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Texas Abortion Law Has Women Waiting Longer, and Paying More

Dr. Bhavik Kumar preparing a procedure room for a patient at Whole Woman’s Health in Fort Worth. The clinic’s president says it will close if the Supreme Court upholds a law that placed new regulations on abortion providers.Credit...Ilana Panich-Linsman for The New York Times

FORT WORTH — When Amy found out around Christmas that she was pregnant, she wasted no time seeking an abortion. Her husband had just lost his job and the couple had been kicked out of their house, forcing their family of five to move in with his parents.

“It would have been the absolute wrong thing to do, to have another baby right now,” said Amy, who is 32. “So I started calling around pretty quickly.”

But she found that getting an appointment for an abortion, even in one of the country’s largest metropolitan areas, proved almost as stressful as the unwanted pregnancy. The number of abortion clinics in Texas has shrunk by half since a 2013 state law imposed new regulations that many said they found impossible to meet. When Amy called the two clinics here just after New Year’s, and a third in Dallas, the earliest available appointment was on Jan. 22.

The United States Supreme Court, in one of the most closely watched cases of the year, is considering the constitutionality of that law and whether it creates too much of a burden on women seeking an abortion.

With the judges apparently deeply splintered, the decision, expected in June, could affect millions of women, though the court might send the case back to lower courts to further study the impact of the clinics’ closings. Similar laws are being challenged in other states.

With no possibility that President Obama’s Supreme Court nominee, Judge Merrick B. Garland, will be confirmed anytime soon, the court might also split 4 to 4, which would let stand an appeals court ruling largely upholding the Texas law but would set no national precedent.

Here in Texas, women are experiencing what it means to navigate the landscape created when roughly half of the state’s 41 abortion clinics closed, with some facing an unnervingly long wait and others traveling hundreds of miles, sometimes leaving the state, for the procedure.

When Amy, who like several others interviewed asked that her last name not be used to protect her privacy, went to Whole Woman’s Health here for her sonogram and abortion over two days in January, she was shocked by how crowded the waiting room was and by how long she had to wait for the procedure: about five hours.

But mostly, she said, she was relieved to have gotten in at all. Her cellphone had broken a few days earlier, causing her to miss a few calls from a clinic employee trying to confirm her appointment. When Amy realized that she had missed the calls, she broke into sobs as she frantically called back.

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Amy said she faced a wait of weeks for an abortion appointment. Arriving for the procedure, she was shocked by how crowded the clinic’s waiting room was.Credit...Ilana Panich-Linsman for The New York Times

“I said, ‘I’m so sorry. Please don’t give my appointment away, because I can’t wait another month,’” she said. “I was terrified.”

Another patient at the clinic last week, Amber, 22, said that she had initially been told she would have to wait 19 days for an abortion, and that she was relieved when the clinic was able to see her in 10 days, because of a cancellation. “I didn’t want to be any further along,” she said, adding that she had become pregnant during a brief relationship with “a guy that treated me really awful.”

Opponents of the law say the wait stems largely from the closing of the clinics, which they tie directly to its requirements that abortion doctors have admitting privileges at local hospitals and that all abortions take place in so-called ambulatory surgical centers.

Texas lawmakers argue that the provisions were intended to improve the safety of the clinics and that despite the closings, as Texas’ solicitor general, Scott A. Keller, put it before the court, “abortion is legal and accessible in Texas.”

Abortion rights advocates say the logistical hurdles for women seeking to end pregnancies include separate Texas laws requiring most women to get a sonogram at least 24 hours before an abortion, from the same doctor, and requiring all abortions past 16 weeks to be done at surgical centers.

Adding the contested law, known as H.B. 2, on top of that, “it’s the straw that broke the camel’s back,” said Amy Hagstrom Miller, the president of Whole Woman’s Health, the lead plaintiff in the case before the Supreme Court. “Just by design, these laws were written to break down access to abortion care.”

Women in the Fort Worth area have more options than many others. Smaller cities, including Beaumont, Lubbock, Waco and Killeen, have been left without a single abortion clinic. But even for women here, and in Houston, San Antonio and Dallas, the law has left some waiting for weeks for abortions, clinic owners say, which can take an emotional toll and make the procedure more expensive and complicated.

The Supreme Court ruled in 1992 that states cannot impose “undue burdens” on women seeking abortions, and during arguments in the Texas case, the court’s four liberal members appeared certain that the 2013 restrictions violated that standard. But some of the more conservative justices questioned whether the law was really responsible for the wave of clinic closings, and whether those that remained open could not accommodate the demand for abortions.

Justice Anthony M. Kennedy, who most likely holds the crucial vote, raised the possibility of returning the case to the lower courts to collect more evidence, delaying a resolution.

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Protesters praying outside Whole Woman’s Health in Fort Worth.Credit...Ilana Panich-Linsman for The New York Times

The plaintiffs say the timing of the closings — 11 clinics, they point out, closed on the day the admitting-privileges provision took effect — is evidence enough.

Whole Woman’s Health has closed its abortion clinics in Austin and Beaumont, and Ms. Miller said its clinics in Fort Worth and San Antonio would also immediately close if the law were upheld. A fifth clinic, in McAllen, on the border with Mexico, would either close or operate at “extremely limited capacity,” she said. Whole Woman’s Health has an ambulatory surgical center in San Antonio that will remain open.

The surgical center requirement has been temporarily stayed by the Supreme Court. But if the court lets the law stand, abortion providers say all but nine of the state’s remaining clinics will close because they cannot afford to meet the construction and equipment standards of surgical centers. No clinics would remain in the vast region west of San Antonio, Ms. Miller said; two have stayed open there, in El Paso, for now.

Already, abortion providers say, long drives and packed waiting rooms have become the norm, and second-trimester abortions have become more common because of the wait for an appointment.

Tenesha Duncan, an administrator at Southwestern Women’s Surgery Center in Dallas, said her clinic’s patient load had doubled since the new law took effect, with more patients coming from rural parts of the state and also from Houston and Austin. Demand is so high that the clinic has expanded its procedure hours to 60 from 40 a week, Ms. Duncan said, and has assigned seven employees to answer phones.

Candice Russell, a 32-year-old administrative assistant from Irving, was 12 weeks along when she learned she was pregnant in 2014, she said, and she faced a wait of two and a half weeks for an abortion in Dallas or Fort Worth.

Instead, Ms. Russell took out a high-interest payday loan and flew to California, where her partner lived and where she was able to get an abortion in a matter of days.

“That’s what floored me — they could see me on this day or this day or this day,” she said. “It put me into this downward financial spiral that lasted a couple of months, but compared to a lot of people, I’m super privileged. I know there are tons of people that will be affected by these closures, and they’re never going to be able to fly to California.”

Volunteers for the Texas Equal Access Fund, one of several groups in Texas that help women pay for abortions, said that because of the longer wait for appointments, the fund was fielding far more requests for assistance from women in their second trimester of pregnancy than it used to.

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Amber being led to the waiting room at Whole Woman’s Health in Fort Worth. She was initially told she would have to wait 19 days for an abortion there, but was relieved when the appointment was moved up because of a cancellation.Credit...Ilana Panich-Linsman for The New York Times

“I’ve been doing intake for over 10 years and it’s just changed radically,” said Jo Wunderlich, a volunteer who talks to as many as 70 women a week who call seeking financial help. “What we’re seeing is very often women are farther along in their pregnancy, it costs more money, we run out of money and fewer women can get funding. It’s a crazy Catch-22.”

Ms. Miller said that particularly near the Mexican border, the clinic closings had prompted more women to try to induce abortions with herbs or the drug misoprostol, which they obtain at flea markets or across the border.

Stephanie, a 20-year-old student, said she had recently driven through the night to Albuquerque for an abortion 16 weeks into her pregnancy after she could not come up with the money in time to have the procedure done at a clinic in El Paso, where she lives. Because of the earlier Texas law that requires all abortions after 16 weeks to be done in surgical centers, her options were limited to the closest such center, 550 miles away in San Antonio, or a regular abortion clinic in New Mexico.

After pawning her camera and receiving some money from groups that help women pay for abortions, she was able to arrange the appointment in Albuquerque. She sneaked out of her parents’ house at 3 a.m., met a friend with a car, and arrived at the clinic by 7. “I was really tired,” she said, “but I knew that’s what I had to do. I had to be tough and try not to fall asleep.”

Dr. Linda Prine, who provides abortions at a Whole Woman’s Health clinic in Las Cruces, N.M., said more than half of her patients on any given day came from Texas. Sometimes she finds them “sleeping in their cars in our parking lot before we open up in the morning.”

At the Whole Woman’s Health clinic in Fort Worth, which looks like a small house, several women waiting for abortions said they did not like the idea of having to get the procedure at a hospital-like surgical center.

“Being that the situation is already overwhelming, I wouldn’t want to go to a big place,” said one woman, 19, who has a year-old daughter and asked to be identified only by her middle name, Renea. She said she had learned she was pregnant when she went to the emergency room after a fight with her boyfriend. “The environment they set here, it gives you more of a welcoming, ‘It’s O.K.’ kind of feeling.”

Other patients at the clinic that weekend had driven from Lubbock, about 300 miles away, and Odessa, 320 miles away.

Amy said her 13-year-old car was too shaky to travel long distances. Had she not lived in Arlington, about 20 minutes from the clinic, she might have been shut off from a choice she described as essential to her own and her family’s well-being.

“If it was far,” she said, “I don’t think it could have happened.”

A correction was made on 
March 19, 2016

An earlier version of this story incorrectly rendered the last name of Amy Hagstrom Miller, the president of Whole Woman’s Health and the lead plaintiff in a case before the United States Supreme Court challenging the 2013 abortion law in Texas. Her last name is Miller, not Hagstrom-Miller.

How we handle corrections

A version of this article appears in print on  , Section A, Page 16 of the New York edition with the headline: Under Texas Law, Women Pay More and Wait Longer for Abortions. Order Reprints | Today’s Paper | Subscribe

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