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A federal judge in Austin, Texas, will issue a decision in the next few days about whether clinics that perform abortion in the state must become outpatient surgery centers.
The Texas law is part of a national trend, in which state legislatures seek to regulate doctors and their offices instead of women seeking abortions.
The laws are collectively known as TRAP laws for 鈥淭argeted Regulation of Abortion Providers.鈥�
鈥淭hey do just that,鈥� said Rochelle Tafolla, a spokeswoman for Planned Parenthood Gulf Coast聽in Houston. 鈥淭hey 鈥榯rap鈥� providers into very tight, medically unnecessary restrictions.鈥�
The Texas law that passed in 2013 requires doctors who perform abortions to first obtain admitting privileges at a hospital within 30 miles. Many clinics, especially rural ones, found it difficult to comply with that rule by the November deadline. The number of Texas clinics that perform abortions has dropped from 41 to 20.
Now the law鈥檚 final rule requires doctors鈥� offices to meet the standards of ambulatory surgical centers, including an array of rules that govern hallway widths, the presence of showers and lockers, heating and cooling specifications. The rules also require conformance with other construction codes that can cost millions of dollars.
The rule goes into effect on Labor Day, unless federal Judge Lee Yeakel of the Western district in Austin issues an injunction to stop it. He is expected to issue a decision by Friday. If he stops the surgery center rule, Texas Attorney General Greg Abbott could quickly appeal to reinstate it.
One Houston doctor, who asked not to be identified because he fears being targeted by abortion protestors, says he will have to stop providing abortions if the final rule goes into effect.
Abortions are a small but important part of his practice: he delivers babies, gives well-women exams, performs gynecological surgery, and even offers tummy tucks.
鈥淎bortion is part of what we鈥檙e trained to do as obstetricians-gynecologists. That鈥檚 the medical point of it,鈥� he said. 鈥淲hen the politicians get into the mix, it becomes a completely different story.鈥�
Planned Parenthood鈥檚 Tafolla said only eight clinics in Texas would meet the newest requirement, and they鈥檙e all in the major cities: two are in Houston (including Planned Parenthood Gulf Cost), two in San Antonio, two in Dallas, and one each in Fort Worth and Austin.
Women in East Texas, the Rio Grande Valley, and west of San Antonio would have to drive hundreds of miles for multiple visits, because a 2011 law put in place a 24-hour waiting period following a mandatory ultrasound, plus follow-up visits for women using the abortion pill.
鈥淪o it isn鈥檛 as simple as saying 鈥極h, there鈥檚 that one place in Houston, there鈥檚 that one place in Austin or Dallas.鈥� There simply isn鈥檛 enough capacity, there aren鈥檛 enough physicians,鈥� Tafolla said.
The Guttmacher Institute, a research organization that studies reproductive rights, says TRAP laws really took off聽in 2010. Twenty-six states now have them.
Groups that oppose abortions say the new laws make the practice safer and therefore protect women.
Melissa Conway, spokeswoman for Houston-based Texas Right to Life, said if the number of abortions and the number of clinics drops in Texas, that鈥檚 something she鈥檚 glad about, but it wasn鈥檛 the intent of the law. She said the regulations are about making abortion safer, so abortion providers should invest in the required upgrades.
鈥淭he choice to have fewer clinics comes down to the abortion providers,鈥� Conway said. 鈥淚f they choose to have disregard for the health of women, and the safety standards, which are practical, common-sense and best standards, that鈥檚 their choice. But that points highly to the fact that they care more about their bottom line than they do their patient care.鈥�
The American College of Obstetricians and Gynecologists鈥� position is that 鈥渨hat those laws do is they limit women鈥檚 access and expose women to increased risk by not enabling them to have a procedure near where they live,鈥� said ACOG CEO Dr. Hal Lawrence.
Lawrence said low-income women can鈥檛 afford to travel, and may try to self-induce an abortion or carry an unwanted pregnancy to term. He added that other outpatient procedures, such as colonoscopy, carry a fatality risk that is 40 times greater than first-trimester abortion, yet colonoscopy does not receive the same unwarranted scrutiny from lawmakers.
Tafolla said legislatures are passing TRAP laws because laws targeting demand for abortion were ineffectual. Other 鈥渄emand-focused鈥� laws include mandatory ultrasounds, a requirement that the patient listen to the fetal heartbeat and waiting periods before abortions.
Legislators who oppose abortions 鈥渢hought they could reduce abortion by focusing on women and shaming them,鈥� she said. 鈥淣ow they鈥檙e focusing on the providers and doing everything they can to shut them down.鈥�