Number Of Abortion Clinics In Texas Continue To Decline Outside Cities : Shots - Health News Three years after winning a big legal battle, abortion providers still find themselves losing the ground war when it comes to keeping clinics open across the huge, populous state.

For Supporters Of Abortion Access, Troubling Trends In Texas

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RACHEL MARTIN, HOST:

Earlier this year, several states passed strict abortion bans. Supporters of abortion rights quickly sued to stop them, and the legal fights appear headed to the Supreme Court. Texas could tell us something about how things could play out. A few years ago, that state passed a new law. Abortion providers sued, and they won. But half the clinics in Texas disappeared anyway. Ashley Lopez at KUT in Austin explains.

ASHLEY LOPEZ, BYLINE: The Planned Parenthood clinic in San Angelo, Texas, used to occupy a gray one-story building on Pecos Street. Suzanne Fernandez worked here for almost 30 years.

SUSANNE FERNANDEZ: At the beginning, I pulled some strings inside. I loved working for Planned Parenthood.

LOPEZ: The building now houses a wealth management company. But whenever Fernandez drives by, which is often, she still feels a pang of loss.

FERNANDEZ: Even the blocks in front of the building that have inscriptions on them, they're all still there.

LOPEZ: Inscriptions naming donors who financially supported the clinic through the decades it was open. Before it closed in 2013, this clinic was one of the last places to get an abortion in West Texas. Now women have to drive at least three hours to the nearest major city.

Fernandez blames Texas lawmakers. A law they passed in 2013 required abortion clinics to operate like surgical centers. It also required doctors who do abortions to affiliate with a nearby hospital. Fernandez says the new rules were too expensive or just impossible to comply with.

FERNANDEZ: The last day was sad, was somber. You know, we all knew that was it.

LOPEZ: To fight the law, abortion providers in Texas sued. But the legal challenge slogged on and on, and the state kept cutting its budget for family planning services. Both pressures forced many women's health clinics to close their doors. In less than two years, Texas went from having more than 40 such clinics to less than 20. Kari White helped study the fallout for the Texas Policy Evaluation Project.

KARI WHITE: West Texas and South Texas - access was incredibly limited. And women living in those parts of the state were more than a hundred miles - sometimes 200 or more miles - from the nearest facility.

LOPEZ: White's research team conducted surveys and interviews with patients as clinics were shutting down. A 19-year-old woman told the researchers she almost gave up on getting an abortion because she couldn't find an open clinic. We asked a staffer from the research project to read that 19-year-old's words out loud for us.

UNIDENTIFIED TEXAS POLICY EVALUATION PROJECT STAFFER: (Reading) It was a very hard thing to do, like, to keep calling and calling and calling. I almost was like, you know - well, forget it. But then, because I knew at the end of the day it was something that I had to do, I don't care how many people I have to call or how far I have to go. I have to do it.

LOPEZ: That woman eventually found a clinic 70 miles away and was able to get the abortion. But in some cases, women had to go on with unwanted pregnancies. One 23-year-old woman from Waco, Texas, was married and already had two children. She told the researchers that she made appointments at two different clinics, but both appointments were canceled after the clinics were forced to close. The staffer reads out loud from her story.

UNIDENTIFIED TEXAS POLICY EVALUATION PROJECT STAFFER: (Reading) I was pretty upset, but I just decided that I guess I'll have to just ride it out. I didn't know what else to do, who else to call.

LOPEZ: In the summer of 2016 - three years after the Texas law passed - the U.S. Supreme Court struck down the two key requirements involving the clinic upgrades and the doctors' admitting privileges. But most of the state's clinics never managed to reopen. There are far fewer abortion clinics in Texas today - 22 at last count. Again, researcher Kari White.

WHITE: There are still clinics just concentrated in the major metropolitan areas of Texas. So access is still a challenge for many women in the state.

LOPEZ: John Seago is with Texas Right to Life. He says what happened in Texas has been a mixed bag for him, too.

JOHN SEAGO: The closures of clinics is definitely a victory for the movement, obviously. However, why - how are we in this situation in the first place? - is what my organization looks at.

LOPEZ: By this situation, Seago is referring to Roe v. Wade, which legalized abortion nationwide. He wants that overturned. Abortion rights advocates were encouraged recently when a new abortion clinic opened earlier this year in Texas. It's in Houston, a city that already has some clinics.

KATHY KLEINFELD: Due to the closures of so many clinics, the remaining clinics that are open are very busy. So our goal was to offer flexibility in scheduling.

LOPEZ: This is Kathy Kleinfeld. She recently opened this new clinic in Houston. It offers abortion by medication - through taking pills - but not the surgical procedure. She says so far her patients have been a mix of professionals, students and women who drive over from Louisiana. Kleinfeld says getting this clinic up and running was no easy task.

KLEINFELD: There's always been conflict and struggles - always. This is not for the faint of heart.

LOPEZ: Andrea Ferrigno works for Whole Woman's Health, which operates several clinics in Texas offering abortion. After the 2013 law, Whole Woman's had to close two clinics, one in Austin and one in Beaumont, a small city near the Louisiana border. Eventually, the managers were able to reopen the Austin clinic but couldn't pull that off in Beaumont.

ANDREA FERRIGNO: It's basically starting from scratch. You know, you laid off a staff; you don't have any physicians that work there anymore. Some of the doctors actually didn't even renew their physician licenses.

LOPEZ: If doctors are available, though, reopening is tough. If a clinic's operating license has lapsed, it has to get a new one from the state. Some clinics also lost their leases and had to sell off equipment.

FERRIGNO: There is also the fear of security challenges - people picketing the clinic, picketing their homes.

LOPEZ: Back in San Angelo, there still isn't anywhere to get an abortion in town. Susanne Fernandez sometimes wonders what happens to the patients she used to help, not just with abortions but also things like pap smears, breast cancer screenings and contraception.

FERNANDEZ: When you get out, go the grocery store or whatever, you run into people. And there is that thing in the back of your mind - where did these women go? Or where do they go now? I don't believe a lot of them found any other health care afterwards.

LOPEZ: Providers in Texas say they want to eventually reopen some of the rural clinics that closed - if it ever becomes possible.

For NPR News, I'm Ashley Lopez in Austin.

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