'Near-total ban': Texas doctors, women assess nation's strictest abortion law

Texas abortion providers and the Biden administration scrambled Thursday as a last-ditch Supreme Court challenge failed to block the nation's strictest new abortion law.  

The Texas law, signed by Republican Gov. Greg Abbott in May, bans abortions when a fetal heartbeat is detected, usually at about six weeks. The law doesn't include exceptions for rape or incest but allows women to have the procedure for "medical emergencies." 

Abortion clinics and maternal doctors on Thursday said they would honor the law despite questions on how it will be implemented. And women began to leave the state for procedures elsewhere, abortion rights advocates said.

The six-week limit gives pregnant women few options, experts say. Most don't know they are pregnant until they miss a period after four weeks. And those who have irregular periods may not know whether they're pregnant before it's illegal to have an abortion.

President Joe Biden said Thursday he would launch a "whole of government" effort to respond to the Supreme Court decision, led by the White House Gender Policy Council and Office of White House Counsel. Biden said he's looking to the Department of Health and Human Services and the Department of Justice "to see what steps the federal government can take to ensure that women in Texas have access to safe and legal abortions."

There are few options at the federal level. While women and doctors in most states can access medications from telehealth providers, Texas and 18 other states require such medication to be accessed only during in-person clinic visits, according to an analysis by the Guttmacher Institute, a sexual and reproductive health organization.

Asked about what the federal agencies could propose to circumvent the Texas abortion law, White House press secretary Jen Psaki told reporters that it's too early to determine any recommendations but that the president has made clear is that  "the impact of last night's decision should be immediate and requires an immediate process."

Surgeon General Vivek Murthy said the Texas law makes abortions "more dangerous and disproportionately impact women who have the fewest resources," adding reproductive decisions should be left to doctors and patients.

Anti-abortion groups hailed the decision on Thursday.

"Hopefully, this law will begin saving the lives of tens of thousands of Texas babies and we look forward to the day that babies' lives will be spared across America," said Carol Tobias, president of National Right to Life.

Abortion rights advocates and doctors assailed a portion of the law that allows citizens to sue providers or individuals who help women get an abortion after six weeks.

"This is obviously a creative and cruel new twist to enforcement of abortion restrictions," said Elizabeth Nash, a state policy analyst with the Guttmacher Institute. "It’s basically the state handing off to third parties enforcement of an unconstitutional abortion ban."

Not all women will have time, money and support to make the average 248-mile trip to the nearest clinics in Louisiana, Oklahoma or New Mexico, Nash said. Those without the resources to leave the state, pay for out-of-state hotels or get time off work might be out of options.

Dr. Kimberly Carter, a member of the Texas Association of Obstetricians and Gynecologists, said doctors who specialize in maternal health are "a little bit afraid" about unwittingly running afoul of the law. 

She said pregnant women can develop medical risks after six weeks of pregnancy such as heart problems or abnormalities revealed through medical imaging, Would a doctor run afoul of the law if they discussed such medical risks with patients after six weeks? 

"We don’t want to be sued out of existence but we also don’t want to disrupt a doctor-patient relationship," Carter said. 

Texas is taking steps to further restrict access to abortion-inducing medication under a new proposal awaiting Abbott’s signature.

The legislation, Senate Bill 4, makes it a felony for doctors who prescribe the medication to women without first conducting an in-person examination. 

State Rep. Stephanie Klick, R-Fort Worth, and author of the bill, said the legislation aims to stop “out-of-state bad actors that are flagrantly violating state law.” 

But Democrats and abortion advocates argued the bill impedes access to abortion.

“I’m really tired of every single session having to come here and debate one more obstacle to a woman having the right to choose what happens to her own body and her own destiny,” said Rep. Donna Howard, D-Austin, during debate in the House over the bill.

Contributing: USA TODAY's John Fritze and Courtney Subramanian and Madlin Mekelburg, Austin American-Statesman