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The woman from Houston haunts Lori Williams.
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The abortion clinic where Williams works, Little Rock Family Planning Services, is a 20-hour-plus bus ride from Houston. Yet this woman, too far along in her pregnancy to get an abortion in her home state of Texas, made that trek. In fact, thanks to an Arkansas law, she had to visit the abortion clinic twice. She needed to come for counseling, and then, 72 hours later, return for the procedure itself.
And that woman, relatively speaking, had gotten lucky: She had found a way to get an abortion.
In 2020, more than 55,000 people got abortions in Texas. Now, in the wake of a Texas law that bans abortion as early as six weeks into pregnancy, that number will likely plunge dramatically. In September 2021, in-state abortions in Texas fell by almost 50 percent compared to September 2020, according to a study released last week by the Texas Policy Evaluation Project, a research group at the University of Texas, Austin that studies reproductive health policy.
Patients are fleeing Texas—not just to Arkansas and other states that neighbor Texas but also to places as far away as Boulder, Colorado, and Seattle (possibly the furthest you can get from Texas, both physically and ideologically). Clinics are stretched to the breaking point. Staff are overwhelmed.
The Texas abortion ban has effectively remapped abortion access across the country.
“These are the women with means, these are the women that can get here,” Williams said. “We know that there are patients that are still not able to access care.”
The influx of Texan patients has even set off a chain reaction for people who live outside of Texas: An Oklahoma City clinic has been so overwhelmed with Texans that it’s sent Oklahoman patients at its sister clinic in Wichita, Kansas.
Before Sept. 1, when Texas enacted its near-total ban, Texan patients made up about 1 percent of the people seen at Little Rock Family Planning Services. Now, they’re closer to 20 percent.
The Texas abortion ban has effectively remapped abortion access across the country.
“I’m grateful that we’re here as long as we can be to assist the patients that we can,” Williams said. “But it’s also just terrible and saddening that these patients are just trying to access their basic health care and have so many barriers in place that it’s become impossible.”
Abortion clinics in other states that neighbor Texas have experienced a similar influx. In August 2021, before the Texas abortion ban took effect, the Oklahoma City Trust Women abortion clinic saw 11 patients from Texas. In September, they saw 127. By mid-October, Kathaleen Pittman, administrator of Hope Medical Group for Women, an abortion clinic in Shreveport, Louisiana, said that Texans had jumped from 20 percent of its patient load to 60 percent.
Planned Parenthood Rocky Mountains, which has clinics in Colorado, New Mexico, and Nevada, saw a 130 percent spike in Texan patients between August 2021 and September 2021. A single Denver Planned Parenthood location saw a 520 percent increase in the number of Texan patients.
Between September and October of last year, Planned Parenthood Great Plains’ two Oklahoma clinics provided abortions to 28 Texans. But between September and mid-October of this year, the clinics had done so for more than 400 Texans. At least 44 Texans have also gone to the Planned Parenthood Great Plains locations in Kansas.
“Some of the patients we’ve seen have multiple children, where they have kids placed with different caregivers at different locations. And they’re missing jobs. And they’re asking exactly how long they’ll need to be there because they’re desperate to get back, or not have an abusive partner know where they are,” said Emily Wales, interim president of Planned Parenthood Great Plains, which operates health centers in Arkansas, Kansas, Missouri, and Oklahoma. “We’re not hearing from them when they say, ‘As it turns out, I couldn’t get care and now I’m being forced to carry a pregnancy against my will.’ They’re not gonna call us and tell us that. But we are going to see, I think, increased levels of desperation and people feeling forced to make decisions they should never have to make.”
Her clinics will not be able to keep up with this demand for abortions, Wales said. “It’s a horrible thing to leave the clinic at the end of the day and feel like you didn’t do enough, because there are patients who couldn’t get on the schedule or to wish that you could work through the night.”
Of the 6.8 million women of reproductive age who live in Texas, about one in six live below the poverty line. Those who seek abortions beyond Texas’ borders tend to fall below that line, according to a 2018 survey by the Texas Policy Evaluation Project.
“When you have so few providers in any part of the country and then you add this huge number of patients from a new part of the country, it does displace folks, all over.”
That survey, which studied more than 600 Texans who got abortions out of state, found that 62 percent of respondents had incomes that were more than 200 percent below the federal poverty level. Almost half were uninsured (although many states don’t allow people to use insurance to pay for abortions). “To pay for their abortion, many patients reported that they had to sell something of value or delay expenses, including bills, food, and their rent/mortgage,” the researchers noted in a paper about their findings.
“The patients are coming with deep needs for support, for financial assistance, for questions about what to do with their children, with work,” said Wales. “When you have so few providers in any part of the country and then you add this huge number of patients from a new part of the country, it does displace folks, all over.”
An Arkansas state legislator has already started making noise about passing a copycat version of the Texas ban in a special session. That bill’s survival will almost certainly depend on the outcome of two Supreme Court challenges to the Texas ban; justices heard the arguments in both challenges on Monday. Most of the justices—including two appointed by former President Donald Trump—seemed skeptical of the law.
“This law that Texas has passed is blatantly unconstitutional,” Marc Hearron, who argued against the ban in the Supreme Court on Monday, told reporters afterward. “The questions today were simply whether the federal court can do anything about it.”
But the outcome of the Texas challenges may soon be moot anyway. On Dec. 1, the Supreme Court will hear arguments in a case about a 15-week abortion ban, which was passed and then put on hold in Mississippi in 2018. The justices have agreed to reconsider whether to let states totally ban abortion prior to fetal viability—a benchmark that typically occurs at around 24 weeks of pregnancy—even though such a change would clearly fly in the face of decades of Supreme Court abortion rulings.
If the majority-conservative court overturns Roe v. Wade, the 1973 ruling that legalized abortion nationwide, or guts its protections to the point of meaninglessness, experts believe that abortion could soon be banned in more than half of U.S. states. And if Roe falls, a new analysis by the Guttmacher Institute found that just 13 states would be left to serve as “destination states,” as they would both be unlikely to ban abortion and be closest to patients fleeing their home states for the procedure.
Those destination states are already trying to curb the chaos wrought by the Texas ban.
The All Women’s Clinic in Seattle, Washington, used to see maybe one Texan patient per month. Since Sept. 1, its providers have seen one or two a week. The clinic has two sister clinics in Las Vegas, Nevada and Portland, Oregon, both of which have seen similar surges in patients from Texas.
“In the 21st century, we’re moving towards the 4th century. And Texas is leading the way.”
“The country is moving in the direction of making abortion illegal and taking us back to the Dark Ages, the medieval times, when women had no choice about being pregnant,” said Warren Hern, whose Boulder, Colorado abortion clinic has also seen a slight uptick in Texan patients since the Texas abortion ban was enacted. (Colorado is another Guttmacher destination state.) “In the 21st century, we’re moving towards the 4th century. And Texas is leading the way.”
Charlie Browne, medical director at the All Women’s Clinic, recently met one patient who had traveled from Brownsville, Texas, a city located on the U.S.-Mexico border. She was just 18 years old.
In the wake of the Texas ban, the clinic has started to totally cover the costs of one Texan patient per week.
“It’s a very small step, but it’s something that hopefully will make a tremendous difference in at least one person’s life,” Browne said. “Many of the women are actually in challenging domestic relationships, I would say. Not necessarily violence or abuse—sometimes that, but sometimes just in a relationship where it’s in your best interest to not continue the pregnancy.”
Over the last year or so, Browne has had several conversations with people who work in and run abortion clinics about what they will do if the Supreme Court hollows out Roe. They’ve had to wrestle with so many questions, he said: Can they open more clinics? Can they get more staff? Can they expand their clinics’ size?
“There are a lot of folks who are nervous about it, myself included, because it would be—ugh, yeah. I don’t know if—ugh,” Browne said, as words clearly failed him. “I kind of bury my head in the sand and don’t want to think about it.”
