Texas' power outage: Planned Parenthood, Whole Woman's Health appointments canceled, sparking reproductive health care crisis

When the electric grid went down in Texas last week, it temporarily closed at least 17 out of 21 abortion clinics in the state, sparking a reproductive health crisis that will take weeks to recover from.

Whole Woman’s Health—one of Texas’s largest independent clinic networks—reported canceling more than 700 appointments across its three clinics, which were closed for five days owing to the outage. Planned Parenthood of Greater Texas closed 15 of its health centers and canceled more than 800 appointments; two of Planned Parenthood South Texas’s locations were able to reopen midweek, though one of them could offer only limited services. And while a spokesperson for Planned Parenthood couldn’t say exactly how many appointments its Gulf Coast affiliate had to cancel, its locations typically serve about 1,500 patients every week.

In total, thousands of people across Texas had to delay their appointments for a range of services, including STI treatment, birth control, hormone therapy, and abortion. Using Planned Parenthood’s chat function, designed to help young people contact health care educators via instant message, some patients were able to reach Planned Parenthood staff about their immediate health concerns during the outage. One patient said she couldn’t reach her local health center to refill a birth control prescription; another patient texted the service about some common symptoms she was experiencing after an abortion; and another was worried about when she would be able to get an abortion in the first place: The outages had prevented her from receiving the state-mandated ultrasound she needed in order to undergo the procedure.

Reproductive health care crises in Texas are like Russian nesting dolls, one inside the other. At their very core is the accumulation of decades of anti-choice legislation, which has made Texas one of the most restrictive states for abortion care. The next layer is an ongoing Medicaid battle, making it more difficult for low-income patients to access even the most basic reproductive health services, like annual exams and cancer screenings. The layer after that is the pandemic, which Gov. Greg Abbott cited as the reason he was banning abortions in the entire state last March. The ban was lifted over the summer and legally voided.

And so the mass power outage that devastated the state isn’t the only crisis abortion providers in Texas face—it’s just the outermost layer, health care providers say.

“Governor Abbott’s consistent failure to lead continues to cause a pileup of one disaster after another, creating compounding consequences for the people of our state,” said Dyana Limon-Mercado, executive director of Planned Parenthood Texas Votes. “While Texans struggle for basic necessities, including food and water, many of our most vulnerable communities are also finding themselves facing medical uncertainty in the middle of a pandemic and an energy crisis. It didn’t have to be this way.”

For some people seeking abortions this month, the infrastructure collapse may have meant inching uncomfortably close to the legal limit at which they could receive care in the state: Texas bans abortion after 22 weeks. While the vast majority of abortions occur in the first trimester, in more restrictive states like Texas—where patients must schedule at least two appointments in order to obtain an abortion and wait at least 24 hours between them—regulations can push patients further into their pregnancies.

The outage may have disrupted the travel plans and childcare arrangements necessary for some people to obtain the procedure. In 2014, nearly one in five Texans lived more than 50 miles away from the nearest clinic, which could mean traveling more than 200 miles in total to obtain the procedure, given the state’s multiple-visit mandate. This is the sort of distance that might require meticulous planning for low-income patients. And it’s not unusual for patients to travel from out of state to get to a Texas clinic: Southwestern Women’s Surgery Center regularly sees patients from Arkansas.

“This kind of situation forces people to carry pregnancies against their will; for many people, abortion just becomes out of reach,” said Amy Hagstrom Miller, the founder and CEO of Whole Woman’s Health. “Our schedules are already limited because we need to maintain social distancing and take other precautions related to COVID, and then this happens on top of that.”

While clinics are back up and running, patients may encounter delays while clinics reschedule thousands of appointments.

Shania Hornsby, a receptionist at Southwestern Women’s Surgery Center, said that although the clinic where she works was closed for only two days, she and the rest of the staff have had to work overtime every day this week in order to see the patients they had to reschedule. And, she estimated, the clinic had to cancel only 50 to 60 appointments.

“I wouldn’t say we’re backed up, but we’ve had to squeeze in more patients, which means longer hours for staff,” she said. “We usually close around 6 or 6:30, and now we’re going till 8 or 9 p.m. It’s been this whole week, and it’ll probably go into next week, too.”

When Fortune reached Hagstrom Miller Thursday afternoon, she said that Marva Sadler, director of medical services for Whole Woman’s Health, was driving abortion pills from their clinic in McAllen to their location in Fort Worth, a distance of some 500 miles, spanning nearly the entire state from the south to the north. Because UPS and FedEx shipments were delayed owing to the outages, Whole Woman’s Health Fort Worth was in danger of running out of abortion medication. On Sunday—usually a day off—when the Fort Worth location of Whole Woman’s Health reopened for the first time, staff saw more than 100 patients for abortion consultations alone.

In some ways, almost no clinic staffers are better equipped to troubleshoot a crisis than those in Texas. In 2013, a hospital admitting privileges law shuttered more than half the clinics, and many remained closed, even after a landmark Supreme Court decision—with Whole Woman’s Health as its lead plaintiff—deemed the law unconstitutional.

Hagstrom Miller was eventually able to reopen one of the two Whole Woman’s Health clinics she was forced to close, overcoming an enormous financial, logistical, and bureaucratic hurdle.

“There are very few people who can pivot and figure out solutions under duress like a Texas abortion provider,” Hagstrom Miller said, referring to the recent outages, which she too attributed to government failure. “It’s such a stark contrast to our elected officials, who are like, ‘Whatever.’”

“We have grit, and we’re scrappy and made it through,” she continued. “But people should never be put in this kind of position.”