Amy Hagstrom Miller began working in the reproductive health field at 21 years old. Fourteen years later, she founded Whole Woman's Health, a group of reproductive health care clinics, many of which are in Texas, that serve over 30,000 women every year. Now, the healthcare provider is poised to make history as the plaintiff in Whole Woman's Health v. Hellerstedt, the Supreme Court case, which will be argued on March 2, addressing two key parts of Texas legislation that severely restrict abortion access in the state.
In the last few decades, we've seen the systematic stripping of abortion rights guaranteed by Roe v. Wade through state-level legislative challenges obscured under the guise of "safety" or "medical necessity." Since 2011, at least 162 abortion providers have closed down or unable to offer this overwhelmingly safe, common procedure — a rate of decline that actually represents the fastest annual rate on record, Bloomberg reported on February 24th. A record-breaking 231 abortion restriction laws were passed in the last four years, and 147 choice-related bills were introduced in January alone, according to RH Reality Check.
As a result, millions of people in the United States are effectively incapable of accessing their legal right to reproductive health care and abortion.
Hagstrom Miller has witnessed and combatted this horrifying reality on a daily basis for years. Before the founder and her employees can even provide clients care, they have the figure out how to help women reach the clinics at all. Hagstrom Miller explained to Mic that about 70% of the women Whole Woman's Health serves are already mothers, many of whom work and must therefore contend with a series of financial, geographic and logistical obstacles. Those hurdles could include traveling hundreds of miles to reach the clinic; taking off multiple days of work; paying for a hotel room if there is a mandatory waiting period after the initial clinic visit; and arranging for child care costs in their absence.
These barriers do not change the fact that people need access to the procedure. Some women have called Whole Woman's Health clinics and said things like, "If I tell you what medicine I have in my medicine cabinet and what I have under my sink, can you tell me how to do my own abortion?" Hagstrom Miller said.
Hagstrom Miller has witnessed this for years, but HB2, an omnibus abortion bill in Texas containing multiple abortion bans, was "the straw that broke the camel's back" and "had to be challenged," she said.
She decided to put herself and her clinics in the public eye to challenge legislation that not only drastically curbs her professional ability to provide health care, but undermines her view of abortion care as a "fundamental right to control our bodies in order to really participate fully as full humans in society."
An undue burden: It's easy to witness the invective political rhetoric about abortion on the national level, but the vast majority of Americans know very little about the ways in which abortion access is being restricted, according to a poll by Vox. Many find out about restrictions at the time they call Whole Woman's Health to make an appointment, according to Hagstrom Miller.
Thanks to the ruling in the 1992 case Casey v. Planned Parenthood, states can't ban abortion altogether given the outcome of Roe v. Wade, but they can regulate abortions out of supposed concern for the well-being of both mother and fetus so long as those regulations don't create an "undue burden."
What exactly constitutes an "undue burden," however, has remained open to interpretation, so conservative lawmakers have passed laws liberally — not just in Texas, but across the country. State lawmakers have enacted increasingly lengthy mandatory waiting periods, based on the argument that doing so allows those seeking abortions to better consider their options — even though the numbers show most have already made up their mind by the time they get the clinic and will most likely not regret the choice.
Other relatively recent state laws require patients to undergo ultrasounds before having abortions, even though it is not considered medically necessary and studies have shown that viewing an ultrasound does not dissuade over 90% of women from having the procedure.
Targeted Regulations of Abortion Providers, known as TRAP laws, additionally impose often insurmountable restrictions on abortion providers, such as unnecessarily complicated and expensive updates to clinic facilities — like ridiculously regulating the size of clinics' janitor closets or the length of grass surrounding the clinic — or requiring unnecessary emergency admitting privileges.
The situation is particularly dire in Texas, the state that passed HB2, the law being challenged in this case. The number of clinics providing abortions in the nation's second-most-populous state has dropped from 42 to 19 since HB2 was passed, according to NBC News. If upheld by the court, it would leave the 5.4 million Texan women of reproductive age with only 10 abortion providers in their state. Studies of post-HB2 Texas demonstrate that the legislation is already creating a dire reproductive landscape for women — as many as 240,000 women have even resorted to self-inducing abortions.
Most women have already made up their mind by the time they get the clinic and will most likely not regret the choice.
What's at stake in this case: This case could set a national precedent that would allow lawmakers to continue to make abortion even harder to access in their states.
Even though the Supreme Court has ruled and upheld that abortion is a constitutional right, the right is currently meaningless to those who live in states that have created "so many roadblocks that a woman can't actually get the care she needs," Jennifer Dalven of the American Civil Liberties Union told Mic.
This case, therefore, could determine that these policies do constitute an "undue burden" and ultimately make abortion more accessible nationwide. And while public opinion may have no official bearing on the court's deliberation process, 65% of respondents to a recent Vox poll of over 1,000 registered voters agreed that the obstacles created by current laws in Texas put an "undue burden" on people seeking abortions.
But the case could also determine that the burden these laws create is reasonable, resulting not just in a mere 10 open clinics in the nation's second-most-populous state, but also setting a potentially horrifying standard for reproductive health care all over the U.S.
"When the court decides to take a case, it usually does so to announce a rule that applies to more than just the case before it," Dalven explained. "The ruling in this case is likely to have implications for restrictions passed by states around the country."
Many are speculating on the outcome of this case, especially given the recent death of the historically anti-choice Justice Antonin Scalia. But even if the court does rule in favor of Whole Woman's Health, change won't happen overnight. Whole Woman's Health has had to close clinics twice based on legislation passed in recent years, and 23 Texas clinics have shuttered since HB2 passed, according to NBC News. Even when legally permitted to re-open, Hagstrom Miller said, "re-hiring staff and opening another facility is challenging."
While the plaintiff refuses to speculate about the case's outcome, Hagstrom Miller and her legal team have put forward a "tremendous amount of evidence that demonstrates the harm this law is causing Texas women and families," she said, and they are hoping for the best.
The majority of Americans want to keep abortion safe and legal. Hagstrom Miller has certainly faced resistance since deciding to sue; Whole Woman's Health clinics have seen an increase in picketers, graffiti and break-ins, she noted. But she has also been pleasantly surprised by how many more people have shown support.
This support actually makes sense given that the most Americans support the right to access this safe and affordable procedure, at least in some circumstances, according to the 2016 Vox poll, and that many women — as many as one in three — will have an abortion at some point in their lifetime.
At the end of the day, Whole Woman's Health v. Hellerstedt is not just about legal access to abortion, but about fighting "the stigma around abortion access" and "shame that surrounds abortion that led to these kinds of laws being passed in the first place," Hagstrom Miller said.
"Whole Woman's Health v. Hellerstedt is not just about legal access to abortion, but about fighting the stigma around abortion access"
"To me what's really on trial here is the dignity women have in making their own health decisions," Hagstrom Miller concluded. "I think any woman who decides she's not ready to have a baby and to bring life into the world through her body should have access to safe, compassionate abortion care if she needs it, period."
The outcome of the case is uncertain. But the health care provider is certain she must take a stand against this steep decline toward a pre-Roe era and, ultimately, "stand on the right side of history."