In a stunning move, the U.S. Supreme Court allowed a sweeping law to take effect in Texas last week that eradicates nearly all abortion care in the second-largest state in the country.
Senate Bill 8, signed into law by Republican Gov. Greg Abbott in May, bars abortion once an ultrasound picks up cardiac activity, which is typically around six weeks. This amounts to a near-total ban: Many women are not aware they are pregnant that early.
At least a dozen other states have enacted so-called heartbeat bills that have been halted by the courts, but the Texas version is particularly insidious. It applies not just to abortion providers, but also anyone who “aids or abets” care, which could include rape crisis counselors or a friend who drives a patient to the clinic. And in order to smuggle it past the Supreme Court, it devolves enforcement to private citizens, offering them bounties for successful lawsuits.
This sweeping piece of legislation didn’t come out of nowhere. It is the latest barrier in a dizzying maze of logistical and financial obstacles to women’s health care that cemented Texas as not only one of the most difficult states in which to get an abortion, but also one of the most dangerous in which to carry a child.
For years now, the state has suffered from a maternal mortality crisis. The United States holds the highest maternal death rate in the developed world. But Texas’ maternal mortality rate is above even the U.S. average, at 18.5 deaths per 100,000 live births. Black women in Texas are disproportionately affected, accounting for 11 percent of live births but 31 percent of maternal deaths.
In 2016, a state committee composed of maternal health experts reported that roughly one-third of pregnancy-related deaths in the state occurred 43 days to a year after the end of pregnancy. Nearly 90 percent of such deaths were preventable, the committee found. Its primary recommendation was simple: Extend Medicaid coverage postpartum for low-income mothers to one year; Texas has historically removed them from Medicaid after 60 days.
Given the availability of a concrete and straightforward solution, one might think Texas’ ostensibly pro-life Republicans would have been compelled to act swiftly. But it was not until this May that they took any substantial action. The Texas House passed a Democrat-authored measure that would have extended coverage after childbirth to 12 months. However, the ultraconservative Senate inexplicably amended it to cut coverage to just six months.
Republican lawmakers have also thwarted efforts to expand Medicaid, despite the fact Texas has the highest rate of uninsured residents, along with the highest rate of uninsured women of childbearing age, in the country.
Rather than addressing maternal mortality, Texas lawmakers have instead spent years decimating access to basic preventive health care. Those who suffer most from Texas’ reproductive health policies are its most vulnerable — low-income, rural, undocumented women and women of color, who already face the steepest barriers to health care.
In 2011, conservative lawmakers slashed two-thirds of the state’s family planning budget. As a result, more than 80 health care clinics closed — 25 percent of the state’s family planning centers — while births to teenagers and abortions rose in the years that followed, as access to contraception and annual exams was drastically strained.
In 2013, state officials excluded 50,000 low-income Planned Parenthood patients from the Women’s Health Program, a lifesaving Medicaid plan. This caused reduced access to birth control and an uptick in taxpayer-funded births (most likely unplanned) and 40 percent fewer patients served. After a five-year legal battle, state officials succeeded in kicking another 8,000 low-income Planned Parenthood patients off Medicaid.
Texas’ Republican officials have steadily eroded abortion rights with a torrent of onerous restrictions over the past decade. These include a 24-hour sonogram waiting period that requires a second clinic visit, restrictions on telemedicine, a 20-week abortion ban and a prohibition on insurance coverage, which forces women to pay for care out of pocket.
While a 2013 Texas law that forced clinics to comply with medically unnecessary regulations was eventually struck down by the U.S. Supreme Court in 2016, it succeeded in slicing in half the number of abortion clinics in the state. Today, there are only 21.
As a result, Texas has more abortion deserts — cities in which an abortion-seeking patient must travel at least 100 miles for care — than anywhere else in the country. Vast swaths of Texas, including the Panhandle and West Texas, are already without an abortion clinic. The entirety of the southern Rio Grande Valley has only one.
For years now, women in Texas have been forced to travel great distances for abortion care. And that is only if they can get time off work and can afford the procedure, as well as travel, lodging and child care (if necessary). It is no surprise that abortion patients in Texas try to end their pregnancies on their own at a higher rate than the national average.
Now under S.B. 8, at least 80 percent of women seeking an abortion will no longer have access to care in Texas. This will force most to travel out of the state at an average distance that is estimated to have grown twentyfold since the law went into effect. Others will either carry out their pregnancies against their will or find ways to terminate without medical supervision.
Even if S.B. 8 is eventually blocked, Texas women will still need to contend with a new ban on dilation and evacuation, the safest and most common type of second-trimester abortion, along with the legislature’s attempt to severely limit the availability of abortion medication. Texas is also one of several states that have passed a “trigger” law that bars abortion if Roe v. Wade is officially overturned.
While S.B. 8 will devastate the lives of Texas women, it shouldn’t be viewed within a vacuum: It emerged from a political culture intent on decimating reproductive health care in the state. It is the culmination of years of sustained attacks from an increasingly zealous conservative legislature that health providers and advocates have long sought to sound the alarm about, sometimes to deaf ears — until now.
Mary Tuma is a Texas-based journalist who covers reproductive rights. Her work has appeared in The Guardian, Vice, The Texas Observer, The Austin Chronicle and Rewire News Group.
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