A month after the U.S. Supreme Court overturned Roe v. Wade, Texas’ two dozen abortion clinics are slowly coming to terms with a future where their work is virtually outlawed.
Some clinics have already announced that they are shutting down operations and moving to New Mexico and other states that are expected to protect abortion access. Others, including Planned Parenthood, say they will stay and continue to provide other sexual and reproductive health services.
But keeping the doors open will likely come at a high cost for these clinics — financially, politically and psychologically — as they absorb more patients with fewer options.
“It’s really hard to find words in the English language that honor what the experience has been like,” said Dr. Bhavik Kumar, medical director of primary and trans care at Planned Parenthood Gulf Coast in Houston. “It’s just devastation.”
Planned Parenthood clinics in Texas have had to turn away patients in dire situations, according to an open letter provided to The Texas Tribune, including minors and a woman who already had children but had been told by her doctor that she could die if she carried another pregnancy to term.
“People are looking at you and asking you, like, ‘Why can’t you help me?’ ‘Can you make an exception?’” Kumar said. “We hear that all the time, and it just feels so inhumane and unethical … to have to do this over and over again.” 
Kumar thought years of navigating abortion restrictions in Texas had prepared him for the overturn of Roe v. Wade. But he wasn’t prepared for the fear that his patients are feeling amid this new legal landscape.
He said he saw a patient last week who was worried about the consequences of even mentioning abortion.
“We’re here in a clinic where we’ve provided abortion care for decades. I’m an abortion-providing doctor, and I talk very openly about abortion,” he said. “But she just had so much fear and apprehension, and was uncertain if she could actually say the words out loud and ask for that help.”
Even if Planned Parenthood can’t offer abortion anymore, it’s committed to staying put and helping Texans access an array of other reproductive health services, including birth control, cancer screenings and testing for sexually transmitted diseases.
Its clinics have been dealing with a surge in demand for long-acting reversible contraception, like IUDs, and information about birth control options including vasectomies, all while expanding their education operations.
But keeping the doors open will mean continuing to contend with a Legislature intent on seeing them shut down. Texas elected officials have spent much of the last decade working to defund Planned Parenthood by removing it from Medicaid and other publicly funded programs.
Even as the state halts abortion services entirely in Texas, Planned Parenthood does not anticipate it stopping those attempts to financially hamstring its work.
“The state has been relentless because of who we are and what we stand for, and that’s unapologetic access to comprehensive sexual reproductive health care, which includes abortion,” Kumar said.
Some clinics plan to relocate
Other Texas clinics are shutting down operations entirely and relocating to “haven states” to continue providing abortions.
Whole Woman’s Health, which started in Texas in 2003 and at one point operated six clinics around the state, has announced plans to relocate to New Mexico.
The group has been slowly pivoting its operations in recent years toward states that protect abortion access, building clinics in Maryland and Virginia and a new location near the airport in Minneapolis. It has invested in a program to help patients travel to these states from Texas.
Now, the organization is closing its remaining four Texas clinics and relocating those operations to an as-yet undisclosed location in New Mexico.
“[Whole Woman’s Health] has served Texans for nearly 20 years, and our love for Texans runs deep,” president and CEO Amy Hagstrom Miller said in a statement. “Even when the courts and the politicians have turned their backs on Texans, we never will.”
Alamo Women’s Reproductive Services, an independent abortion provider, has also announced it will close its San Antonio clinic and a sister facility in Tulsa and relocate to Albuquerque, New Mexico, and Carbondale, Illinois.
New Mexico is Texas’ only direct neighbor that is expected to preserve abortion access, although “neighbor” is a relative term — Las Cruces is more than a 10-hour drive from Dallas or Houston.
The poor, extremely rural state, which has struggled to provide reproductive health care to its 2 million residents, is warily watching this influx of abortion clinics and patients.
The clinics that remain in Texas providing non-abortion care are preparing to serve as the conduit to these out-of-state clinics.
“We understand and deeply empathize with providers who have been forced to close their clinics and move out of state,” said Melaney Linton, president and CEO of Planned Parenthood Gulf Coast, in a statement. “We will continue to work closely with them as we help patients navigate their best options.”
But many Texans will not be able to leave the state, due to finances, child care needs or immigration status.
“Sometimes we hear that it was difficult for them to even come into the clinic that’s closer to home, maybe within 10 miles of where they actually live, let alone having to travel to another state to get that care,” Kumar said. “So it’s very, very scary for folks.”
Hanging on with ultrasounds
For many of the providers who have been on the front lines of contentious legal fights over abortion access in recent years, the overturn of Roe v. Wade was not a surprise. But now that it’s here, they say the reality is worse than they could have imagined.
Most of the patients who come to Houston Women’s Reproductive Services these days already know they want an abortion — and are willing to travel to out of state to get one. Clinic director Kathy Kleinfeld and her staff are in touch with other clinics around the country, helping patients navigate the various legal requirements, wait times and travel logistics that govern abortion access right now.
“It’s very helpful to have someone to talk this through with, who can say, ‘OK, I know this feels overwhelming right now. But have you ever lived in another state? Do you have any friends or family elsewhere?’” she said. “That gets the wheels turning, and if we’re not here to do that, they’re going to have to figure it out on their own.”
For the last month, Houston Women’s has provided only ultrasounds. Kleinfeld said it has seen a steady trickle of patients and identified ectopic pregnancies, false positives and patients who are actively miscarrying.
“In all those circumstances, women would be wasting precious time and money to travel out of state when in fact they may not need the service,” she said. “So it is important to have those ultrasounds in a medical environment where they receive accurate and compassionate care.”
Kleinfeld worries that if that option isn’t available, more people will turn to crisis pregnancy centers. These religiously affiliated nonprofits often offer ultrasounds, but some use coercive and deceptive practices to discourage clients from pursuing abortions.
Kleinfeld said she’s been encouraged by the support her clinic has received, but they’ve scaled back staff and are being realistic about how long they can remain open without their main source of income.
“We’ll do it as long as we can,” she said. “I’m not gonna sell my house and live under the bridge. I’m not going to go that far, but … I think we’re gonna see a lot of creative thinking here and a lot of innovative ideas from some of the brightest people.”
Disclosure: Planned Parenthood has been a financial supporter of The Texas Tribune, a nonprofit, nonpartisan news organization that is funded in part by donations from members, foundations and corporate sponsors. Financial supporters play no role in the Tribune’s journalism. Find a complete list of them here.
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