illegal in Texas.
They’d been hoping to find some way around Monday’s executive order, but Texas Attorney General Ken Paxton had been clear, the lawyers told Kathy Kleinfeld, the administrator at Houston Women’s Reproductive Services: To better combat coronavirus, doctors “must immediately stop” performing procedures deemed “medically unnecessary,” including abortion.
Kleinfeld began calling the women to the back of the clinic, one by one. She saw 20 patients throughout the day, all coming in either to take their abortion pill, or have the initial consultation required by the state of Texas. Most hadn’t heard anything about the ban.
“We had women pleading, saying, ‘Please, please give us the pill,’ saying they promised they wouldn't tell anyone, trying to bargain with us.’”
Some women cried, Kleinfeld said. One told her that she was in a violent relationship.
“She said, ‘You don’t understand. If he finds out about this … he cannot know.’”
In an effort to reallocate medical resources to coronavirus, the Centers for Disease Control and Prevention announced last week that all nonessential and elective medical procedures should be postponed indefinitely. While the CDC pointed to a few examples — carpal tunnel release, cataract surgery, colonoscopy — they did not release an exhaustive list, leaving room for states to make their own interpretations.
On Friday, Ohio became the first state to explicitly include abortion on a list of “nonessential” procedures, announcing a temporary ban on abortions in the state, starting Wednesday. Texas and Mississippi made similar announcements on Sunday and Tuesday, respectively, with other states likely to follow soon.
“The truth is, abortion, for the most part, is an elective procedure that can be done later,” Paxton said Wednesday during a Facebook Live interview.
Abortion providers have scrambled to determine exactly which procedures are still legal, said Molly Duane, an attorney with the Center for Reproductive Rights. In Ohio, clinics are continuing to provide both surgical and medical abortions, capitalizing on the vague language used by Ohio Attorney General Dave Yost, who ordered clinics “to immediately stop performing nonessential and elective surgical abortions.” Clinic lawyers argue that most abortions are necessary.
But the Texas ban was more explicit. Paxton prohibited clinics from providing “any type of abortion that is not medically necessary to preserve the life or health of the mother.” Across the state, all abortion appointments have been canceled, including those for medical abortions, when the patient takes two different pills. Texas providers, including Planned Parenthood and Whole Woman’s Health, filed a lawsuit Wednesday night against Texas Gov. Greg Abbott (R), hoping the courts will issue a stay, allowing abortions to continue during litigation. It’s unclear whether Mississippi’s only clinic will continue to perform abortions.
At Houston Women’s Reproductive Services, everyone wanted to know when they could come back, Kleinfeld says. She didn’t know what to tell them. The governor said something vague about late April, but with the way the pandemic has been progressing, she knows it could be a lot longer.
“We just told them, ‘We are so sorry, our hands are tied, we need to follow the law. … Hopefully we’ll be able to take care of you in a couple of weeks,’” said Kleinfeld.
It’s a particularly bad time to cut off access to abortion, said Kamyon Conner, the executive director of the Texas Equal Access Fund, which subsidizes abortion care for women in North Texas who can’t afford it. With all the coronavirus-related layoffs, she said, women are especially likely to be financially unable to support a child. Others may worry about the consequences of being pregnant during a pandemic.
“Many of [the women seeking abortions] are the very people that we’ve deemed essential to holding Texas together: fast food workers, grocery store clerks, delivery food drivers, and other people doing that kind of work,” said Marsha Jones, the executive director of the Afiya Center, a reproductive justice advocacy organization that serves black women and girls.
The ban will disproportionately affect low-income women, says Kleinfeld: While covid-19 has made it more difficult to leave the state, women who can afford to travel probably still will.
“We had quite a few patients — mostly professionals — already making plans to travel out of state,” said Kleinfeld.
Clinics and abortion funds have already begun “triaging” patients, said Amy Hagstrom Miller, founder and CEO of Whole Women’s Health, prioritizing funds for women who are further along in their pregnancy, nearing the point when they can no longer receive abortion care in Texas or its surrounding states. Since the ban went into effect, Whole Woman’s Health — with three clinic locations in the state — has turned over 150 women away, Hagstrom Miller said.
“There is a 20-week ban in the state of Texas, so anyone that is 16 weeks now would literally have to go somewhere else at the end of this mandate,” said Conner. She worries about women who discover that their baby has a fetal abnormality, news typically delivered at an ultrasound scheduled around the 15 or 18-week mark.
Hagstrom Miller has been sending women to clinics in New Mexico, Oklahoma and Arkansas, she said in a Wednesday news conference, but as the pandemic continues, those options are becoming much harder to access. People are scared to leave their families, she said.
Abortion also becomes more expensive the longer you wait, Connor says: The pill, only available in Texas up to 10-weeks gestation, tends to be significantly less expensive than surgical options. After 16 weeks, abortions can run between $8,000 and $15,000. Typically, Texas Equal Access can only support 10 percent of the women who apply for funding. As the ban stretches on, Connor says, more low-income women will be financially cut off from the procedure.
No one knows how long abortion the Texas ban will last. It could lift tomorrow, if a judge issues a temporary restraining order in response to the clinics’ lawsuit. It could also last months.
“It’s hard to be reassuring when there is so much uncertainty in every aspect of everyone’s lives,” said Kleinfeld.
Kleinfeld has had to turn women away before. She worked at the clinic in 2015, when Texas passed a law requiring all abortion providers to have hospital admitting privileges, halting much of the abortion care across the state. That period was difficult, but in some ways, Kleinfeld says, the last few days have been even harder.
When patients cry, she can’t reach over and give them a hug.