At the center of the case is the Texas Bill, HB2, which enacts restrictions on providers that could make abortion care difficult or, for many women in the state, even impossible to access. But providers aren’t taking the bill lying down: Whole Woman’s Health, a network of abortion clinics with locations in Texas, is challenging the bill.
While waiting for the Supreme Court’s decision, Refinery29 sat down with Amy Hagstrom Miller, the CEO of abortion clinic Whole Woman’s Health and the lead plaintiff in the case. We talked to her about what this bill could do to women’s access to reproductive care, what kinds of laws she’s been seeing nationwide, and what’s at stake in this case. Read what she has to say here, and watch a video of the full interview, below.
This interview has been edited for length and clarity.
Give us a brief rundown of the bill you’re challenging, HB2.
“We’re challenging the notion [that] abortion procedures need to be done in a mini-hospital setting. We’re also challenging the part of the law that says all of the doctors that provide abortions need to have admitting privileges in a hospital.
“We were able to get an injunction from the Supreme Court, which has blocked a large part of the law from going into effect. Which is why we still have 19 clinics open in the state of Texas. Prior to this law passing, there were 44 clinics. If we aren’t successful in the Supreme Court, we’ll go all the way down to nine facilities, and those facilities would only be in the major metropolitan areas. There’s absolutely no care offered outside…Dallas-Fort Worth, Houston, San Antonio, Austin, and that’s devastating for the women who live all across the state."
These provisions that you’re challenging in HB2 are an example of what are sometimes called TRAP laws, which stands for Targeted Regulation of Abortion Providers. Can you explain what TRAP laws are and what they do?
“TRAP laws are based on a political agenda to shut down access to reproductive health care by any means necessary. They’re put forward under the umbrella that they have something to do with women’s health and safety, but really, they’re targeted only specifically towards abortion provision and not towards other similar kinds of health care. So abortion providers have to deal with regulatory interference in their ability to provide care in a way that physicians and other healthcare providers don’t."
Whole Woman’s Health operates in multiple states. What kind of trends have you seen in these kinds of laws coming out? Because this isn’t just an issue in Texas, this is around the country.
“Correct. So there’s this organization called American United for Life, and they have basically a playbook of legislation that they’re trying to introduce all across the country. Each time they introduce bills, they see what works, what didn’t, and then they refine their programs and go to the next state. So it’s really what we’ve come to refer to as ‘copycat legislation’ that’s spreading.
“We have a right that exists on paper, but it’s really meaningless for a lot of people because they can’t access it. It’s one of the stories we’re really trying to tell as part of our case, to illustrate what it means for real people who are trying to access care. Even if it exists legally, you can’t access it because you have to travel far, or you don’t have health insurance, or you can’t get multiple days off work. It’s not actually a meaningful right as you live your life."
She called us about six times during her pregnancy...and by the time she actually got her ultrasound, she ended up being too far [along] to get an abortion in the state of Texas.
“Already we’ve seen, just, a decimated care infrastructure. And if we aren’t successful and the law goes into full effect, you’ll see 75% of the clinics just disappear. Just gone from the care infrastructure.
"One woman called us from Lubbock, which is a city in West Texas. She was a single mom, working mom of three, and we had to tell her, ‘You have to travel 350 miles to the Dallas-Forth Worth area to have an abortion.’ She called us about six times during her pregnancy, trying to figure out how to get time off work, how am I going to afford gas, how am I going to travel round-trip, how am I going to get child care, and by the time she actually got her ultrasound, she ended up being too far [along] to get an abortion in the state of Texas. And that’s not in the best interest of women’s health and safety."
How long did that process take?
“She was eight weeks when she first called us, she was 22 weeks by the time she actually got to Dallas-Forth Worth, raised the money, took the time off work, to have the ultrasound.”
So, over three months.
“Right, of this kind of calling, back and forth. Single working mom of three kids. The vast majority of people actually who have abortions, already have a child. So they know exactly what having a child involves. And so these sort of waiting periods where they’re supposed to think about their decision — so disrespectful.”
These laws are always presented as something that’s in the name of women’s safety. Can you talk about what these restrictions really mean for abortion providers and women seeking care?
“One of the things that’s important to understand is that there was no safety problem with abortion in the state of Texas prior to HB2. It’s not solving anything. Abortion is one of the safest procedures in medicine. It [does have] some moral and ethical complexity for a lot of people. Nobody wants to have an abortion, it’s not on anyone’s bucket list, but medically it’s extremely simple and extremely safe.
"The ambulatory surgical centers are set up for major surgery. There’s an assumption that there’s an incision, that somebody’s whatever part of the body they’re having surgery on is cut wide open, they’re under anesthesia, there’s more than one physician. Women who have abortions can walk into the procedure room, talking, normal. They can walk out of the procedure room, talking, normal. The procedure itself takes five minutes, sometimes ten minutes. There’s no incision, you don’t need to be asleep. So what’s going on here is that they’re putting upon us that physical plant requirement that’s completely unrelated to the medicine of abortion.
“They’ve added these onerous restrictions that don’t increase the safety, but increase the overhead cost and increase the logistical problems of actually building and keeping a facility open. A lot of restrictions on abortion, like waiting periods, forced ultrasounds, mandatory delays, women figure out how to make it through those barriers. They’re not happy about it and it’s disrespectful, but people figure out how to deal with it. But when you restrict the amount of clinics that can stay open, and when you force people to close the businesses, that actually completely takes away the access to abortion.”
Whether you’ve had an abortion yourself, you’ve helped somebody, you trust somebody, you know somebody, you love somebody who has…
"Part of our care model is that we know what it’s like for people to go into a doctor’s office, and we’ve infused a sort of woman-centered feminist touch to clinics. We have purple fuzzy fleece blankets that you get to wrap around yourself in the exam room, because everybody’s always freezing. We’ve created this kind of herbal tea called “TranquiliTea” specifically brewed for Whole Woman’s Health for the recovery room. It helps with cramping, it helps with bleeding, it helps with nausea. It’s this warm herbal tea that we get to serve women post-operatively. These are the kinds of things that ambulatory surgical center [restricts], it denies our ability to do these kinds of things.
"You’ll see a lot of us trying to warm up the ambulatory surgical center environment as much as we can. At Whole Woman’s Health, we name all of our exam rooms after different women, we have purple walls, and then we have a quote from the woman. We can’t have ‘artwork’ on the walls, but we figured out how to stencil a quote on the walls."
What’s your favorite quote on the wall?
"Oh, it’s a tough one to pick! There’s a really good one — we have a quote on the wall in our ambulatory surgical center in Sandra Cisneros’ room that says, ‘Liberation comes from within.’ It’s a little bit of a double entendre, in an abortion clinic exam room, which I actually didn’t intend at first. And then I was like, ‘Oh, that’s actually powerful, and also slightly irreverent and funny.’ That’s one of my favorites.”
What can a regular person do to effect change?
“Part of what I would recommend is talking about abortion, using the word 'abortion.' Not 'shmushmortion,' or ‘reproductive rights,’ or talk about family planning, but to actually talk about why access to save abortion is important to your life. Whether you’ve had an abortion yourself, you’ve helped somebody, you trust somebody, you know somebody, you love somebody who has…
“One of the other things — even progressive people say things like, ‘You know, I’m pro-choice but I’d never have an abortion.’ Don’t just let that kind of thing hang in the air. One of my favorite things to say to somebody is, ‘I’ve never met anybody who wanted to have an abortion,’ and it makes people go, ‘Oh. I didn’t think about it that way.’”
We try to say they have gone too far, and they don’t represent the majority of Americans, and this is not in the best interests of women’s health and safety.
“First of all, it’s important to vote. You know, only 26% of Texans voted in the last election? So, by the time we showed up at the Capitol all fired up and pissed off, we had elected all these people — or not elected them by not participating — who didn’t really represent the majority of people. A big important part is to find out what bills are being introduced, [and] figure out how to show up at a committee hearing and testify for three minutes.
"You don’t have to talk for a long time or have some big speech prepared; you can just go and make your voice heard. It’s your Capitol, after all, it’s your statehouse, it’s your state, and you are as welcome there as the fancy people who walk around in suits.”
To finish up, remind us what is really at stake in this case.
“This case is what people call the ‘reproductive rights case of a generation.’ It’s really a referendum on undue burden.
“What we have done is illustrate the harm and the damage that has been done to people as the by-product of these kinds of restrictions, and not only are we hopeful we can restore access in the state of Texas to safe abortion, we are hopeful we can set a legal precedent that will be useful to states all across the country, that will stop laws that were passing, that will help reverse damage that has been done in places like Mississippi, Alabama, Louisiana, Wisconsin.
“There’s people all over the country watching this case in Texas, as we try to say they have gone too far, and they don’t represent the majority of Americans, and this is not in the best interests of women’s health and safety.”
You can watch the whole interview, below.