Abortion pill restrictions could exacerbate delays for Texans at out-of-state clinics

For more than a year, abortion clinics in New Mexico, Kansas and Colorado have been inundated with Texans seeking care that is largely prohibited in the Lone Star State. Now, those clinics are bracing for another outcome of anti-abortion hostility in Texas as an Amarillo court ruling threatens access to medical abortion nationwide.

The video above is from a previous story.

The US Supreme Court kept that ruling until midnight Wednesday and will then decide whether to leave it barred while the case proceeds. If any part of the ruling goes into effect, abortion providers say it could have disastrous results — especially for those who travel out of state to terminate their pregnancies.

“The parking lots are full of Texas license plates, every single day,” said Emily Wells, president and CEO of Planned Parenthood Great Plains, which operates clinics in Kansas. “Everyone is exhausted…but the Texans come the furthest and are often the panicked the most.”

Medical abortion is less labor and time intensive than surgical procedures, allowing clinics to treat more patients and accommodate the flood of needs better than Texas and the 12 other states that have banned abortions almost completely. The Food and Drug Administration recently began allowing the drug to be prescribed by telehealth providers and mailed to patients, further streamlining operations.

See related story: Doctors say the ‘abortion pill’ mifepristone is also widely used to treat miscarriages.

“It’s also just a stronger preference for a lot of patients,” Wells said. “No one in this moment… feels a great deal of control over their life. To say, ‘Oh, that kind of procedure you’d prefer is not available to you anymore because politicians don’t think it should be’ is pretty awful.”

With the court’s ruling on hold, the biggest barrier to care right now, Wells said, is confusion and fear.

Right now, she said, they just tell patients, “Yeah, [mifepristone] is legal. No, it might not when you get here…but just get yourself here and we’ll do it for you. “

Targeting is a common method

Abortion, including medical abortion, has been effectively banned in Texas since Roe v. Wade expired late last June. But last November, a group of anti-abortion doctors and medical associations filed a lawsuit in Amarillo, alleging harm from having to treat patients who had complications with medical abortion.

Mifepristone, when used together with misoprostol, is the most common method of pregnancy termination in Americans. Numerous studies, combined with 23 years of use on the market, have proven it to be safe and effective in terminating pregnancy.

But Alliance Defending Freedom, a conservative Christian law firm, argued in the lawsuit that the Food and Drug Administration had improperly approved mifepristone, ignored citizen complaints about it and endangered the health of pregnant women.

The ADF filed the lawsuit in Amarillo, where only one federal judge, Matthew Kaksmarek, hears the vast majority of cases. Kaksmarek, who was named to the bench by President Donald Trump in 2019, was formerly a religious freedom attorney who has worked on anti-abortion cases.

In early April, Kacsmaryk He issued a sweeping ruling which sided almost entirely with the ADF and the physicians they represent, and took the unprecedented step of revoking the 2000 FDA approval of mifepristone. Around the same time, across the country, a federal judge ruled that mifepristone must remain approved, at least in the 17 states that brought that separate case, including New Mexico and Colorado.

Fifth US Court of Appeals I intervened and offered a compromise According to Kacsmaryk’s ruling: Mifepristone will remain approved, but the old restrictions on its use will be reinstated. Under this provision, mifepristone can only be used until seven weeks of pregnancy, not 10 weeks; It cannot be sent by mail. Providers will need three in-person visits to prescribe medication.

These requirements — temporarily blocked by the Supreme Court — will further complicate an already overburdened abortion care system, providers and advocates say.

Impact of restrictions on clinics

On a recent Monday, Trust Women, an abortion clinic in Wichita, Kan., received 16,000 calls to their hotline. Many of them were repeat calls as people desperately tried to get through to book an appointment. This year, the clinic is on track to treat about 6,000 patients — the same number of patients who terminated pregnancies at all clinics, statewide, before the Dobbs v. Jackson decision.

The majority of their patients come from out of state, mostly from Texas, and the majority choose treatment over surgery. Zachary Gingrich Gaylord, a spokesperson for the clinic, said the Fifth Circuit’s proposal would likely be impractical for their patients.

“It’s really hard for people to turn their whole lives upside down to travel 12 hours, one way,” he said. “If you just add in another visit, or two, you’d have to spend a whole week here. It’s ridiculous and surreal.”

Most of their patients are already parents, Gingrich Gaylord said, and many travel such long distances with their children. Many rely on support from abortion funds, family and friends to make a single visit; Extending the trip is simply not an option.

For patients who choose surgical abortion, the restrictions on medical abortion will have overlapping effects, said Amy Hagstrom Miller, president and CEO of Hull Women’s Health, which operates abortion clinics in six states, including New Mexico.

“It will make the wait even longer,” said Hagstrom Miller. “Mail-in medical abortion has allowed us to free up space in the clinic for people who would prefer or need to have an in-clinic abortion, so those are the things we pay attention to.”

Whole Woman’s Health just opened a new clinic in Albuquerque, New Mexico, last month. Hagstrom Miller said every patient they treated was from Texas, with the exception of one from Arizona. They also run an abortion fund that helps mitigate the cost of traveling out of state for a procedure they previously offered in Texas.

“But the stark truth is, no matter what we do to try and make the trip uneventful [or] Free hotel, the majority of Texans don’t pass up,” she said. This doesn’t necessarily surprise me, because I know the lives of people who come to us for abortion services, but it’s still horrific to witness on our watch.”

A recent study from the Planned Parenthood Association’s #WeCount initiative It found that, nationwide, there were more than 32,000 fewer abortions between July and December 2022 than in the previous year. While states that still allow abortions are no different from states that have banned abortions, there has been a marked increase in telehealth abortion services, which the Fifth Circuit ruling was prohibiting.

What doesn’t count in this data is the number of Texans who pursue self-administered abortions—getting medications from online pharmacies, international nonprofits, or by crossing the border into Mexico. It is not yet clear how US efforts to restrict mifepristone will affect supply chains for these sources.

If mifepristone becomes more restricted, or taken off the market altogether, clinics that serve Texans say they are preparing to continue offering misoprostol-only medical abortions. While misoprostol can be taken alone to terminate a pregnancy, it is generally less effective and can cause greater side effects than if taken along with mifepristone.

That may make some people more reticent to go down the road of treatment, Gingrich Gaylord said, especially if they have to go back to a condition where they fear seeking follow-up care for any complications.

“Then they may want a procedure, because they may be concerned about those social consequences, and we can do fewer procedures… So, that’s an effect on capabilities,” he said.

Whether or not the Supreme Court prevents this ruling from going into effect, many abortion providers see it as a harbinger of what is to come, even in states where abortion is protected.

“It is hypocritical for the court system to say that we should … let states have ultimate power over what happens within their borders … unless it is appropriate for us to rule in such a way as to make it difficult to access abortion in states that have abortion,” Wells said. It’s still legal.”

Wells said they deal with this uncertainty alongside patients, many of whom were shocked to learn this Texas court case was likely to have widespread consequences.

“It’s completely baffling for patients,” she said. “They have already been treated terribly by their state, with their rights violated, and now they cannot even go to another state and potentially receive care because of something that happened in their home state.”

Texas Tribune is a nonprofit, nonpartisan media organization that informs – and engages – Texans on public policy, politics, government, and statewide issues.


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