Whole Woman’s Health at al. v. Hellerstedt, Commissioner, Texas Department of State Health Services

The petitioners in this case were a group of abortion service providers claiming that two provisions in the House Bill 2 (H.B.2) enacted by the Texas Legislature were unconstitutional as they violated the 14^th Amendment. One of the provisions (the admitting privilege provision) stipulated that a physician performing or inducing the abortion had to have admission privilege at a hospital within 30 miles from the facility where the abortion had been carried out. The other provision (surgical-center provision) required abortion facilities to apply standards that were equivalent to the standards for ambulatory surgical centers in Texas. They sought an injunction order from the Supreme Court of United States (the court) preventing the enforcement of the provisions. They relied on the court’s case law in Planned Parenthood of Southeastern Pa. v. Casey.

When deciding on the petitioners’ complaint, the District Court had observed the effect of the H.B.2’s enactment on the abortion service in comparison to the situation that had existed prior to the enactment. It had listed the negative impacts of the enforcement of both provisions had resulted in the provision of abortion service; the surgical-center provision had created undue burden on women’s right in Texas while the admitting privilege provision had created undue burden on abortion-providing facilities.

The District Court recalled the decision in Parenthood of Southeastern Pa. v. Casey where it was held that the provision of the law was unconstitutional because it had resulted in substantial obstacle (which amounted to an undue burden) against women who sought pre-viability abortion. The District Court observed the statistics brought by the petitioners and noted that there was a significant rate of abortions in Texas and the number of licensed abortion facilities in Texas had declined after the implementation of the admitting-privileges requirement. It had also noted that the number of facilities would continue to drop if the surgical-center provision were to be enforced which would make it impossible for the remaining few facilities to serve the demands of between 7,500 and 10,000 women annually. The District Court also noted that the restriction had greater impact on “poor, rural and disadvantaged women” within the community. [Page 11] The degree of complications had been lesser prior to the enactment of H.B.2 while there hadn’t been an improvement in the risk involved or the quality of care women receive at ambulatory surgical centers.  The District Court observed that the surgical-center requirement hadn’t applied to all ambulatory surgical centers in Texas. The cost of compliance for this requirement also was unreasonably high for the abortion facilities.  The District Court, therefore, held that the provisions unreasonably obstructed women who sought pre-viability abortion.

The United States Court of Appeals for the Fifth Circuit reversed the decision of the district court stating that the district court was barred by res judicata from deciding on the constitutionality of the H.B.2’s provisions. It also held that the state had a legitimate and compelling interest of protecting women’s health when imposing the requirements under both provisions as it hadn’t aimed to obstruct women’s abortion of a non-viable fetus.

The Supreme Court concluded that the Court of Appeals erred when it decided that the petitioners’ claims were barred by Res Judicata. The Court of Appeals also erred in its procedural rulings. The Supreme Court was convinced by the substantive reasoning and findings of the district court. It thus observed that both provisions had restricted access to abortion services and that they hadn’t provided benefits justifying such limits. The Supreme Court was of the opinion that by imposing undue burden on women’s access to pre-viability abortion services, both provisions had been obstacles for women who needed the service. The Supreme Court, therefore, found a violation of the Federal Constitution (the Fourteenth Amendment) and reversed the decision of the Court of Appeals.