In the Fight for Abortion Clinic Access, a Houston Nonprofit Offers a Helping Hand—and a Passenger Seat

A ride may seem a small thing. But for women in need, the Clinic Access Support Network can be everything—even after the demise of House Bill 2.

By Roxanna Asgarian September 19, 2016 Published in the October 2016 issue of Houstonia Magazine

The rain comes down in sheets as Angie Hayes sits in her idling two-door Honda Civic, waiting. A man in a rain slicker and galoshes approaches her driver’s side window, and she rolls it down a crack to receive instructions. “Who are you here for ?” he asks, leaning his umbrella into the gap between his body and the car door. “We’re here to pick up Nicole,” she tells him.

He nods and scurries back inside the Houston Women’s Clinic, one of the few remaining abortion providers in the Greater Houston Area. The clinic is a small red-brick building that almost resembles a house, with a wall encasing its cramped parking lot, complete with a fence that rolls out to secure the property once everyone goes home. Every parking space is occupied, here and at another lot across the street.

After a few minutes, the man comes back out into the wet April heat and tells Hayes to circle the block—a line of cars has pulled up behind her Civic, and since Nicole will be a few minutes, they need the space. Hayes circles on a grid of one-ways, San Jacinto to Wentworth to Caroline and back around. The clinic is always busy like this, even worse on weekends, so she’s used to the routine.

“The rain has pushed away the protesters, but they’re usually here too, right at the gate,” she says, turning back into the parking lot and taking her place at the back of the line. Ahead of us, a young man, holding his jacket around a woman and steadying an umbrella in the air over her, gingerly helps her into his car.

Within ten or fifteen minutes, Hayes is back at the head of the line, and Nicole steps out, an escort protecting her from the rain with his own umbrella. They shuffle over to Hayes’s car, to safety.

After the door closes, Hayes asks her passenger, who’s just terminated her pregnancy, how she’s feeling. “Okay,” Nicole replies. It’s clear that she’s feeling a bit tender, but she’s surprisingly alert. At only five weeks along, she didn’t need much sedation for the procedure.

Nicole uses her manicured hands to push her thick, dark hair out of her face. The rain continues to come down as the car winds through the streets of downtown, finally pulling into the valet drop-off at the Hilton Americas, where Nicole’s staying while she’s in town from Dallas.

“Thank you so much for this,” she tells Hayes, locking eyes with her for a moment before stepping carefully out of the car.

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Image: Jordan Hourie

Nicole, who asked us to change her name for privacy reasons, is an educator in Dallas who sells health and fitness products on the side. At 39, she’s recently divorced, with two children. Having thought her fertile years were behind her, she was surprised to discover she was pregnant. She knew she couldn’t afford to raise another child.

The first chance she got, a few days later, Nicole drove to her local Planned Parenthood clinic. “I went there with my boyfriend,” she says. “There were about 50 protesters there trying to stop us, yelling, praying on rosary beads. He was paranoid; he didn’t even go in. He just kept driving.”

When she followed up, Nicole learned the Dallas clinic had a three-week wait. Wanting to get the procedure done right away—and already planning to visit Houston the following week for a work conference—she called the Houston Women’s Clinic and was able to get the two appointments she’d need to make, as required by law: one for a mandatory consultation and counseling session, and then another, at least 24 hours afterward, for the procedure itself.

While the Houston hotel she’d booked was a short distance from the clinic, she nevertheless found herself faced with an issue of transportation. Patients aren’t allowed to drive themselves home after being medicated—she didn’t want to anyway—and she didn’t know anyone in town who could drive her home after surgery.

She thought about waiting three weeks and having the procedure done in Dallas, where she has a support system, but she wanted to get it over with, both for emotional reasons and because prices for the procedure, already a concern, increase as a woman gets further along and things get more complicated. (At the Houston Women’s Clinic, the cost for the procedure starts at $600 and spikes to $1,000 at 16 weeks, the latest point at which patients are accepted.)

Uber would work fine for her first appointment but, she says, was out of the question for her second one. There was no way to know ahead of time who would be picking her up, and she didn’t want to get in the car, while sedated, with someone she wasn’t sure she could trust. After doing some online research, she discovered the Clinic Access Support Network (CASN), the organization her driver that wet April day, Angie Hayes, founded with a group of likeminded pro-choice activists in the fall of 2013.

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Source: Texas Tribune

Image: Erick Hoffman

Tall, commanding and neon-haired, Hayes, a former teacher, is working toward her master’s in public health, and runs CASN in her spare time. Growing up mostly in Houston and Dallas—and raised in the Church of Christ—she began questioning her faith in college, studying the Old and New Testaments intensely and briefly converting to Judaism before settling on her current agnosticism. Along the way, she says, she realized that some of her other beliefs didn’t fit her, either.

“I definitely had a very different view back then—I viewed it as, oh my god, these people are killing babies. As I got a little bit older and started examining it, the more I thought about it as, I’m really uncomfortable with this idea of abortion, but I can see that there are situations where that’s honestly the better choice. So at that point, I would have still called myself pro-life, but I was very conflicted about it. And then the more I moved out of religion, the more comfortable I felt moving to, okay, yeah, I’m pro-choice.”

Watching the barriers to access for women grow, and hearing women’s stories, Hayes says, has firmed up her convictions. “At this point, I can’t say that I’m uncomfortable with it,” she says. “This is a medical procedure they need. I’m here to help them get the medical care they need.”

The idea for CASN struck Hayes when she was volunteering as a clinic escort—a person who walks with a patient as she enters and exits an abortion clinic, shielding her from protesters at the gate. On her rounds, she frequently noticed women getting dropped off in cabs. Then, someone posted anonymously to a feminist Facebook group Hayes was a member of, soliciting a ride to her abortion.

“I was working the day she needed a ride,” Hayes says, “but I knew a lot of people that were activists in the pro-choice movement, and so I sent her my phone number so that she could get in contact with me, and I found a friend of mine to drive her.”

What started as a loose network of drivers soon became a nonprofit, and today CASN includes three dozen drivers, mostly women, all heavily vetted through background checks and training. The network coordinates addresses with clients via text. Drivers only ever know each woman’s first name, and they don’t save contact information. 

While some women, like Nicole, find CASN themselves, the network also extends its services to women through its relationships with Planned Parenthood and the Houston Women’s Clinic, the city’s two main abortion providers. If a patient comes in for her first appointment and expresses concern about how she’ll get to her next one, counselors hand her CASN’s card. About 150 women each year seek rides from the group, for a number of reasons.

Many are poor and don’t have a friend who can take time off work to drive them. Some don’t have access to a car and live out in the suburbs, where public transportation is spotty at best. Others have been abused and are terminating the pregnancy in secret. Still others, because of the beliefs of their family and friends, can’t ask anyone close to them for assistance. And the the majority—like Nicole—are already mothers, adding further complications, like the need to arrange childcare.

Of course, CASN volunteers don’t always know why women seek their help. They don’t ask.

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Source: Texas Policy Evaluation Project

Image: Erick Hoffman

At the very same time Hayes was busy forming CASN, back in 2013, the Texas legislature was busy passing House Bill 2, a law that would create an even greater need for the network’s services. HB2 required all abortion providers in the state to have admitting privileges at a local hospital—within 30 miles of a given clinic—and all clinics to meet the standards of an ambulatory surgical center.

At the time, conservative advocates said the provisions ensured the safety of women seeking abortions. The American Congress of Obstetricians and Gynecologists disagreed, claiming the law “jeopardize[d] the health of women in Texas and denie[d] them access to the safest and most effective evidence-based protocols for medical abortions.” Providers said the law imposed too heavy a burden on clinics: Hospital affiliations are tricky to acquire, and the statute would impose costly renovations that few could afford to make.

Within six months of HB2 clearing the legislature, in November 2013, the number of abortion clinics in Texas sunk from 42 to 19, according to data compiled by The Texas Tribune. Nearly overnight, the number of women who lived more than 100 miles from the nearest abortion clinic rose from 417,000 to more than a million.

Four clinics in West Texas shuttered, the Tribune reported, leaving women in the entire region, which spans nearly 93,000 square miles, trekking to El Paso to visit the two open clinics there. Women in the Rio Grande Valley, where a third of households live below the poverty line, were now dependent on a solitary outpost in McAllen. In the Greater Houston Area, a sprawling mass larger than the state of New Jersey, the first wave of closures—the result of the law’s admitting-privilege requirement—claimed two of eight clinics. Offices in Sugar Land and Stafford also shuttered, as did locations in College Station and Beaumont.

The second wave of closures—the consequence of the ambulatory-surgical-center requirement—almost claimed the remaining El Paso and McAllen clinics, as well as several more in Houston, including the Houston Women’s Clinic. If that had happened, an estimated 10 clinics would have been all that remained in Texas. But in October of 2014, the Supreme Court temporarily blocked the surgical center requirement while a lawsuit, filed on behalf of abortion providers, wound its way through the court.

Still, as a result of the first wave, the clinics that remained saw a huge increase in patient volume, resulting in longer wait times and lengthier drives (not to mention more second-trimester abortions; from 2013 to 2014, they increased by 27 percent in Texas, according to an NBC review of Texas Department of Health statistics).

Jessica Rossi, a counselor at Houston Women’s Clinic who also drives for CASN, says her clinic sees about 30 women a day for their first appointment and 30 women a day for the procedure itself, an increase of 84 percent over 2012, according to a brief the clinic submitted to the U.S. Supreme Court. The center’s hallways are lined with extra chairs, runoff from an overcrowded waiting room. “We try not to turn people away. We let them come in, because we know it’s hard enough already,” Rossi says. “But our waiting room is small, our pre-op room is small, the counseling rooms used to be just regular offices.”

Hayes says that as HB2 took effect, CASN started getting calls from women farther and farther away—Brenham; College Station; Beaumont; Lake Charles, Louisiana. In addition to providing transportation to local clinics, she and her team occasionally buy bus tickets for women who live outside Houston and arrange places for them to stay.

A few months ago, Hayes says, a woman from Brenham needed a ride but had no car and nobody who’d even take her to the bus station. CASN sent a volunteer out to Brenham and back, two days in a row. “I think it was 85 or 90 miles both ways for two appointments,” Hayes says. “[The driver] had to get up at four in the morning in order to get out there and get [the patient] back in time for her appointment.”

It’s a couple months after that rainy April day when Hayes picked up Nicole, the morning of June 27. Hayes joins several women at the home of Natalie San Luis, a CASN driver and the Houston organizer for NARAL Pro-Choice Texas, an Austin-based lobbying group. The women nibble on cinnamon rolls with their eyes glued to a liveblog of the Supreme Court’s rulings. Soon, the news comes in: In a 5-3 decision, the U.S. Supreme Court has declared HB2 unconstitutional, ruling that the law places an undue burden on women seeking abortions.

A volunteer pours glasses of sparkling wine, and the women toast each other with tears in their eyes. “I read, ‘The Fifth Circuit decision is reversed,’ and I kind of froze,” San Luis says over the phone later that week. “Because I didn’t quite believe it.”

Later, San Luis drops cupcakes off at the Houston Women’s Clinic, where staffers are celebrating the news, knowing they’ll be able to keep their doors open. In the afternoon, dozens rally at Planned Parenthood, where state senators Rodney Ellis and Sylvia Garcia have shown up to address the crowd, recalling standing with Wendy Davis during her 11-hour filibuster of HB2 three years prior, the night before the bill was passed in a special session called by then-Governor Rick Perry.

“We were always arguing that it was unconstitutional, we were always saying ‘you’re kidding, we know it’s not about the women’s safety, it’s about your politics, it’s about your nonsense,’” Senator Garcia tells the crowd. “We made all the same arguments, and isn’t it great that the Supremes listened?”

The mood at the rally is jubilant. Men, women and children of all ages and races stand in the sweltering late-June sun, fanning themselves with “Keep Abortion Legal” paper fans and passing out popsicles and bottled water. One little girl holds a sign that reads, No te metas con las mujeres de Texas—“Don’t mess with Texas women.”

“The June 27 decision was probably one of the best days of my life,” says San Luis. “In Texas, we do this work every day, and we live in an atmosphere where we expect to fight hard just to not lose. We pursue proactive policies to expand abortion access, but we are fighting such an uphill battle that all of us have internalized this idea. So having an unprecedented, once-in-a-lifetime win was simply amazing.”

But activists and advocates are quick to point out that their fight is far from over. Although no further closures are expected, the 20-plus Texas clinics that shut their doors as a result of the now-defunct legislation won’t restart service overnight, if they get back up and running at all. They will have to re-staff their offices and reapply for licensure, which isn’t easy in this state.

And, of course, not everyone is pleased with the ruling—it’s a crushing defeat for Republican legislators and Houston anti-abortion groups, who had long championed the bill. “The decision erodes States’ lawmaking authority to safeguard the health and safety of women and subjects more innocent life to being lost,” read a statement Governor Greg Abbott released shortly after the ruling.

John Seago, legislative director of Texas Right to Life—the state’s oldest pro-life lobbying group, based here in Houston—released a statement of his own, saying that “the Court failed women and preborn children this morning,” adding that the bill “was crafted to provide a crucial layer of defense against the predatory and profit-driven antics of Big Abortion.”

Texas Republicans have vowed to push more abortion restrictions in the upcoming legislative session. In fact, a new rule proposed by the Texas Health and Human Services Commission would mandate that fetal tissue be buried or cremated, something advocates say will increase the financial burden on women considering abortions.

Nevertheless, the hard-fought legal victory has set a national precedent, with the court stressing in its majority opinion that similar laws in states like Wisconsin, Louisiana and Mississippi could be struck down, too. “This is not just about HB2,” San Luis says. “We have history on our side now, we have the Supreme Court on our side. This is a battle that we’re going to continue to fight, but these laws, we won’t have to continue to fight so hard, because the Supreme Court has said that they infringe on people’s ability to make these decisions for themselves.”

As for CASN, its volunteers don’t anticipate seeing a drop in calls. San Luis says that until the state’s family-planning budget—slashed by two-thirds in 2011—is reinstated, clinics in smaller cities and towns like Bryan and Beaumont will remain underserved. “For many women in Texas, you can no longer go to a clinic locally; all the clinics are concentrated in urban settings,” San Luis says. “Until we rebuild that infrastructure that the legislature has spent years and years dismantling, we’re going to see people driving long distances for reproductive health care.”

Hayes says she’s actually increasing the number of volunteer trainings that CASN will host, from about one a month to every couple of weeks. “I can’t imagine it not being needed,” Hayes says. “No matter how free the service is, or how destigmatized, there will always be people who don’t have a friend to drive them.”

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Image: Jordan Hourie

After getting dropped off by Hayes, Nicole is calm, if somewhat subdued, sipping a cup of mint tea in the Hilton Americas lobby. She holds the cup in both hands, with the steam rising up toward her face, as she talks about her family.

She has a 17-year-old son with Asperger’s Syndrome, she says, and an 11-year-old daughter who cheers competitively. “That’s a whole ’nother car note, basically,” she says. “There’s monthly tuition, and they’re going to New Orleans next weekend. I can’t afford to travel with her, so I have to send her alone. Plus, there’s training, there’s uniforms...”

She remembers the anxious feeling she had hearing the clinic in Dallas was booked solid for the next three weeks. “I didn’t want the pressure of waiting. When you’re in this state of pregnancy, you see every baby…” she says, her voice trailing off.

Even though she was early in her pregnancy, her stomach had already begun to protrude, she says, which is common for women who have already had children. It made her think she was further along than she really was, adding another worry to her usual list: her bills, her job, her children. When she was able to get in at Houston Women’s Clinic and discovered she could get transportation help from CASN, she was relieved.

“We have nothing like what you offer in Houston—the funding, the transportation,” Nicole says, referring to her hometown of Dallas. Carpooling with Hayes, she adds, allowed her to protect herself, and therefore her two children. “What she did for me was powerful, just picking me up,” Nicole says. “I knew someone was going to be there and be supportive, that I would be safe.”

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