On Wednesday, the Supreme Court will hear oral arguments in the most significant abortion case to reach the high court in decades. Even with the legal ramifications of an eight-justice Court taken into consideration, the outcome of Whole Woman's Health v. Hellerstedt will have an enormous impact on the ability of women in Texas — and ultimately the rest of the nation — to access reproductive health care.
Rolling Stone recently discussed the case with Amy Hagstrom Miller, the founder and CEO of Whole Woman's Health, the clinic group that sued over Texas' extreme anti-abortion law, HB 2. The law — the same one filibustered by Wendy Davis back in 2013 — has already closed a number of Texas clinics, creating a genuine health care crisis in regions of the state, and if fully implemented would shutter even more. "What's happening in Texas won't stay in Texas," Hagstrom Miller warns, noting that "what's at stake is not only health and safety, but really respect and dignity."
What are you seeing in Texas these days?
This law, and the politicians behind it, have taken away women's decisions. They've created medically unnecessary obstacles that make it harder to access safe abortion services, plain and simple. The closing of these clinics has harmed people. It's created higher costs. It's created delays of up to 20 days to get an appointment. And it's created extra obstacles for women who are seeking safe abortion care, as is supposedly their right, on paper. You've seen the burdens fall hardest on low-income women, women of color and rural women — we see their dignity, and them being able to make their own health decisions, being taken away.
Even as recently as last month, we had a waiting list at our Fort Worth clinic of up to 60 patients just waiting for an appointment. Prior to HB 2 coming into effect, the Dallas-Fort Worth area had ten licensed abortion facilities, and now we're down to four. And we're serving not only the Dallas-Fort Worth area, but also Lubbock, Midland and Southern Oklahoma, because some of the clinics there are closed.
Prior to HB 2 going into effect, there were 44 licensed abortion facilities that were serving people all over the state. And now we're down to 19.
One of the things that I think is important to point out is that this law does nothing to prevent unplanned pregnancy. So it's shut down these clinics, but the same amount of women in the state need safe abortion care. Now these women are faced with extra obstacles — travel, delays — and in some cases it's pushed them into the second trimester. There used to be a clinic in Lubbock. And, for instance, we've had a woman call us, she's a working mom with three children, without health insurance, and she's trying to figure out how to make it all the way to Fort Worth from Lubbock for two different appointments — it's 600 miles round-trip each time — and pay for child care, pay for time off work. It's already pushed her into the second trimester, just trying to figure out the logistics. These specific cases really illustrate how these multiple obstacles are making safe abortion care out of reach. That's the landscape in Texas already, today, and has been for some time as the provisions of HB 2 have gone into effect.
How are you feeling about the potential outcomes of the Supreme Court case?
I mean, it's time for the Supreme Court to stop this damn law. This law went forward on misinformation, as though the state had an interest in women's health and safety. And what's happened on the ground is it's forced women to experience delays, or to even take matters into their own hands — in some cases we're seeing self-induced abortion.
We feel very confident that we're going to prevail in this case. Partly we feel that confidence because the Supreme Court has already stepped in twice on our behalf, and given us an injunction to protect the full law from going into effect and to keep some clinics open. We expect a 5-3 ruling. Even though the passing of Justice Scalia has been in the news a lot, when push comes to shove, we still need five justices to rule in our favor to stop this law from going into effect.
But I don't want to speculate too much about Supreme Court precedent, because that is far and away not my area of expertise. My expertise is to tell you what it's like to provide abortion care in a place like Texas. And what I do know is that this law has a lot to do not just with Texas, but with other states across the country — because what's happening in Texas won't stay in Texas. And we've got many states that are looking to us to step in and show that this law has done undue harm to women, that it disproportionately affects huge parts of our population, causing abortion care to be completely out of reach.
But you are hopeful that Justice Kennedy will side with the liberals on the Court?
I'm very hopeful that Justice Kennedy cares about dignity. I think that the Supreme Court justices are going to hear the stories of the thousands of women that are presented in this case and understand that women deserve to be able to make their own health decisions. What's at stake is not only health and safety, but really respect and dignity.
And you aren't particularly relieved about what Justice Scalia's passing does to the idealogical makeup of the Court?
We always knew Scalia would vote against us. His passing is a huge event — I feel sympathy for his family, and it's huge as far as the new nomination goes — but for our case, to me, it doesn't change anything.
You mentioned you're seeing women who are self-aborting in Texas. Could you say more about that?
We have seen women trying to order medications off the Internet. We've seen people crossing the border. We're seeing people using many methods of what we call self-induction, the safest of which would be medications, but we've also seen people actually causing physical harm to themselves trying to induce.
In the years that you've been running abortion clinics in Texas and elsewhere, what are some of the changes you've seen in the landscape, politically or otherwise?
The number of anti-abortion laws and restrictions and regulations that have passed in the last few years across the United States is unprecedented. Hundreds of restrictions have been introduced. And many of them are "copycat" restrictions. Many of the bills have been written by Americans United for Life, which has a kind of a playbook of model legislation that's spreading across the country as they see what will stick — testing things in Texas, and then the exact same bill is introduced in Ohio and North Dakota and Michigan and Indiana.
What we saw in the Eighties and Nineties were street protests, clinic blockades, clinic invasions. Those were very observable to the public, and people were very turned off by them — it's offensive, they're screaming and harassing women. And we still have that to some extent at many of our clinics.
But one of the strategies that the anti-abortion people took on in the second half the Nineties and the 2000s was to focus legislatively, and on the legal and regulatory system, as a way to close clinics and make it tremendously difficult and disruptive for providers to run a stable clinic environment. The anti-abortion laws that have been passed are enforced and policed by state health departments. And those health departments have increasingly become politicized, almost as a tool, or an arm, of a restrictive state government, state legislator, or the anti-abortion movement in general. We see the anti-abortion movement filing anonymous complaints on clinics all across the country, triggering clinic inspections that are very disruptive to the clinic's ability to provide care.
This does two things: One, it's extremely hard to provide medical care in that kind of environment, where you're constantly under scrutiny. But secondly, that method of protest is invisible to the public. It's not like having a big picket sign outside the clinic. It's not observable or monitored in the public sphere, so it's causing all of this harm and disruption behind the scenes for clinics and patients and doctors. It's become a tool of our opposition to make it more and more difficult to keep clinics open.
One thing I always wonder about with anti-choice politicians and activists is: What is their ultimate aim? If it was really about protecting women's health, or saving babies, it seems like they would use very different tactics. Do you have any thoughts on that?
If it was indeed about reducing unplanned pregnancy or reducing abortion, you would see abortion restrictions coupled with robust family planning and robust sex education. And you don't. In fact, 40 percent of the women we see in Texas for an abortion were unable to get the contraceptive method they wanted before they got that unplanned pregnancy in the first place. You see cuts in family planning and cuts in preventative care at the exact same time you see clinic closures. So it's not about reducing the number of abortions, or getting rid of abortion — it's about a much bigger and more fundamental issue that really goes back to respect and dignity and equality.
Any final thoughts?
It's been a crazy three years. It's been tremendously disruptive. But at the same time, we feel very honored to stand on the right side of history and to bring this case before the Supreme Court on behalf of the women and families in Texas who deserve this representation, and who deserve to have their stories brought to the national stage, and deserve to have somebody fighting for their dignity and their access to health care. So I feel very excited, on some level, that we are going to have our day in the highest court in the land.
This interview has been edited for length and clarity.