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Without this Texas clinic, women with unwanted pregnancies would have to travel 230 miles or cross into Mexico

As patients arrived at the Rio Grande Valley's lone abortion clinic last week, they were greeted by two men standing outside: a security guard and a protester clutching a rosary and a sign reading, "Pray to end abortion."

Above them dangled a banner: "We are open!"

For now, they are.

Whole Woman's Health, which describes itself as "a privately owned feminist organization," runs the clinic and half a dozen other facilities nationwide. It was founded in Austin, the Texas capital, in 2003 and in the last three years has become mired in a legal battle against a restrictive state abortion law that has twice forced the McAllen clinic to close.

Now Whole Woman's Health is lead plaintiff in a lawsuit before the U.S. Supreme Court to block the Texas law, which has already contributed to the closing of about half the state's more than 40 abortion clinics, including some in the Rio Grande Valley.

This month the Supreme Court heard arguments in the case, the most significant one on abortion since 1992. That year the justices upheld the landmark Roe vs. Wade ruling, but said states may regulate abortion so long as they do not place an "undue burden" on women seeking to end their pregnancies. That allowed Republican-led states like Texas, Louisiana, Ohio and Wisconsin to pass increasingly strict abortion regulations in recent years.

The Texas law requires abortion clinics to upgrade into ambulatory surgical centers and to use doctors who have hospital admitting privileges. The McAllen clinic's doctors don't have admitting privileges. To become a surgical center, the clinic would have to widen hallways, add equipment and get rid of the lavender diffuser, herbal tea and purple walls full of quotes by famous women.

The law's supporters say its aim is to protect women's health by requiring comprehensive medical care at abortion clinics. Opponents say medical complications are rare — the McAllen clinic has only had two patients who had to be transferred to local hospitals for minor bleeding — and that the law's real aim is to make abortions virtually impossible to obtain in the Lone Star State.

Abortion providers fear that women who lose access will take matters into their own hands, especially near the border, where they can head to Mexican pharmacies and obtain drugs to induce an abortion — a risky procedure without a doctor's supervision.

Now the high court must decide whether the Texas law amounts to an undue burden for more than 1 million women who live at least 150 miles from a licensed abortion clinic. That includes women here in the Rio Grande Valley, for whom the next nearest clinic is 230 miles north in San Antonio. Both sides say the stakes are especially high in this heavily Roman Catholic, low-income area of mixed-status migrant families.

As protests have intensified outside the clinic here over the last year, the staff has added the guard and security cameras in addition to the usual volunteer escorts.

Yolanda Chapa, founder of the McAllen Pregnancy Center a few blocks from the clinic, arrived soon after it opened on Wednesday wearing silver Virgin of Guadalupe earrings and a white doctor's coat. She stood near a sign — "Abortion is always the wrong choice" — to intercept women on their way in, offering free pregnancy tests and sonograms. Chapa said she was hopeful the Supreme Court would uphold the law and rule against the "abortion mill."

"Back when I started, there was no fence, no guards, no cameras. We were really making a difference," said Chapa, who during the last eight years has worked with more than 7,200 women, 119 so far this month, including seven "sidewalk referrals" at the clinic and 29 "babies saved."

"The challenge is big, but God is greater," she said.

Inside the clinic in pink scrubs, administrator Kristeena Banda had just returned from protesting outside the Supreme Court in Washington and felt encouraged by the crowds and an order the court issued March 4 blocking a restrictive new abortion law in Louisiana. But Banda still worried the justices might rule in favor of the Texas law.

"If it does go into effect, you will completely wipe out abortion access in this area," said Banda, a mother of three from the Rio Grande Valley who had an abortion at the clinic in 2006, the year Whole Woman's Health took over for a doctor who had run it for years. "We have Mexico a hop and skip away from us, and what happens is women take it into their own hands."

The clinic has appointments booked through the end of the month. It has a staff of seven and two doctors who travel from Houston and San Antonio, one per week, to work here. Local doctors won't do it, Banda said, "due to the backlash." The center provides two types abortions: medication (mifepristone and misoprostol) or surgical, depending on a woman's preference and how long she has been pregnant.

With the lawsuit pending, the McAllen clinic has been exempted from some of the new law's requirements, but not all. It cannot provide surgical abortions beyond 15 weeks because it's not a surgical center, and cannot provide abortion medication if a woman is more than seven weeks pregnant.

According to the new law, instead of being sent home with the pills, women must take the pills with the doctor, rushing home after the first pill, which can cause heavy bleeding.

State law also requires that the same doctor consult with a woman 24 hours in advance and complete the procedure, a logistical challenge for both doctors and patients. If women miss their initial consultation, that delays when they can take the pill, especially with only two doctors traveling from out of town, and has led to more surgical abortions, Banda said.

The clinic performs about 1,900 abortions a year, she said, roughly 60% surgical, 40% through medication. Both types cost about $600 during the first trimester, more later in a pregnancy, and even if the women they serve had insurance, which many don't in this poor region, it doesn't usually cover the cost.

For many women, Banda said, "they have to choose between feeding their kids or having the procedure."

If the clinic closed, she said, many women could not afford the additional cost of travel, child care and missing work to get to San Antonio. Migrant women living in the U.S. illegally or on visas also fear traveling to San Antonio because they have to pass a Border Patrol checkpoint, where others seeking medical care are often nabbed.

Instead, Banda said, desperate women may buy the misoprostol abortion pills over the counter in Mexico and try to self-induce abortions without consulting a doctor.

Misoprostol can be taken alone to induce an abortion and is also used to treat ulcers. So though abortion is illegal in Mexico outside of the capital district, the pill is widely available. People were buying the drug to sell at flea markets in the Rio Grande Valley, but after the new state law passed, heightened scrutiny of the sales led to busts by local law enforcement making that more difficult.

Now a package of 28 pills sells for $126 just across the border, $25 for the generic. Those in search of the drug can easily buy it about 25 miles east of McAllen, at pharmacies that line the main street of the Mexican border city of Nuevo Progreso, a mecca for retirees known as "winter Texans," who walk across the border bridge daily and return with discount medications.

Staff at Pharmacy U.S., Almost Free Pharmacy, Linda Pharmacy and Trevino's Pharmacy & Liquors all said they sell the drug, often to women who cross the border looking to, as they say in Spanish, "bring my period back."

"If they ask me if I have it to abort, I can't sell it. But if they ask for it for ulcers, I can," said Raul Gonzalez, a cashier in a white coat behind the counter of Almost Free Pharmacy.

Gonzalez said the store doesn't have a policy against selling the drug for abortions, and he's not particularly religious, but he believes in being honest. He noted that the medication doesn't come with instructions for use as an abortion pill.

"Normally when you take it, you have to see a doctor," he said.

Banda, the clinic administrator, said she sees two or three women a week who have taken the abortion pill on their own. It's not as effective as the two-drug combo, and many took it incorrectly. Some took a bottle or two, worried the first few pills were not having an effect, and risked hemorrhaging. Others remained pregnant, Banda said.

"If we give up, who's going to help these women?" she said.

Among the roughly 40 patients at the McAllen clinic Wednesday was a young woman who said she had been to Nuevo Progreso but never bought abortion pills and hesitated to take them on her own.

"I wanted to do it the right way, to where it is monitored," she said.

The petite Latina in white jeans and a tailored leather jacket asked to be identified by her initials, K.D. She had dropped out of high school, married and started her own business, but said she didn't feel financially prepared to have a child. She was unaware of the clinic's legal battle to stay open, and was upset to hear the news.

"I just don't understand how other people can choose what's right or what should be done when they're not in that situation," she said. "If maybe they were put in the situation of women, they would think differently."

Another patient at the clinic Wednesday, a willowy 18-year-old in jeans and a maroon sweater, had also heard about Mexican misoprostol — at her high school.

"Everyone talks about it. Most of the girls know about the pills," said the woman, who also asked to be identified by her initials, R.A.

R.A. has never been to Nuevo Progreso. She said that when she told a friend she was pregnant, "she told me she took the pills from Mexico and she's not pregnant anymore. She said, 'Do you want them?'"

R.A. declined the friend's offer, turning to the clinic instead. "It's more safe than taking pills by myself," she said.

She would have trouble traveling to the nearest clinic in San Antonio for treatment. She lives with her father, who doesn't know about the pregnancy, and who would notice if she were gone for several days.

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R.A. said she feels bad about not telling her father the truth. She had noticed the protesters outside the clinic, and said she knows some consider what she's doing a sin. But she doesn't plan to stay with her boyfriend, has been admitted to college and hopes to study to help with the family business.

"People should understand that abortion sometimes is the best decision for some people," she said before leaving the clinic Wednesday, determined to return for her next appointment.

molly.hennessy-fiske@latimes.com

Twitter: @mollyhf

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Copyright © 2016, Los Angeles Times
A version of this article appeared in print on March 18, 2016, in the News section of the Los Angeles Times with the headline "Clinic fears fallout from abortion law - If justices rule for Texas, women may take it into their own hands, it says" — Today's paperToday's paper | Subscribe
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