Recipe for Disaster

Using absurd building regulations in an underhanded attempt to shutter most of the state’s abortion clinics, Texas legislators risk a public health crisis.


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Liposuction. Colonoscopy. Skin cancer excision. Vasectomy. A D&,C after a miscarriage. Childbirth.

These are just a few of the many procedures the State of Texas allows to take place in facilities that do not meet the requirements of an Ambulatory Surgical Center (ASC) or mini-hospital. Yet each of these procedures has a rate of complication equal to or higher than abortion.

Under the guise of “protecting” women’s health, Texas legislators have singled out abortion clinics as facilities that will now be forced to comply with extensive ASC regulations in order to continue providing services to the thousands of women in Texas who require them.

It is an insidious and devastating move on the part of anti-choice politicians looking to limit women’s access to abortion services. The regulations—which do nothing to improve abortion safety—involve expanding hallway widths and ceiling heights, reconfiguring bathrooms, adding locker rooms, janitorial closets, and parking spaces, upgrading HVAC systems, and recoating floors, walls, and ceilings in special finishes.

Retrofitting the existing facilities to meet ASC regulations will cost each clinic millions of dollars.

“Claiming to make what is already a very safe procedure safe is not promoting safety,” says Center for Reproductive Rights attorney David Brown, a member of the team challenging the Texas restrictions. “It’s about limiting access, pure and simple."

Abortion is one of the safest medical procedures. In fact, according to medical experts, abortion services have a 99% safety record, with less than 1% of patients experiencing any complications and even fewer requiring further treatment at a hospital.

The upshot of the regulations: more than a dozen of existing clinics across the state will be shuttered. If the legislation is enforced, fewer than ten clinics, all clustered in eastern metropolitan areas, will remain open—in a state with a female population of 13 million. As a result, many women will be forced to travel hundreds of miles to access needed care. For the thousands of low income and undocumented women in Texas for whom transportation is a significant barrier, this is a deal breaker.

“Preventing access to safe reproductive care does not diminish the need for it. In fact, it is a recipe for a public health disaster,” Brown says. “Already, Texas has seen an uptick in the number of women using black market methods and even physical trauma to self-induce abortion.”

That’s why the Center for Reproductive Rights has been battling on the ground in Texas—to insure that a public health crisis provoked by restricting thousands of women from obtaining reproductive care does not come to bear.

For five scorching days this August—in a cramped courtroom in Austin, Texas—our legal team argued on behalf of these women before U.S. District Court Judge Lee Yeakel.

In the case, Whole Woman’s Health, et al. v. Lakey, the Center represented five Texas clinics and three physicians and their patients. The Center’s legal team called a number of expert witnesses who testified to the overwhelming safety of abortion, the costs and unfeasibility of the unnecessary measures, and the harms of restricting whole swaths of the state from accessing safe, legal abortion care.   

In addition to addressing the ASC requirements, the case also challenges the law’s admitting privileges requirement, which calls for any doctor who performs abortion services in a clinic to have admitting privileges at a nearby hospital. Another superfluous restriction considering the safety measures currently in place, this requirement has already shut down more than a dozen clinics.

The American Medical Association and the American College of Obstetricians and Gynecologists (ACOG) oppose both the ASC and admitting privileges laws because they “jeopardize[s] women’s health in Texas,” and do “nothing to protect the health of women.”

The good news: on August 29th, we prevailed. Judge Yeakel issued a decision that ruled the ASC provision to be an undue burden on women seeking abortion care and blocked the state from enforcing the law. He also deemed the admitting privileges provision unconstitutional as applied to the clinics represented in the case. 

Of course, it’s not over yet. Within 45 minutes of Judge Yeakel’s decision, the state had asked the 5th Circuit Court of Appeals for an emergency stay to block the district court’s ruling.

Although the final outcome for the Texas legislation remains uncertain, a lasting victory lies in this trial’s success in exposing politicians’ use of the false pretext of women’s health to erode abortion rights. 

Texas faces a number of public health challenges, but women receiving abortions at licensed clinics by licensed providers is not one of them. For example, the number of women dying in Texas each year due to complications from pregnancy and childbirth has been growing dramatically for a decade.  It is now 100 times more dangerous for a woman to bear a child than to have an abortion in Texas.

“If Texas politicians cared about women, they would work to fix that crisis,” notes attorney David Brown. “Instead, they have slashed family planning budgets, and faked excuses to close clinics that serve women. It’s sad and shameful to play politics with the lives of women.”