Dr. Bhavik Kumar has been a Texas abortion provider for six years, with the last two at the Planned Parenthood Center for Choice in Houston, Texas. He started practicing shortly after House Bill 2 — the last Texas abortion law to go all the way to the Supreme Court before it was struck down as unconstitutional — went into effect. In the three years between the law’s passage and the Supreme Court’s decision, HB2 forced roughly half of Texas’ abortion providers to shut their doors.
A new bill, passed by the Texas State Legislature in May and signed into law by Gov. Greg Abbott in June, has the potential to be even more disruptive. Instead of outlawing abortion outright, the new law empowers private citizens to sue doctors like Kumar, nurses, members of his staff, as well as anyone else who “aids and abets” an abortion — family members who drive patients to the clinic, faith leaders who provide counseling, abortion funds — for $10,000 each. The ban applies to abortions that take place after heart activity can be detected in the embryo — six weeks gestation, or roughly two weeks after a woman’s missed period, when many women don’t even know they are pregnant yet.
Kumar, who moved from London to a small town in east Texas when he was 10 years old, felt called to abortion care in medical school, when he learned how few young doctors were being trained to provide abortions. “Growing up in Texas as a gay brown man — my family and I were documented for about 11 years — it really resonated with me how certain policies and systems worked to oppress people and take away their rights,” Kumar says. “I learned about abortion, and how safe it is, and yet we weren’t being taught about it… It really made me think, who is going to provide abortion care in Texas? What about all the people that I know and care about who need access to abortion in a state like Texas?”
But the threat of SB 8 is giving even Kumar pause about continuing to provide abortion care in Texas. “To think about [having to contend with] maybe one lawsuit, maybe hundreds of lawsuits? Maybe many of those are trivial and will go away with time, but it’s still very daunting to think about,” he says. Rolling Stone spoke with Kumar — who joined a lawsuit filed Tuesday to prevent the law from going into effect — about the terrifying prospect of providing abortion care while also having to defend yourself from a virtually limitless number of lawsuits.
The law isn’t scheduled to go into effect until September 1st, but I’m curious if any of your patients are already expressing concern about the law to you?
In Texas, it’s not uncommon for me to hear somebody say “I didn’t know abortion was still legal.” Or “I didn’t know I could even get this care.” Or “Is this OK? Am I going to get in trouble?” I hear those things often just because we have so many TRAP laws [which seek to put so many burdensome regulations on clinics as to force them to close], and there’s so much misinformation out there already.
In the last month or so, I’ve heard more patients ask about Senate Bill 8. And they’re telling me, “I don’t know what I would have done if this law was in effect.” They’re telling me they had a several-week wait until they were able to get their appointment, during which they had to talk to their partner, or their mom, or whoever about what they were going to do with this pregnancy. They were surprised, like, “I didn’t even know, first of all, that I was pregnant that early. It took me several weeks to get it here. I needed to talk to some people before I got [the abortion].” And then there are the folks saying, “I came in here two weeks ago, but I needed to save up the money — I wouldn’t have made it in here before that six week period.”
And that’s not surprising to me. The vast majority of folks that I see will already have cardiac motion [in the fetus] by the time I see them. I’m worried — even if you can get an appointment on the same day, and you’ve made your decision, and all the things are perfect, and you don’t have to deal with TRAP laws, it’s very, very difficult to get [a timely appointment] in the first place.
How is the law already being felt by the staff at the health care center where you work?
Texas definitely has a history of attacking abortion rights and access, so for those of us who do this work, this isn’t new. We are certainly used to this sort of senseless attack on the work that we do and the care that we provide our patients.
I think what feels different with Senate Bill 8 is that this is the first of its kind. There’s a large amount of uncertainty, and uncertainty is very scary. We don’t know how this is going to pan out. We don’t know who will be suing who. We don’t know if this will affect health centers, physicians, abortion funds — if it’s going to affect all of us. If our nurses are going to be affected, or staff, the folks who are answering the phones? Will this be zero lawsuits? Will this be hundreds, thousands of lawsuits every day? We have no idea what this is going to look like.
I would say we are all certainly feeling the possibility of this law going into effect. I would say that we’re all feeling it in different ways, but I think anybody who is connected [with] providing abortions in Texas is feeling the weight of this law going into effect.
You mentioned that this law is the first of its kind — an abortion ban that’s being enforced by private individuals, rather than the state. There is an endless list of people who could sue you for providing abortions, or sue people for offering support to those who are considering an abortion. Has anyone indicated that they plan to sue you or your health center?
I’m not aware of any threats directly to either me or to the health center where I provide care. But I’m not monitoring this myself or anything. We do know there are folks out there that are organized — members of organizations that oppose what we do, lobby for anti-abortion legislation — so we can speculate who might bring lawsuits like this forward. We certainly have a number of repeat protesters, folks that were there pretty much every day at our health centers. There are definitely likely folks that might bring lawsuits forward, but nobody has directly said, to my knowledge yet, that they plan on doing anything like that.
Has the health center been targeted in the past?
I’ve provided abortion care in Texas for a little over six years now. I’ve worked at a number of different health centers. They all have protesters. They harass us. They harass my staff and our patients. It’s very unfortunate. Right now, things are pretty much normal for us. Abortion is still legal. We are still providing care. The same protesters are out there and doing what they do. What has changed is that we’re getting closer to September 1st, and as we’re moving closer, we’re beginning to organize and think about what we will do or need to do if this law does go into effect. And if this law does go into effect, that we do everything we can to provide the care for the people who need it now, and are able to access care before September 1st. And if that means increasing our capacity to be able to meet that demand, then we need to do so.
When you talk about increasing capacity ahead of September 1st, is that because you’re anticipating demand decreasing after September 1st, or is it because the health center is worried about the implications of the law and considering limiting care after September 1st?
We haven’t made any firm decisions about how things are going to look after September 1st, but we have to anticipate a landscape where access to abortion is very, very different.
The demand or need for access to abortion is not going to change. The number of people becoming pregnant and then deciding that they need to have an abortion doesn’t change because a law is passed, right? We know that people need access to abortion on September 1st just as much as they needed it on August 31st. If access were to look different, we want to make sure that we can provide that care before we potentially have to comply with this law, so that way we did everything we can and helped all the people that we were able to before this law goes into effect and we potentially have to comply with it.
This law is being referred to as a six-week ban, but my understanding is the only enforcement is through these civil lawsuits. If a doctor or health care center had the financial means to defend themselves from these lawsuits, could they continue offering legal health care?
We’ve never seen how this plays out. We don’t know what these lawsuits will look like. We don’t know who will bring these lawsuits forward and we don’t know how many of these lawsuits are going to be filed.
My day-to-day job — just providing health care to people still in a pandemic — is already difficult. I’m very, very tired and exhausted by the work that I’m doing. To think about [having to contend with] maybe one lawsuit, maybe hundreds of lawsuits? Maybe many of those are trivial and will go away with time, but it’s still very daunting to think about. And that gives me, as a physician providing abortions, pause. How much can I do, and what could happen? It can range from “not much” to “a lot,” and the uncertainty is scary — for all of us. It’s not just me making this decision, but anybody involved [in] providing abortion care, whether it’s providing direct health care or somebody funding it or it’s somebody driving somebody to their abortion appointment. I think it’s very difficult to know exactly what we’re facing until this law goes into effect and we see what happens.
Were you worried at all about the potential fallout from joining this lawsuit to stop the law? Are you worried that it might open you, or the staff at your health care center, up to further harassment?
Yeah, absolutely. That was definitely a consideration. It’s something that I still think about. I’m a physician. I wanted to practice medicine, take care of my patients, and do my job, providing abortion care in Texas. Instead, what’s happening is I’m having to get involved with lawsuits to give voice to science, to give voice to what I see and hear from my patients.
It is scary. It is concerning how much unknown there is in joining the lawsuit — what that might mean for me personally, my family, the health center where I work, our organization and our staff. What I fall back on, at the end of the day, is: This is the right thing to do.
My patients will continue to need this care — it’s not going to stop on September 1st. When I look back on this, I want to make sure that I did the right thing, that I did everything that I could to make sure that they had access to the care that they needed. Because at the end of the day, when I’m going to sleep, that’s who I think about. I think about the patients. I think about the folks that I’m going to have to say: “I can’t take care of you today because of this law. I’m very, very sorry, but I’m not able to — only because of this law.” I want to know that I did everything I could, and we tried as hard as we could — if it means filing a lawsuit, then let’s do it, because there are people that are going to suffer if we don’t do it.
As someone who has lived in Texas for most of your life, and dedicated your life to providing medical care for Texans, I’m just curious what it was like for you to watch the hearings and hear witnesses speaking in support of this law that empowers private individuals to come after you, specifically?
It’s very difficult to hear. Most of the people who spoke in support of Senate Bill 8 don’t do the work that I do. They don’t talk to people I’m seeing. They don’t know their stories. They don’t know their names. They come from a different place. I think there’s a lot of privilege there. I think there are a lot of assumptions that they have. And I think there’s a lot of misinformation.
I don’t want to blame them, but if there is not openness to understanding what it’s like for somebody who needs to end their pregnancy, who needs access to abortion. If [supporters of SB 8] just explored that and listened, I think they may come to a different conclusion. I’m not saying it would be easy for everyone to understand — everyone has their own process and journey. But that’s what keeps me going: that everyone has a different story and it will affect you when you start listening to those stories and understand why people need to have access to abortion. I hope that they have some moment in their life where they can be open to that, and just listen.
These laws always disproportionately affect people of color. We live in a state where maternal mortality is very, very high — and uniquely high among black women. And I really worry about what will happen to folks once this law goes into effect. I see people who are physically unable to carry the pregnancy to term because of their health conditions, and that tends to be people of color and especially black people because of the low access to health care, and because of the low coverage of any kind of insurance, but especially with Medicaid and the state’s refusal to expand Medicaid and all the things that go into being a person of color living in Texas. This is going to be very, very difficult. I think we’re going to see some extreme things among low-income folks and people of color as this law potentially goes into effect.
Have you ever had an experience that’s made you doubt your path, that’s made you say, this is too hard, I’m ready to do this work somewhere a little less difficult?
Senate Bill 8 has certainly given me pause. This has been a very difficult law to think about in terms of what it will mean for access to abortion. On a personal level, the idea of the unknown when it comes to numerous lawsuits that are obviously frivolous, but still something that I would have to deal with. It gives me a lot of pause. And I wish it were easier for me. I’d certainly enjoy an easier path. With all of these restrictions and laws, we are the ones that have to face our patients and enforce them.
I’ve met thousands of people who’ve needed to end their pregnancies. I’ve heard their stories. I know their names. And I know that there will continue to be thousands of people in the future that will continue to need this care in Texas. As much as I would like to make it easy for myself, I don’t think I could go to bed at night knowing that I’m not doing everything I can to help people who need to end their pregnancies. I wish it were easier. I really wish I could go to work, and take care of my patients, and then go home. But unfortunately, that’s not the state that we live in, and this is part of what it means to provide abortions in Texas.
This law feels almost like an extension of the TRAP laws — targeted restrictions on abortion providers — a law intended to make it so difficult and expensive and onerous to continue operating that people will just give up. Are you worried that this will be replicated in other states?
We see this already happening with all different kinds of TRAP laws. When one state succeeds in limiting or banning abortion to some extent, other states copy it. There’s a playbook that anti-abortion folks use. If we were to look at [other laws like] the mandatory delays [before an abortion]: some states were able to pass a 24-hour mandatory delay; other states, 48 hours or 72 hours. Once it works in one state, other states begin to copy that.
I think that if Senate Bill 8 were to be successful in Texas, and they were able to limit abortion, it will put a strain on health centers. What we saw with HB2 [which required health centers that provided abortion to have hospital-like facilities and their clinicians to have admitting privileges at a local hospital] about five or six years ago is that when there is an extreme law that we may or may not have to comply with, it shuts down health centers. With HB2 [Planned Parenthood of Texas] shut down about half of the health centers — the number went from about 40-something to maybe 20. And something similar could happen with Senate Bill 8.
We don’t know exactly what the strain will be for each individual health center. We could lose staff — they’re not able to go to work, or [the implications of the law] may seem scary to them — and if we don’t have staff, we can’t see patients. If we can’t see patients, we’re not able to keep our doors open.
I am worried. This has happened before. There’s a pattern. It could make things in Texas a lot worse and other states could do something very, very similar, especially if it’s successful — even in the short term.
The pattern that anti-abortion politicians have is really chipping away at abortion bit-by-bit until it makes a significant dent. And in places like Texas, it’s already made a significant dent. We don’t need to overturn Roe v. Wade to see what the effects of not having access to abortion is. We’re already seeing that in Texas.