"The intent is to make this 5- to 10-minute abortion procedure seem dangerous": The plaintiff in Whole Woman's Health v. Hellerstedt on defending her Texas clinics all the way to the Supreme Court

Restrictions on abortion access make it hard to provide the care women need. Amy Hagstrom Miller is fighting back

Published March 2, 2016 10:56AM (EST)

Justices Alito, Roberts, Thomas and Breyer   (AP/Reuters)
Justices Alito, Roberts, Thomas and Breyer (AP/Reuters)


Molly Ivins, Anne Richards, Sarah Weddington, Wendy Davis, Cecile Richards . . . .

Amy Hagstrom Miller, who will face the Supreme Court this week in defense of her group of clinics, Whole Woman’s Health, is one of those Don’t-Mess-With-Texas women whose fight for rights has improved the lives of other women and families across America.

Hagstrom Miller is a mission-driven small business owner. At age 21, after graduating from Macalester College with degrees in religious and international studies, Hagstrom Miller accepted a job in a family planning clinic that faced hostile protests and regular threats of violence. She was motivated, she says, by her commitment to human rights and justice, a desire to be deeply present with women facing hard decisions and shaping their own futures with intention. Twenty-seven year later, Hagstrom Miller owns eight clinics in five states, many in hard-hit communities. Their name, Whole Woman’s Health, reflects her ongoing determination to treat abortion care as more than a medical procedure:

The identity questions women examine when they have an unplanned pregnancy. . . . It's the big stuff—religion, family, life and death—and the decision about what to do allows the woman to think about what she wants from her life.

But in recent years, maintaining a safe, supportive oasis for the “whole woman” has become almost impossible. For years, Hagstrom Miller and her staff jumped through hoops as the Texas Legislature imposed more and more TRAP laws (Targeted Restriction of Abortion Providers), which are “safety” laws aimed at driving clinics out of business and eliminating abortion access. But after each costly accommodation, religious right politicians imposed yet another demand.

In 2011, Hagstrom Miller challenged a law that forced Texas women to endure forced ultrasounds over the course of two visits with a 24-hour waiting period between. Whole Woman’s Health lost, but didn’t go out of business. So, the State of Texas imposed even more restrictions.

In 2013, the Texas Legislature passed House Bill 2, despite fierce protests that filled the legislative chambers with chanting women and made Wendy Davis a national hero to many. HB2 bans abortions after 20 weeks, severely restricts access to medication abortion, forces doctors to seek (otherwise unnecessary) hospital admitting privileges, and requires that all abortion care take place in a surgical center. Under the law, Hagstrom Miller’s doctors are forced to walk a woman into an operating theater before handing her two abortion pills and a glass of water.

This week, the Supreme Court will hear a challenge to the law, with Whole Woman’s Health as the lead plaintiff. One way or another, the litigation will be over. What has life been like for Hagstrom Miller and her family and her staff during five years of never-ending legal battles? In the following interview she talks about the experience.

You’ve spent the better part of a decade simultaneously accommodating and fighting regulations that have little to do with women’s health and everything to do with putting you out of business. Before the religious right latched onto this TRAP strategy, every aspect of your clinics—the décor, the non-directive counseling process, the medical care, the follow-up—said this is a safe, supportive place to listen to your own heart and mind. How has that changed for your staff and patients?

So many things have changed about the patient experience! It’s by design from our opposition. One objective of their strategy is to make abortion seem more scary, complex and complicated than it actually is. For the patient, that shows up in the language of “health and safety,” and the physical plant which is built for surgery. The intent is to make this 5- to 10-minute abortion procedure seem dangerous, and that is exactly what it does.

Women who have heard this rhetoric come in and ask, Will I ever be able to have a child again? Are you going to cut me? Do you use knives? This sensational focus causes so much unnecessary anxiety that much of our job is to provide education and comfort for the women in addition to our medical expertise.

In addition to the fear, women often say that they are the only one they know who has had an abortion. They say, I’m Catholic. I’m Christian. I’m a mother. And we let them know, in fact, “The majority of our patients are Christian. The majority are mothers already.” Our patients choose to have an abortion because they want to be better — I want to be a better mother, to focus on the children I already have, to finish school. It is an active choice toward whatever they are valuing, a woman acting with intention to choose between possible futures. That is what drew me to this work and what has kept me wanting to serve as a witness to a woman as she determines the course of her life.

It didn’t used to be this way, back when you first started providing abortion care. Tell us more about the changes.

In the 1990s, antagonism to abortion focused on the external part of the clinic. It took the form of physical threats, invasions, and shooting physicians—like the murder in Brookline (Massachusetts]. Since that time opponents have moved inside the clinic. They penetrated the walls by using the regulatory and legal system as a way to attack women and providers.

Women are now forced to look at an ultrasound, forced to listen to a script, forced to endure a waiting period. All of this puts forward the notion that women are stupid, that they have undertaken a difficult decision without having thought about it.

The second part—the regulatory attack on the provider—makes it difficult to stay open, but it also paints us as careless rather than caring, as unsafe and in need of constant oversight instead of as the compassionate medical professionals that we are. These days, rather than being impartial and professional public servants, regulators are often an arm of the antiabortion crusade. In 2000, regulators were professional nurses who came in with a public health approach. Now it’s a "gotcha!" approach, with the assumption, particularly in Texas, that we’re doing something wrong and it’s the health department’s job to catch us. In the Texas regulatory system, you are guilty until proven innocent. So abortion foes file anonymous complaints about us and other providers, and we are put in the position of proving they are not true.

The outcome is that clinics are increasingly doing two things: 1) We end up practicing for the regulators. Our energy is consumed with regulatory issues, compliance, plans of correction. It can—if you let it—take away your focus on being present with the women in your clinic. You’re managing for paper instead of for the patient. That is by design. 2) We are in the position of being forced to explain and enforce the very laws we disagree with. We are agents of the state—compelled to be the enforcers because the state has put us in that position. To serve a woman well, in my opinion, we need to be able to sit beside her and be her ally and comfort, rather than a part of the system that is making her life more difficult.

I can’t help but think about the irony—that America’s “small government” libertarians are part of the coalition forcing this on you and your staff and patients.

Get this. We were required to make fetal development booklets with misinformation available to all patients. And the abortion providers have to pay for the production of those materials. Not only do we disagree with the content of the material but we are being assessed the fee to produce this propaganda that the state is requiring us to give out.

In the new documentary "Trapped," Mississippi abortion provider Willie Parker tells his patients that abortion causes cancer, because the law requires him to say this, and then tells them that there’s no evidence to back this claim. John Oliver dubbed it Parker’s “Bad Doctor – Good Doctor” routine.

Yes. Like Willie Parker, we have a script that complies with the mandated “information.” And then the doctors who have to deliver false information add their own expertise: I’m required by the state to tell you this, but here are the mainstream medical associations that have refuted this claim.

It’s absurd.

It’s completely absurd. Women see right through it. Sixty-five percent of the women we serve have one or more children. They’ve all seen an ultrasound before and yet we force them to watch another as if they don’t know what’s growing inside of them. They know, and they are committed; there is a resolve: What do I have to watch? How long do I have to wait? I need an abortion, so what do I have to do to get one? It’s almost like an Onion article. What wall do I have to climb? How long do I have to stand on my head? Just tell me what I need to do.

It’s taken a decade of right-wing ratcheting, piling one absurd "safety” regulation on top of another to get us to the point that John Oliver could act out Willy Parker’s bizarre monologue with two quarreling hand puppets. What does that do to you?

I have a rigorous quest internally and philosophically to not let this onslaught change who we are. My commitment is to holistic care: one-on-one counseling; physical surroundings that are warm and comforting with fleece blankets and herbal tea and lavender walls; and freedom to talk about spiritual or cultural concerns. I am committed that these aspects of care not get sacrificed. We will comply with whatever we have to comply with and challenge whatever we have to challenge. But the hearts and minds of women are at the center of who we are.

That said, the litigation and keeping our clinic open to the media has been consuming. People see me at a professional meeting or training and ask, “How can you even manage to be here?” But if the fight ties up my spirit in regulatory paperwork then they have won. So it’s even more important for me to be involved in strategy, theory and innovative work.

What is it like from an emotional standpoint? I could imagine it being quite the roller coaster.

I feel really proud as a plaintiff, that we are standing in the light and welcoming this conversation. But internally, it’s been extremely disruptive, for my staff and for me as a small business owner trying to provide a stable environment for nurses and other team members who work for me and who deserve it. When the state forces us to close doors on a clinic, it feels heartbreaking because we know what that means for the women of that community. We know it’s not our fault, but internally we question ourselves: Was there more we could have done?

Grief comes up at surprising times. Sometimes grief comes when we get a win. I didn’t expect that. When the Supreme Court took up our case, I was elated. But I had waves of grief for the clinics we had already closed and the women denied services. And not just for Whole Woman’s Health. So many doctors can’t work anymore, so many clinics can no longer serve other communities.

Does it wear you down?

In my nature I’m extremely resilient. I’m super hopeful. But as a byproduct of all of this I’ve developed the skill of putting things in little boxes in my head. This could happen ... but I can’t worry about that. I can’t have my feelings in advance. Sometimes I’m scared of how good I’ve gotten at this, but it contributes to my ability to lead. It lets me do what I can rather than sitting back and freaking out about the unknowns.

The Supreme Court decision will come most likely at the end of June. I have to have contingency plans, so I do think about the future. But I have a practice of detachment from the outcome. I have to detach from are we going to win or not. It’s the right thing to do, whether or not we win, it is right to stand up to this law that has caused devastating harm to women.

How do you try to comfort and support your staff?

There is a depth of connection with us at Whole Woman’s Health because of how much we’ve been through together. We have an incredible bond—a deep sense of trust and respect for each other that has sustained us through a whole lot.

It’s been hard for me not to be able to protect them. As I watched corporate vice president Andrea Ferrigno get aggressively cross-examined during the trial, I wanted to step in and protect her from those bullies. As I watched my director of clinic services, Marva Sadler, tell people that we had to lay them off, it was excruciating. At the same time, they are incredibly deep, profound, healthy, resilient adults. They give me tons of energy.

Our clinic in McAllen on the Texas-Mexico border has had to close and reopen, and we have laid people off twice. It’s the only clinic south of San Antonio, the only one for 250 miles in any direction. After the 2014 injunction that blocked the ASC provision and the admitting privileges requirement, Andrea drove down there to reopen. On the first day, one of our allies, Ana Rodrigues DeFrates from the National Latina Institute for Reproductive Health, was there and helped to check patients into the front desk. A Mexican restaurant next door came to the waiting room and took orders from patients. A hotel down the street gave a discounted room to the doctor we flew in. The community was so happy when we were able to reopen. Feeling their support was incredible.

When we reopened that October, it had been a year since we had provided abortions there. Most of our former employees had other jobs, but they all came on the day we opened, even if they had to take sick leave. These are medical assistants and nurses with an hourly wage and most have a couple of kids. Their commitment to justice feeds all of us.

How do you take care of yourself?

I have an absolutely fabulous partner. We’ve been married since 1992 and together since 1988. I have really supportive family and close friends. I’m someone who relaxes by doing things. I swim. It’s a very physical way that I maintain my breath, because if you don’t breathe when you’re swimming, you drown. I also spend a lot of time with my family, going to my kids’ soccer games and cooking. Thanks to the pressures, I’ve become quite the gourmet chef in the last couple of years. [Laughs]

How do you talk to your kids and your parents about all of this?

My kids know what I do for a living and why, and they know that there are people who disagree. They watched Wendy Davis’ filibuster of HB2 online, like many people around the country. One of my kids has nicknames for the bully politicians. But the topic of my work and the conflict doesn’t dominate our conversations. It’s not what we talk about around the dinner table every night. The focus is on them.

My parents are in their 80s. They are very proud of what I do, as are my in-laws. They’re proud of my standing up for what’s right. They are proud that I’m taking on bullies, that we are speaking on behalf of those who don’t have a voice.

Would you say that this work has a spiritual dimension for you?

Absolutely. I was raised in a liberal Christian tradition, and I come to the work because of that background, not in spite of it. I’m drawn to the moral and ethical dimension of the values and dreams and all of the issues that surround an abortion decision. A lot of women have spiritual concerns as part of unplanned pregnancy. We welcome women to bring their whole family with them for the ultrasound, counseling, or the procedure. That is part of our mission.

The Jesus that I was taught about would be holding the hands of women inside the clinic; he wouldn’t be screaming at them. Acting on Christian principles is holding the hands of people at difficult times in their lives, and being supportive and nonjudgmental and kind. That is very much what we bring to the work. I don’t know how to say it more clearly than that.

What can other people do to support you?

People need to understand that this isn't just about Texas. All over the country politicians are trying to take away women's ability to make decisions about ending a pregnancy. In the last five years, antiabortion politicians in states across the country quietly passed 288 laws very similar to these Texas laws, making it harder for a woman to get an abortion.

So if people want to support us, speak up and show up so each of us can get the care we need with dignity and respect. Question the false narrative that TRAP laws serve a state interest in women’s health and safety. Ask who is benefiting from the stigma and challenge it when you hear it. Talk about why access to safe abortion with dignity is important to you personally, whether you have had an abortion or not.

By Valerie Tarico

MORE FROM Valerie Tarico

Related Topics ------------------------------------------

Abortion Hb2 Healthcare Supreme Court Whole Woman's Health