One Texas patient who was taking birth control had no idea she was pregnant until it was too late. Others came in for their state-mandated ultrasounds but had their abortion appointments delayed by Tropical Storm Nicholas. They, just like the first patient, will now have to travel hundreds or even thousands of miles in order to end their pregnancies — if they can get together the money, time off work, and child care necessary to do so.
This is what it looks like to try to get an abortion in Texas since the passage of SB 8, a law that bans nearly all abortions after six weeks, before many people know they are pregnant. For the few patients who do realize it in time, it’s a race against the clock to schedule an appointment and get the money for the procedure — which costs an average of about $500 and typically isn’t covered by insurance. “There’s a sense of urgency that’s causing a devastation among our callers,” said Shae Ward, hotline program coordinator at the Lilith Fund, which funds abortions in Texas. “They just are like, ‘If it’s not done by then, I don’t know what I’m gonna do.’”
The options aren’t good. While one Texas doctor, Alan Braid, has been vocal about performing an abortion in defiance of the new law, providers generally say they are complying. That means patients who aren’t able to get an abortion before six weeks, or who don’t realize they’re pregnant before then, have to make what’s often a multi-day journey to a clinic in Oklahoma, Kansas, or even as far away as Michigan or New Jersey. Such a trip is simply out of reach for a lot of Texans. “If you can’t afford the $500 to get seen in-state,” Ward said, “then you definitely can’t afford the $500 to get your procedure somewhere else, and then also a flight and also a hotel.”
Abortion funds and other groups are stepping in to help people make the journey, but they fear they’re not reaching everyone. Calls to the Lilith Fund, the state’s oldest abortion fund, are down since the law’s passage, suggesting that some Texans may now believe there’s no way for them to get an abortion, and no point in trying.
Meanwhile, providers are preparing for a potential flurry of lawsuits because of a provision in SB 8 that allows ordinary people (even outside of Texas) to sue anyone who assists with an abortion — and that promises plaintiffs at least $10,000 if they win, an incentive that has already prompted a lawsuit against Braid. Fearing such legal action, some doctors had already stopped providing abortions in Texas even before the legal limit. And some fear that the law could launch a wave of vigilantism and surveillance that will disproportionately target people of color, who are already at risk of harassment and violence in the legal system.
Overall, less than a month after it went into effect, abortion rights advocates are concerned SB 8 is already working as intended. “This bill is created to use fear and cruelty to prevent people from accessing care,” Ward said. “And that’s what it has done to some degree.”
The impact of Texas’s six-week abortion ban
Ten or even five years ago, it was hard to imagine a US state passing a near-total ban on abortion — and courts letting it go into effect. Six-week bans have passed before, largely in red states, but they’ve always been blocked by courts. That’s because such a ban is in clear violation of the Supreme Court’s decisions in Roe v. Wade and Planned Parenthood v. Casey, which prohibit states from banning abortion before a fetus can survive outside the womb (generally understood to be about 24 weeks).
The sponsors of the Texas law, however, attempted to get around this problem by making it more difficult to challenge in court, as Vox’s Ian Millhiser explains. By leaving enforcement up to ordinary people rather than state officials, they made it harder for abortion providers to sue the state to block the law. And the Supreme Court — now with three justices nominated by President Donald Trump, who pledged to ensure that the Court would overturn Roe — essentially endorsed the strategy by allowing the law to go into effect.
The result: Texas patients are seeing their lives upended by a law that many thought would never see the light of day. “They’re having their choice ripped away from them,” Ward said.
Not that it was easy to get an abortion in Texas before the passage of SB 8. Under state law, patients had to get a mandatory ultrasound, then wait 24 hours before they could get the procedure. Now, however, if the ultrasound shows cardiac activity — which usually happens around six weeks’ gestation — the patient is barred from getting an abortion in the state.
That means getting an abortion in Texas is an even bigger scramble. Pregnancy is dated from the first day of a person’s last menstrual period — so when someone misses their next period, often the first sign of pregnancy, they’re already four weeks along. That leaves only about two weeks to get an ultrasound, wait a day, then get the actual abortion — all of which often necessitates taking time off work and arranging child care (the majority of people who seek abortion in America are already parents). “You have to get all these pieces together, still within that super short amount of time,” Ward said.
Then there’s the money. An unexpected $500 cost is a serious problem for many in Texas, where the minimum wage is still just $7.25 an hour. “I’ve talked to so many people who are like, ‘If we didn’t hear from you, I was either choosing between this procedure or my rent,’” Ward said.
All those barriers mean that for many people, getting an abortion in Texas is no longer an option. For example, one Texas patient, who was taking birth control, experienced spotting that she thought was her period, according to a release from Planned Parenthood Advocates of Texas. By the time she realized she was actually pregnant, it was too late to get an abortion in Texas under the new law.
Clinic staff called providers in Kansas and Mississippi, but none could take her. The closest appointment they could find was in New Mexico, a 15-hour drive away. The patient, who has two children at home, told Planned Parenthood staff she was not sure what she would do.
She’s far from alone. For Texas patients beyond the six-week limit, the new law has increased the average driving distance to a clinic from 17 to 247 miles, a 14-fold jump. More travel means more money — for plane tickets or gas, as well as the hotel stay that’s often required (many neighboring states, like Oklahoma, also have waiting period laws that require someone to make two appointments one or more days apart).
Then there’s the need to find child care. For example, one Texas patient recently came to a Planned Parenthood clinic seeking an abortion so she could focus on caring for her severely ill child, who was hospitalized, Vanessa Rodriguez, a contact center senior manager at Planned Parenthood of Greater Texas, told Vox. “When she arrived at her initial appointment, she was still wearing her hospital visitor badge.”
But doctors determined she was past the new legal limit, so she would have to go out of state. “That would require her to leave a very sick child,” Rodriguez said. The patient is still deciding what to do.
And even for those who are able to overcome all the obstacles and make it out of state, clinics in nearby areas are quickly filling up. Planned Parenthood health centers in Oklahoma, for example, have seen a 646 percent increase in Texas patients since SB 8 went into effect, according to a legal declaration filed by Planned Parenthood physician Joshua Yap.
The same is true for Trust Women, which operates a clinic in Wichita, Kansas, and one in Oklahoma City. “It’s been a huge surge in patients from Texas,” Rebecca Tong, co-executive director of Trust Women, told Vox.
And the surge is more than neighboring states can bear. Large Texas cities like Houston and Dallas have more abortion clinics than the entire state of Oklahoma, Tong said. The overflow has Trust Women clinics scheduling appointments out into October, when they would usually be able to see patients the same week. Like many clinics in the Midwest and South, Trust Women locations only perform abortions two days a week. They are considering adding a third day, but “I’m pretty sure if that if we opened up our Oklahoma City clinic five days a week, it still wouldn’t be enough to help the huge need coming out of Texas,” Tong said.
What’s more, the future of abortion in Oklahoma is uncertain. The state has its own six-week ban scheduled to go into effect in November. And while, in the past, Tong would have felt confident that courts would block the ban, now that the Supreme Court has allowed SB 8 to go into effect, she’s not so sure.
“When the law went into place in Texas, it was completely believable and also 100 percent unbelievable that it was actually happening,” Tong said.
Despite the law, Texans still have options
Despite the obstacles, abortion rights advocates in Texas and surrounding areas say Texans still have options. They can go to needabortion.org to get information on SB 8, clinics in Texas, and groups that can help them get an abortion there or elsewhere, Ward said. The Lilith Fund provides funding for abortions, while other groups, including La Frontera Fund and Fund Texas Choice, can provide funds for lodging and transportation. “There is a whole network of support that people have here in Texas to lean on to be able to access care,” Ward said.
The website PlanCPills.org offers information on how to order abortion pills online in order to self-manage an abortion at home. “Self-managed abortions are safe when people have resources” to perform them, Ward said. “This is information that people should definitely know about.” (A separate bill, signed into law last week, could make it easier for Texas to prosecute out-of-state providers who mail abortion medication to the state; that law goes into effect in December.)
Overall, reproductive rights advocates emphasize that SB 8 does not mean the end of abortion care for Texans. But they also acknowledge that they’re in a hard fight.
That’s especially true because of the law’s unusual enforcement mechanism: Rather than state officials enforcing the six-week ban, private citizens are empowered to sue abortion providers or anyone else who “knowingly engages in conduct that aids or abets the performance or inducement of an abortion.” Plaintiffs who win their suit will be entitled to at least $10,000 from the defendant.
This aspect of the law, which Supreme Court Justice Sonia Sotomayor criticized as turning ordinary Texans into “bounty hunters,” does not directly target people seeking abortions. But it could put anyone else involved in an abortion, from doctors to Uber drivers to abortion funds, at legal risk. At least one lawsuit has already been filed: Oscar Stilley, a self-described “disbarred and disgraced former Arkansas lawyer” who is currently serving a 15-year sentence for tax fraud, sued Braid, a San Antonio doctor who wrote in the Washington Post that he performed an abortion after six weeks in defiance of the law. Stilley says he does not personally oppose abortion, but wants the law to get a full hearing in court. He was also attracted by the promise of $10,000.
The possibility of more lawsuits is a concern for the Lilith Fund, as well, even though the group is confident it is operating within the law. The promise of a payout “just incentivizes a flood of claimless lawsuits against us,” Ward said. “Lawsuits are probably going to come and they don’t have to be substantiated on anything.”
The fund has worked with lawyers to help protect staff and volunteers in the event of a lawsuit. And as much as possible, it’s focused on helping people in Texas seeking abortions. For them, Ward’s message is simple: Though abortion in the state may be severely restricted right now, “there’s still a network of people who are willing and happy to support you and your decision.”