The most recent omnibus abortion restrictions included four main provisions, three of which go into effect on October 29 of this year. Many Texas medical providers and reproductive choice organizations have filed a complaint and called for an injunction on two of those provisions, but one mandate will without question be implemented in a few weeks: The ban on abortions that are 20 weeks along or later.
This two-part series addresses the consequences of the 20-week ban on women's reproductive rights and why lawmakers and citizens must work to keep both elective and medically necessary abortion accessible for all women.
Throughout the debate and protest over the abortion restrictions, the 20-week ban sometimes takes the backseat to discussions regarding the ambulatory surgical centers requirement, which will shut down all but five clinics, or the mandate that practitioners have admitting privileges at a nearby hospital. Even pro-choice people sometimes avoid openly discussing the topic because, according to Whole Woman's Health founder, president, and CEO Amy Hagstrom Miller, “A lot of people are uncomfortable with later term abortions.”
Read more about how the impending 20-week ban affects disenfranchised women.Although Roe v. Wade protects women's constitutional right to abort a pregnancy until the fetus is viable (in Texas, 24 weeks), the 20-week ban was passed on the grounds that the state has another compelling state interest in preventing fetal pain.
The reasoning is based on faulty science: The most comprehensive studies on fetal pain have concluded that, although the circuitry for sensation begins to develop around 24 weeks, the brain pathways required for experiencing pain are not functional until much later in the third trimester.
Nevertheless, conservatives in the state legislature were able to redirect the conversation toward the topic of women's responsibility, claiming that all women should be able to choose an abortion before 20 weeks. Defending the rights of women who have been characterized as cavalier or nonchalant often makes even pro-choice lawmakers uneasy.
When I spoke to Amy, she explained how that discomfort drives many pro-choice legislators, activists, and voters to focus on procedures that are medically necessary—that is, a woman and her doctor decide to terminate a pregnancy due to health concerns. And although many later term abortions do fall into that category, many other women decide to terminate a pregnancy in the second trimester for a host of other reasons.
“Our inability to talk freely about [elective, later term abortions] and only focus on the tragic cases is going to inform earlier cases down the road,” Miller said. “When a woman doesn't want to be pregnant and doesn't feel ready to have a child, that's reason enough.”
Frequently, women choose abortion after 20 weeks for the same reasons why women choose abortion before 20 weeks. But in many cases, they are forced to postpone the procedure due to a lack of access, education, health care, and funding for the procedure.
The 2011 sonogram bill, which requires a visit 24 hours before the procedure, now forces many women to take days off of work and find childcare and lodging. Between scheduling an appointment, finding transportation, booking a hotel room, and finding funding, several weeks may pass before a woman decides to have an abortion and can feasibly visit a clinic.
The health care professionals at the Whole Women's Health ambulatory surgical center in San Antonio frequently witness the consequences of increasingly cost-prohibitive abortions. 98 percent of the women over 18 weeks receive funding help for the procedure.
“We've seen a 10 percent increase in second trimester abortions just since the sonogram bill has passed,” Miller said.
Many low-income women also find out about their pregnancy later because they lack access to health care, further narrowing their window of opportunity for a procedure. Still others are the victims of sexual assault or teenagers, who push back seeking medical help because they are frozen by denial.
Protecting later term abortions is also important for women who choose to have the procedure due to changing life circumstances. Military wives whose spouses die, women who are going through divorce, and women who have lost their job often find themselves unable or unwilling to take on the responsibility of motherhood.
According to ANSIRH, a reproductive health think tank, the rate of second trimester abortions has remained fairly consistent over the past two decades even as the number of abortions have declined.
And if the HB 2 provision requiring four in-office visits for medication abortions is implemented, the number of women seeking later term abortions may grow in Texas, although there will be fewer safe, legal clinics offering care.
“They've created a perfect storm to have more later term abortions by restricting medication abortion, which is one of the safest methods available,” Miller said.
Although the 20-week ban, particularly when combined with the restrictions on earlier abortions, applies to all Texas women equally but affects disenfranchised women the most. “The people who have the means, the money, the access, the education are going to have an abortion as soon as they can,” Miller said. “With each barrier we pass, wealthy women who have the means can jump over the barriers, but more and more women can't.”