Entrance to the Hope Medical Group abortion clinic in Shreveport, Louisiana

Uncertainty overwhelms abortion clinics in Louisiana

NEW ORLEANS – Before Texas enacted the nation’s strictest abortion law this fall, sending hundreds over the Louisiana border to seek care, those in need of abortion services could get medical attention in a matter of days. But the possibility of an imminent Supreme Court decision allowing states to further restrict access has pushed the wait for people seeking abortions in Louisiana to weeks, said Kathaleen Pittman, the clinical administrator at Hope Medical Group for Women in Shreveport.

The stress is overwhelming clinics in Louisiana, already among the most restrictive states for abortion in the nation.

Anti-abortion activists are the most confident they’ve been in years about the possibility of reversing Roe v. Wade, while abortion rights advocates are worried the landscape is rapidly shifting against them.

LISTEN: Supreme Court hears oral arguments on Mississippi law banning abortions after 15 weeks

As both await a decision, health care providers are shouldering the burden of uncertainty and a scramble for health care services. As the clinic nearest the Texas border, the phone at Hope Medical Group has been ringing constantly, Pittman said. It’s one of only three abortion providers in the state. 

A staff member prepares the recovery room at the Hope Medical Group for Women in Shreveport, Louisiana.

A staff member prepares the recovery room at the Hope Medical Group for Women in Shreveport, Louisiana. The clinic went from 20 percent of clients being from Texas to 70 percent in the wake of a Texas abortion ban. Photo by Liliana Engelbrecht/Reuters

The clinic went from 20 percent of clients being from Texas to 70 percent, and the number is increasing daily, Pittman added. They come from as far away as San Antonio, Houston, and Austin. 

“The calls we’re getting range from desperation to absolute anger. We’ve brought in new staff to help alleviate some of the congestion. It’s a constant balancing act.” 

All three of the state’s clinics are booked solid for the next three weeks with the influx, clinic administrators say. Wait times of two weeks in states neighboring Texas have become common, according to researchers at the University of Texas at Austin, and could become longer if similar restrictions in neighboring states continue, their report notes.

The consequences of these wait times for pregnant people have been well-documented — from the increased health risk associated with pursuing some procedures further into a pregnancy to the lost wages and additional expenses of travel and child care that often accompany seeking an abortion hundreds of miles from home. These realities make it disproportionately harder for Black people and those who are low-income to seek abortions, and these groups will also be the hardest hit if restrictions are tightened, abortion-rights activists say.

A case overload is especially difficult to handle in a state like Louisiana, which mandates state-directed counseling and a 24-hour waiting period before performing an abortion procedure. This means an abortion requires two appointments, not one.

Anti-abortion group holds rally in wake of Supreme Court abortion case.

Anti-abortion group holds rally in wake of Supreme Court abortion case; launching a “Louisiana Is Ready for a Post-Roe, Abortion-Free Future” ad campaign on Dec. 1, 2021. Photo by Louisiana Right to Life

Yet abortion rights are not popular in Louisiana. As the state moves to further limit or even abolish the procedure, anti-abortion groups say they will support more social services for pregnant people and their children. That big picture worries abortion rights advocates and doctors, who say there are already significant gaps for people seeking reproductive health services in this area of the country and worry it could get worse.  

“Louisiana is having to pick up the burden of upholding constitutional rights for our neighboring states,” said Michelle Erenberg, the executive director of Lift Louisiana, a nonprofit that advocates for abortion access.

Mississippi abortion case looms large 

At the center of the Mississippi case currently before the Supreme Court, Dobbs v. Jackson’s Women’s Health, is the idea of fetal viability, or the point at which a fetus can survive outside the womb. The 1973 Roe v. Wade decision protects a person’s constitutional right to an abortion until this point and gives states the power to restrict that right after the point of viability. That decision was reaffirmed nearly two decades later in Planned Parenthood v. Casey. 

At the time of Roe, fetal viability was considered around 28 weeks. In the decades that followed, as medicine advanced, the consensus moved to 23 or 24 weeks. 

The court has used this standard to rule against some abortion restrictions that occur earlier in pregnancy. The question before the Supreme Court justices is “whether all pre-viability prohibitions on elective abortions are unconstitutional.” The justices could choose to overturn Roe or Casey outright; they could also leave Roe intact and weaken it by throwing out the viability standard. Without fetal viability as a legal framework, states would have more freedom to restrict abortions earlier in a pregnancy.

The Supreme Court’s most recent decision, keeping the Texas law intact that allows citizens to sue anyone who aids someone who gets an abortion before six weeks, yet also allowing clinics to sue the state over the law, will likely only add to the uncertain landscape.

According to the Guttmacher Institute, a reproductive health research organization, 26 states are likely to ban abortion if Roe v. Wade is overturned; 12 of them, including Louisiana, having trigger laws that would impose near or total bans immediately. 

Right now, Louisiana allows abortions up to 20 weeks; laws banning abortions at 15 and six weeks, respectively, have also been passed but cannot take effect unless Roe is overturned. As of 2020, Louisiana lawmakers had passed 89 abortion restrictions since Roe, the most of any state, according to a tally from the Guttmacher Institute. 

Abortion rights and health advocates say there is already a gap in health services, even without restrictions. In  2011, Louisiana had seven abortion clinics. Today, it has three. Ninety percent of people live in a parish that has no abortion clinic, according to the Center for Reproductive Rights, and 45 percent of women must travel more than 50 miles to reach a clinic that provides abortion services.

Erenberg said that there are people now seeking abortion care who will not be able to get an appointment in time and “will be forced to carry a pregnancy to term.” 

Anti-abortion activists across the country have worked for years to get a case like Mississippi’s before the Supreme Court. In Louisiana, they say they’ve been preparing for a moment like this and feel like the court is ready to make a change. 

“We’ve been fighting this fight for a very long time and we’re ready to see some significant changes on the federal landscape,” Angie Thomas, the associate director of Louisiana Right to Life told the PBS NewsHour. “This is a time for the Supreme Court to clean up abortion jurisprudence. Whether they will go all in and allow states to do what they want is what we’ll be watching. It should be up to the state. It’s where abortion has belonged all along.”

Why restrictions disproportionately affect Black people

In Louisiana, 60 percent of people believe abortion should be illegal in most or all cases, according to a 2019 study. So Meredith Hammock was not surprised this fall when she couldn’t find a reproductive rights march in New Orleans among the hundreds planned as part of the national Women’s March effort to rally ahead of the Supreme Court term. So she organized her first rally, drawing an estimated 200 people, mostly young women, to march for reproductive rights in early October. 

While activists across the South have been sounding the alarm for some time, Hammock believes many are being drowned out by anti-abortion activists emboldened by the latest actions out of Texas and the high court. She also worries about the other healthcare services that will disappear if the clinics are forced to close.

“I couldn’t sit by and allow my city to not be a part of this [march] that we badly needed to be a part of; so, I just did it. I just let the energy move me,” Hammock said.

Student protestor holds up a sign reading, "I'm an angry black woman" at a pro-choice rally in New Orleans

Loyola University student Maya Davis holds a sign that reads, “I’m an angry Black woman” at an abortion rights rally in New Orleans on Oct. 2, 2021. Photo by Bobbi-Jeanne Misick/WWNO

Marchers carried bright neon signs saying, “It’s not your body,” “It’s My Body, My Choice!” and “Always a Woman’s Choice!” — chants that echo similar protests 50 years earlier. A new call to action read, “I’m an angry Black woman.” Hammock is part of a new generation of activists that vows, in part, that if another decades-long fight is necessary, they will raise the voices of Black women. Many protests came on the heels of last summer’s “Black Lives Matter” marches. 

Community activist Arsene DeLay speaks at abortion rights rally in New Orleans

Activist Arsene DeLay speaks at an abortion rights rally in New Orleans on Oct. 2, 2021. Photo by Bobbi-Jeanne Misick/WWNO

It’s why the keynote speaker was New Orleanian activist and musician Arsene DeLay, who challenged the crowd to listen to Black women, who she says are most often affected by laws that govern reproductive rights. 

“This isn’t about getting rid of abortion. It’s about getting rid of safe access. We’ll have a lot more deaths,” Delay told the NewsHour. “Whenever there is a blow to civil liberties, it is often women of color, Black and brown women who suffer the most. The mortality rate when it comes to Black mothers is beyond alarmingly high.” 

Black women in Louisiana were five times more likely to die while pregnant. According to the CDC, Black women received 62 percent of all abortions provided in 2015 in Louisiana, though that number includes people who live both in and out of state. Anti-abortion and abortion rights activists alike say deep-rooted socio-economic differences may lead Black women to choose abortion more than white women. Abortion rights activists go further, as they consider systemic racism to be a driving factor.

“People’s ability to actually have a voice is still a privilege. We need the critical mass to give a s**t. Black women have been deeply affected by this for a very long time,” Delay said, her voice raspy and booming. “What’s exhausting to me is the fact that I’m fighting the same goddamn fight that my mother fought, my grandmother fought, and my great-grandmother fought. I’m in these streets hollering about the exact same issues; waiting to be recognized as a human being.”

Thomas, from Right to Life Louisiana, said for “for too long, we’ve looked at abortion as an easy answer to the difficulties of poverty. We are going to walk with women. We’re going to help the poor. We’re going to help the needy.”

On its website, Right for Life has built a list that points pregnant people to existing resources, such as pregnancy counseling and adoption services.

Anti-abortion activist rally at the Louisiana State Capitol as the Supreme Court argues a Mississippi abortion case.

Anti-abortion activist rally at the Louisiana State Capitol as the Supreme Court argues a Mississippi abortion case. Photo by Right to Life Louisiana.

“Louisiana is ready to help women in a post-Roe abortion-free future with an abundance of private and public social services,” Thomas said. “I’m looking forward to a day when we can primarily focus on getting women and children the help that they need and not fight this big abortion fight all the time,” Thomas said. 

Abortion rights activists don’t believe that anti-abortion groups will suddenly step up for the longstanding issues at hand. 

“It seems disingenuous to me. We have advocated year over year to raise the minimum wage in Louisiana which would dramatically improve the economic positions of women. Organizations like Right to Life have never come out to support that,” Erenberg said. “It patronizes the pregnant people who want to live their lives the way they want to.”

A decision from the Supreme Court isn’t expected until next summer. Until then, activists wait and do the best they can to prepare. 

“In the end, the more people that join forces together; then the louder we will become. At some point, it always gives and bends towards justice. No one should give up. We’ll keep fighting the fight until we prevail,” Hammock said.

Clinics meeting the need despite uncertainty

As the justices mull arguments, clinic staff are focused on helping women and combating misinformation in a state where access has never been robust. For now, abortions continue.

“We’re going to keep pushing forward,” Pittman said. “The difficult part for many people to understand is that it pushes care for Louisiana women aside and delays care for them too. We’re just so limited. There are just so many people we can see at a given moment.”

Despite the political noise, women are greeted by staff members who offer assurance and understanding once they are safely inside the clinic. The clinic director puts her arm around one woman as she escorted her to the back of the clinic. A television in a corner of the waiting room is tuned to BET. A separate “chill room” with soft music and large leather couches offer patients a chance to rest before their procedure.

Administrator Kathaleen Pittman works at the Hope Medical Group for Women in Shreveport

Administrator Kathaleen Pittman works at the Hope Medical Group for Women in Shreveport, Louisiana. Photo by Lila Engelbrecht/Reuters

Many of the women’s stories are troubling for Pittman, the clinic administrator who started working in an abortion clinic 30 years ago. As the momentum shifts, the decades-long fight has taken a toll, but she said no one feels defeated. 

“I don’t think people have given up. I think people are discouraged. A lot of us are really disappointed with how things are going in terms of legislation and decisions with the courts,” Erenberg said. “Some of us are starting to realize that our reliance on the courts to uphold people’s fundamental rights may be more significantly damaged than any of us thought it would be.”

Pittman says deciding to have an abortion is very emotional. Still, most show up at the Hope Medical Group for Women because they are overwhelmed by inequities and poverty. According to a 2019 report from Planned Parenthood, 75 percent of people who have abortions are low-income or poor.

Similarly, a new study reported in the American Journal of Public Health found that for women denied abortions; public-assistance programs failed to make up for the cost of a new baby and to pull households out of poverty. Further, women who want an abortion but are denied one are more likely to spend years living in poverty than women who have abortions, according to the study.

“Forcing women to continue pregnancies when they have said upfront that they can’t handle it at this point in time; that is just cruel,” Pittman said.