Amy Hagstrom Miller still remembers the day the legislation known as HB2 took effect in Texas. At her six abortion clinics across the state, doctors met personally with dozens of patients waiting for procedures, dutifully explaining that they could no longer help them. The new law mandated that all abortion providers have admitting privileges at local hospitals—a requirement few providers could meet. At Hagstrom Miller’s McAllen clinic, patients were informed that their closest provider was now 250 miles away.
The clinic president specifically recalled a patient who pleaded with staff, saying she had three children and couldn’t travel that far for an abortion.
“Can you tell me what I can do?” the woman asked. “Is there something in my house, something that might be under my sink, or something in my medicine cabinet that I could use? Because I have to have this abortion.”
The U.S. Supreme Court overturned HB2 in 2016, ruling that its requirements placed an “undue burden on abortion access.” But to this day, women in Texas are still three times more likely to try to end their own pregnancies than in the rest of the country. And this week, the court will hear arguments on a nearly identical law out of Louisiana—one that could not only irreparably harm abortion access in the state but also undermine the very foundations of Roe v. Wade.
To understand the stakes in Louisiana, experts say, you need to know what happened in Texas.
The laws in Texas and Louisiana aren't just similar—parts of them are nearly identical. In fact, the Louisiana attorney general acknowledged that his state’s law had actually been modeled off the Texas legislation—borrowed from a playbook of anti-abortion laws billed as protecting women’s health and safety, but used to shut down clinics across the country. Signing HB2 into law in 2014, then-Gov. Rick Perry declared that the legislation would “cement the foundation on which the culture of life in Texas is built." Less than a year later, then-Gov. Bobby Jindal claimed his state’s version was part of an effort to make Louisiana “the most pro-life state in the nation.”
Both the Texas and Louisiana laws say abortion providers must be able to admit and treat patients at a hospital within 30 miles of their clinic, without the approval of another doctor. But in practice, abortions rarely result in hospitalization. The rate of complications is far higher in colonoscopies, dermatologic procedures and liposuction—none of which require doctors to have admitting privileges.
Many hospitals don’t see the point in handing out admitting privileges to abortion providers who will rarely be there. Religiously affiliated hospitals may also have philosophical qualms, while others simply don’t want to deal with the crowds of protesters that working with an abortion provider can draw. (Outlets like LifeSite News regularly list the address and phone numbers of hospitals that give admitting privileges to abortion providers.)
After HB2 passed in Texas, Hagstrom Miller said, her clinics applied for admitting privileges for 15 doctors at 25 hospitals around the state. Only three received them.
“It just created this perfect storm, where the right to an abortion existed on paper, but people’s ability to access it, and clinics ability to stay open and actually provide it, became almost impossible,” Hagstrom Miller said.
The effects of the law are hard to overstate. In the two years following its implementation, the number of facilities providing abortions in Texas was cut in half, from more than 40 to roughly 17. On average, researchers at the Texas Policy Evaluation Project found, the distance women had to travel for an abortion increased by 20 miles. For women whose nearest abortion clinic shuttered, that distance increased four-fold.
In the year following HB2, the number of abortions performed in Texas dropped by 18 percent. At the same time, the number of second-trimester abortions increased 13 percent, as women were forced into longer waiting times at the few remaining clinics. On average, women received abortions a week later than usual after the law took effect—the difference, for some women, between accessing a simple medication abortion and having to undergo a surgical procedure.
Even today, four years after HB2 was ruled unconstitutional, Texas has only 22 facilities providing abortion. Many of the state’s providers retired or changed specialties, and some clinics lost their leases. Starting over in the void left by a restrictive abortion law isn’t just as simple as re-opening clinic doors: It requires new licenses, new staff, and a landlord willing to work with an abortion provider in a politically fraught time.
Last year, scholars at the University of Texas at Austin surveyed women at three Texas clinics about their experience. Nearly 30 percent said they had considered or attempted performing their own abortion before making an appointment. (This was before the dawn of Aid Access, an abortion pill shipment site that would have made doing so even easier.) These women were also more likely to have faced barriers like cost, distance from the clinic or lack of child care, and to cite those as reasons for attempting an at-home abortion.
“The situation that we are already in in states like Texas and Louisiana is that it is hard for a lot of folks to get to a clinic,” Professor Abigail Aiken, the lead researcher on the study, told The Daily Beast. “The study is showing us, as a result of those barriers, people are looking for other ways to do their own abortion.”
If laws like the one in Louisiana are allowed to take effect, Aiken said, the situation is likely to get worse: “I feel pretty confident saying that yes, if you put abortion more and more out of reach, you are more likely to see more and more attempts at self-managed abortion.”
In fact, the situation in Louisiana could be even more dire than in Texas. If Act 620 took effect, there would be just one abortion clinic left for nearly 1 million women of reproductive age. (In Missouri, which dropped to just one abortion clinic in late 2018, the number of abortions dropped more than 50 percent last year.)
Louisiana also has a 24-hour waiting period in effect, meaning women would have to travel to that single clinic twice, or stay overnight, in order to actually receive their procedure. Nearly three-quarters of all women seeking abortion in Louisiana are already mothers, meaning they would also have to secure childcare for the journey. Women also make up a disproportionate number of the state’s low-wage workers, who are less likely to be able to take time off for travel.
At the same time, Louisiana has one of the highest maternal mortality rates in the country—second only to Georgia, where legislators tried to ban all abortions after six weeks last year.
“We are at a loss for what to do,” said Lakeesha Harris, director of reproductive health and justice at the New Orleans nonprofit Women With A Vision. “We only have one abortion clinic in Mississippi right now and that’s holding on by a thread. There’s no going to Alabama.”
She added, “All around us, where states are already struggling to service the people they are servicing, abortion would be just chipped away.”
Abortion opponents have made it clear that this is exactly what they wanted. In 2014, while Louisiana legislators were still considering Act 620, an anti-abortion activist emailed the bill’s sponsor, telling her about a similar law that had seen “tremendous success in closing abortion clinics and restricting abortion access in Texas.” Writing about the Louisiana law earlier this month, the anti-abortion group Operation Rescue said it could cause “a significant number of abortion facilities shut down nationwide” if upheld by the Supreme Court.
Indeed, the effects of the case challenging Act 620 are likely to ripple far outside of Louisiana. With two new, Trump-appointed justices on the court, some advocates worry that the case could result in the overturning of Roe v. Wade, the 1973 case that made abortion legal across the country.
More likely, however, the justices could allow Act 620 to stand, paving the way for more states to enact increasingly stringent restrictions on abortion in the years to come. In 2019 alone, states passed 58 new restrictions on abortion—23 of which have been stayed, pending a court decision. According to Planned Parenthood, there are currently 17 abortion cases one step away for the Supreme Court.
For Hagstrom Miller, who will be returning to the Supreme Court steps Wednesday, less than four years after her clinics claimed victory there, the whole thing smacks more than a little of deja vu.
“We’re back at the Supreme Court, waiting them for them to decide if states get to further restrict abortion access,” she said. “And it is super frustrating because the court already ruled in [our] case, and we won.”
But, she added, “Whatever happens in that courtroom, I think it’s important for us to realize that in our communities and in our states, we’re really building a lot of power. We have more support for abortion rights int his country than we ever have in my lifetime.”