The big red arrow pointing to the front doors of the Whole Woman’s Health clinic in downtown McAllen, Texas, has finally disappeared. So, too, has the accompanying all-caps sign that read “ABORTION CLINIC.”
These weren’t meant as navigational tools. Rather, they were warnings posted by the anti-choice family physician, Dr. Juan Campos, whose offices are next door. He removed the signs earlier this month. But perhaps Campos doesn’t realize that his neighbor, the Rio Grande Valley’s last remaining legal abortion facility, is open once again.
Lucy, the clinic manager at Whole Woman’s McAllen, hasn’t even had time to notice the changes to the decor outside. She’s back on the job after what she calls a “roller coaster” of a year: Since its passage last summer, Texas’ omnibus anti-abortion law, HB 2, has now twice shuttered her workplace. If federal courts are not sympathetic to the Texas abortion providers—including Whole Woman’s Health—who’ve asked that the law be struck down, the clinic may close a third time.
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But four days after Whole Woman’s McAllen reopened for the second time on October 18, Lucy, who asked that her last name not be used, told Rewire that she refuses to act as if the facility might shutter again.
“I’m trying to think positive,” the Rio Grande Valley native said, “that we stay open forever and ever.”
It’s been a difficult year for the employees at this Whole Woman’s—there are other locations in San Antonio, Fort Worth, New Mexico, Minnesota, and Maryland—as their livelihoods are ping-ponged between federal judges who disagree about the constitutionality of HB 2.
The law has four major tenets: It bans abortion after 20 weeks, severely restricts the prescription of medication abortions, requires doctors to have hospital admitting privileges, and mandates that abortion facilities operate as hospital-like ambulatory surgical centers.
For Lucy, along with the other staff and patients at Whole Woman’s McAllen, the first blow came in November, after HB 2’s admitting privileges provision went into effect. That part of the law requires doctors who provide abortion care to have admitting privileges at local hospitals, and no institution in the surrounding Rio Grande Valley would grant them to the clinic.
Still, it managed to keep its doors open for a few months. Lucy and her staff helped patients get ultrasounds and information about traveling to the Whole Woman’s ambulatory surgical center in San Antonio, where the facility’s provider has been able to obtain hospital admitting privileges nearby. They even offered gas cards and vouchers to help defray the costs of making the 500-mile round-trip drive.
During a court challenge to HB 2 this August, Amy Hagstrom Miller, Whole Woman’s Health founder and CEO, testified that only a few patients took the McAllen clinic up on that offer. Even with assistance, the time and money involved in making an overnight trip was just too great an obstacle.
Hagstrom Miller shuttered Whole Woman’s McAllen in March, unable to sustain it without the ability to see patients for abortion care, and with no hospital admitting privileges forthcoming.
On March 5, Lucy joined the other staff members and their supporters in the Rio Grande Valley for a candlelight vigil mourning the clinic’s closure. The Valley vigil ended with a somber march outside the little one-story downtown building, and a chant: “We won’t forget.”
To support her family, Lucy then took a job at the Whole Woman’s ASC in San Antonio nearly four hours away, uprooting herself and her family from the area they’d called home for their entire lives. Other staffers also took jobs at the San Antonio center, or moved even farther north to the Whole Woman’s facility at Fort Worth. While Whole Woman’s employees speak of their jobs in almost reverent terms—part of the overall mission of Whole Woman’s is right there in its name, serving the emotional, physical, and even spiritual aspects of their patients’ needs—the seven nurses, doctors, managers, and staffers at McAllen are also just regular folks trying to put food on the table. Many, like Lucy, have relatives who rely on their incomes. So when their clinic closed, they had to do their best to make ends meet.
In San Antonio, Lucy’s kids missed their grandma, who was still back in McAllen. Lucy grew homesick.
“It was difficult,” she said. “I moved my whole family to San Antonio. It was a dramatic change.”
This August, though, a federal judge in Austin ruled that the law’s admitting privileges and ambulatory surgical center requirements were unconstitutional when applied to Whole Woman’s McAllen, the last remaining legal abortion provider in the Valley.
Soon afterward, Lucy went back to work in McAllen. She and her staff began telephoning Valley residents who’d made appointments for abortion care in San Antonio and telling them that they were no longer facing the overnight trip north for their procedures. They were thrilled and relieved, but also confused: Why, on some days, could they access the same care close to home as fellow Texans in other cities, and why must they drive hundreds of miles on other days?
For patients, all the flip-flopping is baffling and upsetting. “They feel hurt emotionally,” said Lucy.
The clinic’s reopening didn’t just bring back people in need of care; throngs of protesters showed up too. Jackie Ho-Shing, a University of Texas—Pan American (UTPA) student who’s taking the semester off to work as an organizer for Planned Parenthood Texas Votes, volunteered the first weekend as an escort, walking patients past angry picketers to the peace and quiet behind clinic doors.
She described it as an “eye-opening experience.”
Ho-Shing told Rewire that she grew up in a conservative religious household, but nothing in her childhood had prepared her for the anger she says she felt from the anti-choice protesters—mostly older folks, many of them men—who’d gathered at the reopened facility.
“It was like—what’s the green guy?—the Hulk,” remembered Ho-Shing. “It’s scary when they get really angry or aggressive with women who are just coming in for a consultation.”
The anti-choice turnout was further evidence that obstacles to legal abortion care in Texas don’t only come from anti-choice lawmakers denouncing mainstream medical science on the floor of the state capitol building in Austin. In addition to withstanding the protests, Texans in need must also scrape together gas money, arrange child care, and obtain time off from work in order to get through the clinic doors. Although the Valley’s bigger cities are almost all within 100 miles of McAllen, plenty are located in the fertile, flat plain that stretches from the Gulf of Mexico to the Hill Country in Central Texas.
Still, in September, Whole Woman’s McAllen served dozens of patients—people who might otherwise have had to wrangle cars from friends or family members, arrange bus tickets, or even carry unwanted pregnancies to term, with legal abortion care a 500-mile round-trip drive out of reach.
That lasted two weeks.
The first week of October, the Fifth Circuit Court of Appeals in New Orleans ruled that HB 2 was, in its view, constitutional. Whole Woman’s McAllen—and every other non-ambulatory surgical center abortion provider in the state—would either have to make plans to implement million-dollar remodeling jobs, rent costly and hard-to-find space in existing ASC’s, purchase a facility outright, or, more likely, shut down entirely. In federal court, attorney Stephanie Toti of the Center for Reproductive Rights, which has represented Whole Woman’s and other Texas abortion providers in challenges to the law, said that the ASC requirement “essentially amounts to a $3 million tax on the performance of abortions” in the state.
When Texans went to sleep on October 2, they had access to 20 abortion facilities. When they woke up on October 3, just eight legal abortion providers—all ambulatory surgical centers—remained open in the state, all of them located in major metropolitan areas.
Whole Woman’s McAllen wasn’t one of them. Yet again, Lucy and the other staff had to close the doors, leaving patients without a provider and seven people without a job.
“It’s emotionally draining,” said Lucy.
Texans in the Rio Grande Valley found themselves facing that 500-mile round-trip drive to access legal abortion care once more. But HB 2’s provisions “didn’t stop” abortion in the area, said Lucy. They just pushed it underground for all but the wealthiest residents. HB 2 is such a barrier to abortion access, Lucy reports, that she sees many patients who try, frequently unsuccessfully, to end their own pregnancies using pills obtained over the Internet, in flea markets, or in Mexican pharmacies.
One patient, she says, had even gotten some kind of injection in Mexico. It didn’t work.
Luckily, a surprising mid-October Supreme Court ruling allowed Whole Woman’s McAllen to reopen once again, temporarily blocking parts of HB 2 before a Fifth Circuit panel has yet another go at the law.
With these back-and-forth decisions, residents of the Valley feel that their needs are being repeatedly discounted by faraway legislators, who don’t understand the very real impact of their actions on millions of people. Despite her experience shielding patients from handfuls of angry protesters, Jackie Ho-Shing told Rewire that it’s frustrating when people—everyone from state legislators to urban-dwelling feminists—write off or stereotype the whole of Valley residents as poor, ignorant conservatives.
“I think people think we live in the backwoods of Texas, and that we’re all poor and we don’t understand anything,” said Ho-Shing.
People forget, Ho-Shing points out, that the Valley has two University of Texas outposts. McAllen and Brownsville are thriving business and shopping destinations for folks from all over the world. More than 1.3 million people call the sprawling four-county Valley area home.
“I think my community is pretty kick-ass,” said Ho-Shing.
For Ho-Shing, the Valley is very much a place where people “band together,” as she put it, to help each other in times of need. But there’s only so much that locals can do, she notes, when family planning budget cuts and laws like HB 2 put reproductive health care out of reach. She says the Valley community deserves the same resources that Texans in San Antonio, Dallas-Fort Worth, and Houston can access.
“We make sure we take care of each other, but sometimes that’s not enough,” said Ho-Shing. “We need access to health care and access to all these things that big cities have that they take for granted.”
When lawmakers write the needs of those in the Valley off as less important than the interests of right-leaning voters, it is not only Texans who need abortion care who are harmed. Entire families are sometimes irreparably negatively affected by the shuttering of reproductive clinics. For example, the Rio Grande Valley consistently has some of the highest cervical cancer rates in the United States. Moms often have to choose between paying bills and paying for screenings, or they must wait months for appointments at free clinics. Latinas in the Valley have a higher cervical cancer mortality rate than their peers elsewhere in Texas and the country.
The more clinics are forced to close, the more danger Valley residents are in—and the more facility employees like Lucy have to worry about keeping the jobs their families need them to have, jobs which can disappear overnight.
For now, Lucy is back at work once again. Just four days after the Supreme Court decision blocking HB 2, she estimated that Whole Woman’s had already served 18 patients who’d had appointments in San Antonio.
In retrospect, says Lucy, HB 2 has made other Texas abortion restrictions—like the state’s mandatory ultrasound law—seem tame in comparison. That law exempts people who live more than 100 miles from a legal abortion facility from having to wait 24 hours between their state-required sonogram and their abortion procedures. Now that the McAllen clinic is open again, this means that most Valley residents now need to make two trips, a day apart, to get an abortion there.
“But hey, at least they don’t have to travel!” she said.
In the coming weeks, Lucy hopes they can bring on more staff to help her manage the patients—real people, with real families, who don’t simply stop needing abortion care every time Whole Woman’s closes.
“We need more hands,” said Lucy, who’s currently working full-time at the reopened clinic. “All the help we can get.”