Though she wasn’t scheduled to work until the next day, Kat Craft, part-time hotline coordinator for the Lilith Fund, decided to check her work email on Oct. 31. She was in for an unpleasant surprise. An emergency ruling by the U.S. Fifth Circuit Court of Appeals upholding House Bill 2 had made it illegal for doctors to perform abortions in Texas without admitting privileges to nearby hospitals. As a result, up to a third of abortion clinics had suddenly closed. Most of Craft’s clients had abortions scheduled for the next day and now her inbox was jammed with messages from the Lilith Fund board. Everyone was scrambling to find out which clients had abruptly lost their provider.
As an abortion fund, the volunteer-run organization offers small financial grants to women who need abortions but can’t afford them. If a woman qualifies for financial help from the Lilith Fund, a caseworker like Kat Craft will fax a voucher directly to the woman’s chosen abortion clinic. Given the enormous need for financial aid in Texas, the Lilith Fund finances only women days away from their abortion procedure.
But the Fifth Circuit’s ruling on Texas’ anti-abortion bill was causing major confusion for Craft. Which clinics were still open and able to process the vouchers? Were appointments being pushed back or canceled? What would happen to clients already up against the 20-week abortion limit? How much farther could women travel? On Friday morning, the day after the Fifth Circuit’s ruling, Craft and Lilith Fund staff began phoning abortion clinics to find out.
In Dallas, Merritt Tierce and her team were doing the same thing. Tierce is the executive director of the Texas Equal Access Fund, an abortion fund that serves North Texas (the Lilith Fund serves Texans south of Austin). “I called all the clinics myself,” Tierce said, “and I was impressed by how much confusion there was among them.” Few seemed to know which clinics were open and some staffers didn’t know whether they were taking clients. Tierce found that overnight, Tarrant County residents, who have roughly 5,000 abortions per year, were without an abortion provider. Two out of five clinics in Dallas closed. A few providers mistakenly told women that other clinics were shut when they were in fact still taking patients.
Such confusion is widespread. Even days after the law went into effect, there still isn’t a definitive count of how many abortion clinics are open. A coalition of women’s health advocates who challenged the admitting privileges law in court argued that up to a dozen clinics would close. Amy Hagstrom Miller, CEO of abortion provider Whole Woman’s Health, said that 14 clinics had stopped providing abortions. This number could go up or down as physicians gain admitting privileges at nearby hospitals or as their shift availability decreases (some physicians are itinerant and cover a wide geographic region). What’s clear is that no physicians in West Texas, the Panhandle, the Rio Grande Valley or between El Paso and Interstate 35 can provide abortions for lack of hospital admitting privileges. In this bleak and rapidly shifting landscape, women trying to navigate abortion access are lost.
“We haven’t ever seen anything quite as dramatic as this,” said Megan Peterson, deputy director of the National Network of Abortion Funds, a nationwide umbrella group that represents abortion funds like Lilith and Texas Equal Access. “With so many clinics closing so suddenly, the loss is huge.”
Some women had no idea it was coming. When the Texas Equal Access Fund’s intake coordinator, Kamyon Connor, called the clients who had upcoming appointments, she was the first person to tell them that their clinic had closed. Women responded with disbelief, shock, fear and anger. However, many Lilith Fund clients didn’t seem surprised when they got the call. Many had already been contacted by their clinics, and Craft noted that their chief emotion seemed to be frustration. Some women had figured out which clinic they could go to but didn’t know how they would get there.
On Friday, Aspen Webster, a hotline volunteer for the Lilith Fund, spoke to a working mother of three who was 19 weeks pregnant and rapidly approaching the limit at which she could legally have an abortion in Texas. (House Bill 2 bans abortions after 20 weeks gestation. That provision went into effect on Nov. 1 and has not been challenged in court.) She was scheduled to go to a clinic in Houston that day but the clinic, a 45-minute drive from her home, had postponed her appointment until Monday. Then on Monday the clinic canceled the appointment altogether and referred her to another provider, this one three and half hours away. The woman had no idea how she would find childcare or get the extra time off work she now needed. In McAllen, another Lilith Fund client whose local clinic closed was referred to a clinic in San Antonio, a four-hour drive away. Craft increased the voucher by another $100, but the woman was despondent, saying that the transport and accommodation challenges required to get to San Antonio were insurmountable for her. A third Lilith Fund client was driving to Albuquerque, New Mexico, because she was at the legal limit for abortion and couldn’t afford to wait.
Women now face more than just extra travel. Those transferring to different providers must undergo a second state-mandated sonogram, costing roughly $100, and another 24-hour wait to satisfy abortion restrictions enacted in 2011.
“The amount we usually offer to clients in their first trimester is between $80 and $120, and much of that goes toward the cost of the sonogram,” Tierce said. “Now they have to pay for that again, and it doubles their need for financial help. This extra cost is a major hardship for our clients.”
Neither abortion fund knows whether their clients will undergo the abortions they’d planned for. Only once the procedure goes ahead will the clinic redeem the abortion fund voucher. “We won’t know for a while yet whether those women were able to jump through all the extra hoops,” Tierce said. She expects that few of them will. Likewise, Craft expects the number of calls coming into the Lilith Fund to drop. “Most of our referrals come through the abortion clinics, but if they are closed, women won’t know where to go for help,” she said.
For this reason, the Lilith Fund plans to expand its mission. Previously, caseworkers would work with only women who already had abortions scheduled. Now they plan to call anyone who contacts the hotline for help. With safe, legal abortions so much harder to find in Texas, the Lilith Fund is becoming not just a source of financial aid but also a navigator for women in distress. Tierce noted that there are now so many legal and logistical barriers that she doesn’t blame women if they give up. “I’m grateful that anyone still calls us expecting that we can help,” she said.
Conversely, anti-abortion groups are buoyed by the enactment of the admitting privileges requirement believing that it reinforces a “culture of life”. But although the new law has reduced provider capacity significantly, it has probably done little to reduce abortion demand. “Everyone who calls us today needs more help than before,” Tierce said. “People are really desperate now.”