Abortion rights supporters rally outside the Supreme Court in Washington, D.C., March 2. (Susan Walsh / AP Photo)

As 38-year-old Stephanie Toti approached the steps of the Supreme Court on March 2, the number of people rallying nearby was stunning and heartening. More than 3,000 reproductive rights supporters gave her the energy she needed to argue one of the most important cases affecting women and girls since the Roe v. Wade decision affirmed the right to abortion. Toti, senior counsel at the Center for Reproductive Rights, where she has worked for 10 years, was the lead litigator in Whole Woman’s Health v. Hellerstedt, a case that will determine whether the increasing number of new abortion restrictions constitute an undue burden on a woman’s right to access abortion. At issue is Texas House Bill 2 (HB 2), one of the toughest abortion restriction laws in the country. After its passage in November 2013, the numbers of clinics in Texas that provide abortions went 44 to just 18. In addition to abortions, the clinics that closed also provided contraception, breast exams, cancer screenings and other health services to mostly low-income and rural Texans. As a result, remaining clinics can barely keep up with demand, and there are now long waiting lists for a procedure in which time is of the essence. If the court upholds HB 2, clinics in Texas are likely to continue to close, and other states will be free to enact similar laws. A decision is expected this month. Toti recently spoke with Truthdig about HB 2 and what’s at stake. What do you remember about that day [March 2]? Throughout the morning, while I was arguing inside the courthouse, our supporters were out there speaking and rallying. I had known all along that this case had historic implications, but seeing that display of support and energy over the day’s events was really something. I was really glad to see that the justices were so familiar with the medical evidence in the case and were able to quote it and ask detailed questions about it, because the medical evidence is on our side. Nearly every medical association in the country has come forward to condemn the Texas laws as medically unjustified and harmful to women’s health. Every leading medical association, including the American Medical Association and the American College of Obstetricians and Gynecologists, has condemned these laws as being medically unjustified and purely political. This is what women are being driven to more than 40 years after the Supreme Court established the right to access abortion care. You just turned 38. I’ve read that during the lower court proceedings, Texas Solicitor General Scott Keller’s team didn’t take you seriously. I had some frustration in the early part of the case, because even though I was the lead attorney, whenever the Texas lawyers wanted to approach us with a question or offer, they would always approach my co-counsel, who’s a male lawyer. Explain the specifics of HB 2. The laws that we’re challenging in Texas require that all doctors who provide abortions have admitting privileges at a local hospital, even though abortion rarely results in hospitalization, and other doctors who provide outpatient procedures aren’t required to have admitting privileges. The Texas law also requires that all abortions be performed in ambulatory surgery centers, which are essentially mini-hospitals designed for procedures that are far more complex than abortion. And even medication abortions—abortions that involve a woman taking a series of pills—are required to be performed in multi-million dollar surgery centers. What’s at stake? The stakes in this case are huge. The court is going to decide whether states can restrict abortion access based purely on the whims of politics without any medical evidence or justification. If the court were to uphold these laws, then three-fourths of the clinics in Texas would be forced to close, and we’d see clinics in other states in the region fall like dominoes. Many of those states have already enacted copycat measures. These TRAP [Targeted Regulation of Abortion Providers] laws have, in the last few years, become the focus of the anti-abortion movement. These are sham laws that claim to be designed to protect women’s health but are geared at shutting down abortion clinics and preventing women from accessing safe abortion care. On the other hand, if the court strikes down these laws, it will send a clear message to states that when they regulate abortion, those regulations must be evidence-based and consistent with medical standards. It’s shocking to read about so many clinic closures in 2016 and amazing to think that the popular slogan in the late ’60s and early ’70s was “free abortion on demand.” What strikes you the most about the clinic closures? Widespread clinics closures are causing huge delays in access to abortion. The remaining abortion clinics are unable to keep up with demand for their services. Women in some parts of Texas have to wait two or three weeks to get an appointment. Some women are hundreds of miles away from the nearest clinic. In addition to long wait times, they are dealing with obstacles to transportation and child care. What we’re seeing is that women who have the resources are increasingly going out of state. We’ve presented stories to the Supreme Court about women flying to California, New York and Florida in order to get timely access to safe abortions, but for women without the resources to travel, obtaining access to abortion becomes impossible. Women are trying to take matters into their own hands, using drugs obtained on the black market or trying to douche with harmful substances or resorting to more violent measures. Punching stomachs—we’ve heard stories of that kind of thing. There was a case in Tennessee right before Christmas last year of a woman who attempted an abortion with a coat hanger and was then promptly arrested for it. Tennessee is one of the states that have enacted copycat laws modeled on the Texas law. We have a case against those laws going on right now. The number of clinics there has also dwindled. On Feb. 5, The Washington Post published a piece titled, “After Planned Parenthood closures, poor women start having more babies.” It isn’t surprising, because so many clinics have closed, but it’s shameful that this isn’t getting more attention. How many presidential debates have we had? And this issue hasn’t come up once. The consequences are absolutely devastating for women in Texas. The birth rate has been rising and will continue to rise, and many of the clinics that closed are in medically underserved areas. These clinics weren’t just providing abortion care to women, they were also a source of family planning services, of contraception, of cancer screenings, and women in these communities are now losing access to all of those services, and they are much worse off as a result. What about do-it-yourself abortions? On March 6, economist Seth Stephens-Davidowitz wrote an Op-Ed for The New York Times titled “The Return of the D.I.Y Abortion.” He found that Google searches for “how to have a miscarriage” and “how to self-abort” are on the rise. Unfortunately, these laws in Texas, and similar copycat laws around the country, have been leading to an increase in attempts at self-induced abortion. This clearly puts women at risk. Women are, in some cases, buying drugs from the black market or on the Internet. If they get the real medications that are used by doctors to induce an abortion, well, that’s safe, but sometimes they are getting counterfeit medication or who knows what, and sometimes they don’t have proper information about how to use those medications. I’m familiar with a case of a woman in west Texas who obtained some drugs for the purpose of causing an abortion, but she used them later in her pregnancy, past the time when a doctor would use these drugs, and because she had had a prior cesarean section, the medications caused a uterine rupture and put her in the hospital with some very serious complications.
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