Metropolis: Wednesday, August 4, 2004
Julia takes part in a Washington, D.C.,abortion rights march, in memory of her unborn son.
Abortion Law Refugees

Women needing late-term procedures can no longer get them in Texas.


Julia had already decorated her unborn son’s nursery, when an ultrasound at 22 weeks revealed that he was a tiny body of suffering. Severe, permanent muscle contractions had swelled his skull and joints and deformed his legs and his hands and feet were clubbed. His muscle tissue had deteriorated to only a quarter of normal size. By the time the shadowy image on the ultrasound was deciphered, she realized she was facing the unthinkable.

@body:"He would have never been able to walk, sit upright, hold a pen ... run, or crawl. He would never even be able to hold himself up in a wheelchair, let alone push himself around in it," Julia said. But most haunting in her mind was the image of her son unable to suck his own thumb. "It seemed like such a travesty to withhold from a child even the ability to console itself," said the Austin woman, who asked that her full name not be used.

With only a few days in which to make a decision, Julia and her husband, after much soul searching, determined that the best outcome was not a brief life filled with suffering and surgery. "Our son would not have lived longer than a year or so, and he would have required surgery after surgery just to achieve one year," Julia said. "We decided that termination of the pregnancy was the only caring option." She recalls how the couple spent time saying their final goodbyes. "My husband held my hand as I prayed and handed Thomas over to heaven," Julia said.

A year and a half and two miscarriages later, Julia is pregnant for the fourth time. But she is concerned about a new law in Texas that it virtually impossible for women to terminate their pregnancies from 16 weeks onward. "My husband and I deserve to be able to save this child [from suffering] just as we saved Thomas, should we be faced with the horrible choice again," Julia said, "It is a decision that no mortal should ever have to face, but one that I would gladly make again to prevent any of my children from suffering."

Elective abortions are still legal in Texas until the third trimester, or about 24 weeks. But since Jan. 1, because of the new law, there’s practically no place in the state that a woman can get one after 16 weeks. Texas women are being forced to travel to Louisiana, Arkansas, and Kansas to have the procedures done.

Before January, Fort Worth’s West Side Clinic, for instance, saw five to 15 women each week seeking abortions beyond the 16-week stage. It was one of only two clinics providing that service to West Texas. Changes that would allow the clinic to perform such abortions, under the new law, would cost about $2 million, without increasing patient safety, said clinic official Bob Gross.

"We are seeing a lot of reproductive refugees of the system," said Bethany Herrera, patient relations supervisor at Routh Street Clinic in Dallas. "They come to the clinic looking to get help, but we have no choice but to send them away with referrals out of state."

In spring 2003, a bill called the Woman’s Right to Know Act whipped up a storm of controversy in the Texas Legislature because of three provisions: It instituted a 24-hour waiting period between when a woman seeks an abortion and when it can be performed, directed that a 20-page so-called "Woman’s Right to Know" booklet be given to prospective patients, and required abortion providers to keep the identities of all their patients in their records. The booklet, along with vivid pictures of fetuses, lists alternatives to abortion and gives what many have called inaccurate information on health risks associated with the procedure.

But the bill as passed also includes another requirement that managed to escape the floodlights of controversy and debate: Abortions from 16 weeks onward now can be performed only in hospitals and ambulatory surgical centers.

The clause is a major Catch-22. Very few Texas hospitals perform elective abortions, and the few that do charge extremely high fees and require that the patients go through complicated ethics reviews. And of the state’s hundreds of surgical centers, none performs abortions.

Abortion rights supporters and providers say that -- while the provision was ostensibly aimed at protecting the health of pregnant women -- it actually endangers them. They say the law makes follow-up care more difficult to obtain and denies the procedure to mothers who late in their pregnancies discover that the fetuses they are carrying have serious and often irreversible deformities. In fact, abortion rights supporters believe the provision was intentionally designed to make such abortions unobtainable in Texas.

A videotape of floor debate on the bill shows the sponsor, staunch abortion opponent Frank Corte Jr. of San Antonio, using a map to show the locations of more than 250 ambulatory surgery centers around the state, where abortions could be performed. Herrera, of the Routh Street Clinic, said Rep. Corte denied during debate on the bill that the provision would limit access to abortion. "I’m surprised his nose didn’t grow longer than Pinocchio’s," she said.

Kathi Seay, the Republican legislator’s policy advisor, denied the charge. "I can assure you that he did not misrepresent the implications; he was not dishonest in any way -- shape, form, or fashion," she said. "He was very upfront with the number of ambulatory surgical centers in the state, and the fact that -- if there are physicians that choose to do those in those settings -- there should not be a lack of access at all." Which, in a way, is the point Corte’s opponents make: The centers don’t do abortions, so access is denied.

Gross, vice president of Fort Worth’s West Side Clinic, said the new law greatly increases the already-heavy burden for women seeking such procedures. Such women must now spend much more time and money in obtaining abortions, the cost of which usually increases for every week it is delayed.

"Most often, women seeking abortion after 16 weeks are women who wanted to have a baby but discover late in their term that they have fetal anomalies incompatible with life," said Sarah Wheat, director of public affairs for the Texas Abortion and Reproductive Rights Action League. Fetal tests such as amniocentesis routinely are not performed before 16 weeks gestation, and results don’t come in until after 20 weeks. "If the physician recommends that she terminate the pregnancy, what can she do if there are no places for her to go in Texas?" Wheat asked.

Kyleen Wright, president of the Texans for Life Coalition, disagreed. She said that "just a tiny percentage of women" seek abortions for reasons related to the mother’s health or fetal abnormalities. "You don’t make policy on two percent [of the population]; you make policy on the 98 percent," she said. "Far more are protected by that law than the small number that are inconvenienced."

Another group affected are teen-agers, who make up a third of the women obtaining second trimester abortions nationally, said Diana Philip, executive director of Jane’s Due Process, which promotes fair and equal access to reproductive choice for Texas teen-agers. Young women often wait until the second trimester, she said, because of lack of medical care, trauma from rape or incest, or fear of an abusive household. In one case, she said, a first-generation Mexican-American teen-ager’s family told her "she’d be hurt, disowned, and thrown out of the house if she ever came home pregnant," Philip said. She hasn’t heard of a single teen-ager making it out of state on her own. "The patient just doesn’t make it there," she said.

No agency or group tracks the number of women leaving the state for abortions because of the new law. But a North Louisiana clinic director, who asked not to be named, said about 20 Texas women a week now make the trip to her facility to seek abortions after 16 weeks. "But we get phone calls from a whole lot more," she said. "We’ve gotten women from all over Texas -- McAllen, Corpus Christi, Lubbock, Abilene. ... They are surprised to find so many restrictions in place. They seem to think it’s been done secretly so that they just didn’t know what was going on."

In Mississippi, lawmakers in March passed an even more restrictive law, restricting abortions from 13 weeks on. But according to news reports, a federal judge temporarily blocked enforcement of the Mississippi law on July 23, stating that it "did nothing new to protect patient health." The decision could spur a court test of the Texas law. Janet Creps, a staff attorney for the national Center for Reproductive Rights, said her group might challenge the 16-week provision in Texas if the Mississippi ruling becomes final and is upheld by appellate courts.

Creps believes that the new Texas law does little to make abortion safer but definitely makes it more expensive, because of the requirements it imposes on providers. In order to be considered a surgical center, an abortion clinic would have to meet requirements regulating air flow, firewalls, corridor width and room size, staffing, and even the number of parking spaces needed for physicians and staff, Creps said. "These structural requirements are big-ticket items that would require closing down the clinics and doing a lot of physical plant changes," she said.

In the end, said Herrera, of the Routh Street clinic, "It’s the same procedure that doctors in clinics have performed in clinics for the past 30 years with an enviable record of safety."

However, abortion opponent Wright said that safety record is not so enviable, because reporting of complications from abortions has been "very deceptive." Often when patients are taken to a hospital, "physicians will report the complication as being a result of pregnancy rather than abortion," she said. "They [abortion providers] have been very successful at masking their safety record."

Kae McLaughlin, TARAL’s executive director, said that such allegations are irresponsible because they imply that clinic physicians are criminally negligent. Anti-abortion activists’ strategy, she said, "is to ... level charges against things we cannot prove, because they know the state does not keep statistics" on complications other than those leading to death. The Texas Department of Health reported that about 6.6 percent of abortions in 2002 were performed after 15 weeks and that, out of all abortions in Texas, only one patient died from complications.

When a Dallas physician wrote to surgical centers around the state, he found only one whose operators said they’d consider performing abortions and none that actually do so now. That could change, however -- by a total of one.

Wheat said that a new Planned Parenthood clinic under construction in Austin should be able to meet surgical center specifications, although its construction has been slowed by threats and protests. It’s due to open this fall. "It’ll be the one place in the state where women could go to get the procedure done from 16 weeks," she said "Still, it’s a long ride from El Paso to Austin."

You can reach Joyce Tsai at

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