It’s been three years since the U.S. Supreme Court struck down parts of Texas’ controversial abortion law – and yet, most of the clinics forced to close after it first passed haven't reopened.

The law, known as House Bill 2, was seen as one of the most restrictive crackdowns on abortion clinics in the country. It required clinics to operate like surgical centers and that doctors performing abortions have admitting privileges at a nearby hospital.

Closures After The Law

Like many other clinics across the state, the Planned Parenthood in San Angelo found the new requirements almost impossible to comply with. Shortly after the law passed, the clinic closed its doors.

KUT's Ashley Lopez reports

“I really do miss it,” said Susanne Fernandez, who managed the clinic for more than two decades. “[We] were helping women be seen for their needs.”

The former clinic looks a lot like it used to, Fernandez said on a visit to the building earlier this month. The only difference is it’s been painted gray.

"There is that thing in the back of your mind - where did these women go?"

“Even the blocks in front of the building that have inscriptions on them, they are all still there," she said. "They are just covered up.”

The clinic was the last abortion provider in that part of West Texas, a mostly rural, expansive part of the state, hundreds of miles away from any major city.

Fernandez said she knew many of the women the clinic served – who were largely low-income – would be greatly affected by its closure.

“The last day was sad; it was somber,” she said. “We did a lot of cleaning up. We all knew that was it.”

Fernandez said she still runs into women who used to come to the clinic.

“There is that thing in the back of your mind - where did these women go?” she said. “Where do they go now? I don’t believe a lot of them found any other health care afterward.”

As a legal challenge to House Bill 2 worked its way through the courts, many other clinics were forced to close. In less than two years, Texas went from having more than 40 clinics to roughly 17.

Kari White, an investigator with the Texas Policy Evaluation Project, said women living in rural areas were affected the most.

“What we saw is that West Texas and South Texas access was incredibly limited,” she said. "Women living in those parts of the state were more than 100 miles – sometimes 200 or more miles – from the nearest facility.”

That came at a great cost to women in those areas, said Joseph Potter, another investigator with the Texas Policy Evaluation Project.

“Women who came from places where the nearest clinic had closed had greater expenses in terms of child care, transportation, travel expenses and so forth,” he said. “So, the people who were directly affected by the clinic closures suffered.”

No 'Rush' To Reopen

By the summer of 2016, the nation’s highest court had struck down the most onerous restrictions in Texas’ law. Supreme Court justices ruled state lawmakers had overstepped and placed an “undue burden” on women seeking the legal procedure.

The ruling, however, hasn’t changed the landscape for abortion access in Texas all that much, White said.

“There are about 22 facilities that are open in the state,” she said. “So there hasn’t been this rush of clinics reopening following the Supreme Court decision. There are still just clinics concentrated in the major metropolitan areas of Texas.”

There are a lot of reasons for this, said Andrea Ferrigno, corporate vice president for Whole Woman’s Health, which operates multiple abortion clinics in Texas.

"It's basically starting from scratch. You laid off the staff, you don't have any physicians that work there anymore. Some of the doctors didn't even renew their physician licenses."

After House Bill 2 passed, Whole Woman’s Health was forced to close its clinics in Austin and Beaumont, a small city near the Louisiana border. So far, Ferrigno said, the clinic has been able to only reopen the Austin clinic.

“It’s basically starting from scratch,” she said. “You laid off the staff, you don’t have any physicians that work there anymore. Some of the doctors didn’t even renew their physician licenses.”

Ferrigno said hiring new doctors isn’t easy either, because the state has a lot of restrictions for those who perform abortions. She said clinics that closed also may no longer have a state-issued license to operate in Texas, and they probably had to break their leases and sell equipment.

“There’s a lot of different limitations. There’s also the question of – or the fear of – security challenges,” Ferrigno said. “People picketing the clinic, picketing their homes. There’s a lot that goes into that.”

Sarah Wheat, a spokesperson for Planned Parenthood of Greater Texas, said that’s why the Supreme Court ruling was not a reversal of the effects of House Bill 2.

“It was a huge validation,” she said, “but what it did not do is restore the entire clinic networks that have been built over time.”

In fact, the latest abortion clinic to open in Texas isn’t a formerly shuttered clinic. Kathy Kleinfeld, who has been running clinics in Houston for more than two decades, opened a new one in the city that provides only the abortion pill.

Kleinfeld said getting a new clinic up and running in the state is no easy task.

“There’s always been volatility and conflict and struggles. Always,” she said. "This is not for the faint of heart.”

Kleinfeld said she suspects she was able to get her new clinic opened mostly because she’s been doing this work for so long.

“If I were new to Texas, it would have been a whole different story,” she said. “I have watched the regulations evolve over time into what they are now.”

The Political Future

One of the biggest hurdles facing abortion providers is future restrictions.

Wheat said she and others at Planned Parenthood of Great Texas are concerned about a continued lack of access to abortion and family planning in areas like Abilene, San Angelo and Odessa.

She said they want to restore services in that part of the state, but it’s always hard to commit to opening a clinic anywhere in Texas.

“It’s not a simple decision because you don’t know what new challenges, restrictions and legislative attacks are going to happen within a year,” Wheat said.

State Rep. Donna Howard, D-Austin, said it’s not surprising that there wasn’t a wave of clinic reopenings after the Supreme Court invalidated parts of the law. She said it’s difficult to get people to commit to that “when you have a legislative body that is so hostile to your particular line of business.”

Howard said that’s partly why “it’s hard to say” whether – perhaps over a long timeline – access to abortion will return to what it was before House Bill 2. She said the situation has also been made more complicated by a slew of states passing even harsher abortion restrictions.

“Until we get to a different space, politically, I am going to be probably very concerned about any sort of expansion,” she said.

Got a tip? Email Ashley at alopez@kut.org. Follow her @AshLopezRadio.