Anyone who’s read the transcript or colorful dispatches from Wednesday’s oral arguments in the Whole Woman’s Health case knows the four liberal-leaning Justices took some of the swagger out of Texas Solicitor General Scott Keller.
What Knocked Keller Off His Lone Star High Horse?
That would be many illuminating laser lines of questioning, among them Justice Breyer’s about how closing facilities, cutting off clinical access to safe medications and procedures, delaying abortions until later in pregnancy, and forcing women onto freeways and into overnight stays hundreds of miles away from home just might lead to an increase in the number of women who end their own pregnancies outside of the formal health care system. Justice Breyer and his sistren repeatedly call out the illogic of these cascading effects flowing directly from the state’s dementedly disingenuous claim of wanting to enhance women’s health by enacting the sweeping set of anti-abortion laws that is HB2.
What Happens When There Is a 75 Percent Reduction in the Number of Clinics?
Here’s a hint: It isn’t fewer abortions.
Justice Breyer correctly points out that excessive restrictions on abortion provision limit clinic access and increase the necessity for self-administered abortion care. The Texas Policy Evaluation Project report concluded that as many as 100,000 women in Texas have already attempted to end their own pregnancies outside the formal medical system. Global data have consistently demonstrated that highly restrictive laws do not reduce the abortion rate, they simply relocate the site of abortion care from the hospital to the home.
Before your mind goes conjuring up gruesome images, take note that this is not your grandmother’s self-induced abortion. Coat hangers and other dangerous methods, while still occasionally employed, have largely given way to safer methods. More often than not, the women in the TxPEP report, and other studies, used traditional herbs or safe and effective pharmaceutical pills purchased online―the same pills they would be prescribed by a healthcare professional for a fraction of the costs.
What Abortion Access Looks Like Under HB2 for People Living in Poverty
The abortion costs borne by people living in poverty are much higher than one might think. A pregnant woman in Texas who is struggling to make ends meet may be shocked to discover that her health insurance doesn’t cover abortion. Like the rest of the 13.5 million women of reproductive age in the United States who rely on Medicaid, she’ll have to pay out of pocket for the abortion medication or the procedure, both of which cost about $500 in the first trimester. Tack onto that the price of bus tickets or gas, which could be high if she’s one of the 10,000 women who live more than 150 miles from the nearest abortion provider under HB2. Plus, she has to come up with money for a place to stay overnight and child care for the kids she had to leave behind. That’s all assuming she can afford the lost wages for the days away from work. All told, securing an abortion can cost some families half a month’s pay.
Mustering Bravery and Ingenuity to Secure an Abortion
As a matter of household economics, that is simply not feasible for many women in this position, who may turn to the internet to research less expensive alternatives to clinic-based care. Unfortunately, her Google search might turn up headlines about Purvi Patel, Jennie Linn McCormack, Kenlissia Jones, and other women who’d been in her shoes and ended up arrested and jailed for allegedly ending their own pregnancies outside the formal medical system. What is she to do? She doesn’t feel she has the resources to take care of another child, doesn’t have coverage for an abortion, doesn’t have money to pay the costs out of pocket, and doesn’t want to go to prison for taking matters into her own hands.
The reality is that if 75 percent of the clinics in Texas close, we won’t see 75 percent fewer abortions. Resourceful women and their loved ones will find ways to end pregnancies outside the formal medical system. For some, the self-induced abortion experience will be a positive one, occurring in a safe place through effective means while accompanied by a loved one. For others, particularly people living in poverty, immigrants, and people of color who are disproportionately arrested for pregnancy-related crimes, the self-induced abortion experience may be shrouded by the fear of jail or deportation.
A Better Way That Truly Enhances Women’s Health
In addition to fighting laws like HB2 and others that threaten to cut off clinic-based abortion care, we must also work to halt the criminalization of self-induced abortion, which effectively curtails the abortion right altogether for many people. Instead of going after people for ending their own pregnancies, we should be working to end the stigma, restrictions, and other barriers to health care that overzealous lawmakers have imposed on abortion access. Should the Court deadlock 4-4 and allow the lower court opinion to stand, 5.4 million women of reproductive age in Texas will be forced to run the gauntlet of HB2 abortion restrictions against the ticking clock of the 20-week abortion ban. However, should the Court muster a majority and strike down these regulations as the wolves in sheep’s clothing they are, it will help to remove at least a few of the obstructions from the obstacle course that has become abortion access in this country.
That’s still not enough, of course. Women deserve access to the full panoply of provider-directed and self-directed abortion care options, along with the freedom to choose the setting and method right for them―without fear of going broke or getting locked up. This is what it would look like to truly enhance women’s health through expanded, rather than contracted, abortion care options.