This article was originally published by The PUBLIC.
When Jaylynn discovered she was five weeks pregnant last August, she felt a rush of anxiety — she had only a handful of days to decide her future before Texas Senate Bill 8 (SB 8) went into effect.
“In one week, it was going to be September 1st. If I didn’t make a decision, there was a high likelihood I couldn’t terminate if that’s what I wanted.” Jaylynn is a Black Latinx woman living in Houston, Texas working as a development and communications manager for Fund Texas Choice.
“When you put this time clock on it, that adds a lot of extra stress and emotional difficulty trying to navigate it all.”
Jaylynn is one of the thousands of Texans who has traveled out of state for abortion care since SB 8 went into effect last fall. And recently, on March 11th, The Texas Supreme Court effectively shut down a federal challenge to the near-ban, dashing hopes that the justices would reverse course.
While abortion-rights advocates remain focused on the Supreme Court’s impending decision in Dobbs v. Jackson Women’s Health Organization, Texas residents already know what it’s like living in a post-Roe world. And when Roe is likely weakened or overturned this year, the data and stories streaming out of Texas can be understood as a harbinger of what’s to come.
As the most restrictive abortion law in the country, SB 8 bans most abortions once embryonic cardiac activity can be detected. This can be as early as six weeks after a person’s last period — before most people know they are pregnant, a devastating time window that weaponizes a woman’s body clock and capitalizes on an overburdened, convoluted, and bureaucratic healthcare system.
When Jaylynn reached out to her gynecologist, they weren’t able to offer her any advice on abortion access other than referring her to a number for a local abortion clinic.
“They didn’t have any appointments until a week from when I called, and they told me I had to have a second appointment [due to state-mandated waiting periods], but they couldn’t guarantee it would occur before September 1st.”
Jaylynn says the pressure created in such a tiny and fraught period of time made the decision-making process nearly unbearable. She describes the pressure to decide so quickly as “wreaking psychological and emotional havoc. I thought, ‘I may not even be able to go through with my choice.’”
Finally, after debating her future for another week, she traveled back to her home state of Maryland for a medication abortion. SB 8 increased the existing restrictions on medication abortions via mail, which were already illegal in Texas, by adding penalties of jail time and a fine of up to $10,000 for anyone who prescribes pills.And even after successfully securing an appointment, Jaylynn was up against a barrage of financial challenges, including travel, lodging, food, and transportation to the clinic. With assistance from the National Network of Abortion Funds (NNAF), she connected with a local fund that helped cover flight and transportation costs.
The psychological and emotional labor coupled with time preparing and planning to access healthcare can be insurmountable for some people. Jaylynn’s total expenses for her medication, abortion, flight, and hotel surpassed $2,000. The abortion alone cost over $500.
“It’s one thing to be caught off guard [needing healthcare] that’s not covered by insurance, but when you ask folks to travel hundreds or thousands of miles, it makes it nearly impossible to get an abortion, and then you end up in a situation you’re not in a financial, mental, or emotional position to carry it out,” Jaylynn emphasized.
And this is not a decision people should have to make under duress, as extensive research has shown increased rates of postpartum depression and poorer mental health outcomes later in life among women whose pregnancy was unplanned. Likewise, research has also demonstrated strong links between unwanted pregnancies and children’s poor physical health, mental health, and poorer educational outcomes.
A March 2022 brief, compiled by researchers at the University of Texas at Austin’s Texas Policy Evaluation Project (TxPEP), shows the lengths Texans were forced to travel and highlights the numerous obstacles they faced in securing abortion care during the first four months SB 8 was in effect.
Not only does out-of-state travel often rob women of physical support from loved ones, anxiety also runs high among those who aren’t currently pregnant but have medical conditions that make the ban more harrowing. Someone like A’Leah, a 33-year-old white Texan with polycystic ovary syndrome (PCOS), who understands all too well how her health status confers additional hardship.
A main symptom of PCOS is the presence of infrequent or prolonged menstrual periods, and it affects as many as 5 million people of reproductive age. Less than half of all people with PCOS are diagnosed correctly, making millions of Texans unknowingly vulnerable to the constraints of SB 8.
“With PCOS, my cycles are never normal,” says A’Leah. “I have gone up to four months without a period before. Also, with my first pregnancy, it would not show up on at-home tests because my progesterone levels were high. We are done having kids, but I had to get off of hormonal birth control due to health reasons.”
“If I needed an abortion, having PCOS makes it difficult to know I would be pregnant in the six weeks they now allow.”
Delays experienced by participants from the TxPEP survey made it impossible to access abortion care in Texas, “even if they found out that they were pregnant shortly after missing a menstrual period,” the researchers wrote.
“Some reported calling in-state abortion facilities and being told that appointments for the mandatory ultrasound and counseling visit were not available until the next week, after which they would be ineligible for care in Texas.”
To reach the nearest out-of-state clinics still means traveling for days and navigating a labyrinth of restrictive laws to meet ultrasound and counseling requirements.
For Daniela, a 20-year-old Hispanic woman studying full-time in East Texas, finding the time for appointments and travel on top of her education demands, classes, and schoolwork was inconceivable.
As finals week approached last fall semester, Daniela was so busy she didn’t realize her missed period was something more than a result of stress. Once a home pregnancy test revealed a positive result, she found the nearest center that offered a free ultrasound, hoping she was within the timeframe to access care in Texas. With limited time and financial means, she knew it would be challenging to drive out of state.
A local pregnancy resource center told Daniela she wasn’t eligible for an abortion in Texas.
“I didn’t exactly know how much to trust their dating [of the gestational age], but I also didn’t know the date of my last period. I’d been so focused on studying and classes that I didn’t even realize I’d missed it.”
According to TxPEP, one in four participants in their survey visited pregnancy resource centers, which are organizations that offer free basic services — like ultrasounds — but actively dissuade pregnant people from choosing abortion, which can delay care even further.
Daniela managed to secure an appointment for three weeks later and drove six hours to obtain an aspiration abortion in Louisiana. “My friends helped me with the gas money, and I slept in my car for a couple of nights. I was so exhausted from not sleeping well, having nausea, and driving.”
In Louisiana, the law requires that patients interested in the aspiration option — an abortion using gentle suction to empty the uterus — attend state-mandated counseling and wait at least 24 hours before the actual abortion procedure.
“I got lucky, and my boyfriend paid for half of it, but he couldn’t take the extra time off work to come with me. I wish I could have had him there. If it had been in our area, he could have come,” says the 20-year-old.
An entirely different herculean set of logistical complications present themselves for those who do not wish to or simply cannot travel.
When Emma, a first-generation Mexican-American living in San Antonio, chose a medication abortion, she was not interested in going to an out-of-state facility for her care.
“I had had a medication abortion before and felt comfortable if I could access medication through a [local] clinic,” she says. “I didn’t want to go out of state and lose the comfort of my own home, support of my partner, and jump through hoops.” Instead, she reached out to a friend who helped with logistical support to obtain the pills needed to self-manage her abortion.
Due to her fears around SB 8 — the accompanying legal ramifications and potential punishment for her medication abortion — Emma didn’t seek follow-up care with a physician. Only weeks later, when she was still experiencing pregnancy symptoms, did she schedule a miscarriage management appointment and discovered she was still pregnant.
“I didn’t have contact with medical staff [for support or help],” she explains. For the second time, she reached out to a friend for help, and this time was able to secure both of the pills needed. She described experiencing “excruciating” pain for four and a half hours, finally passing the pregnancy around the fifth hour, all without the ability to consult with a physician.
With local clinics being too backlogged with appointments, Emma could never receive an ultrasound to estimate the gestational age. The nature of SB 8 — which deputizes citizens to enforce the ban as makeshift bounty hunters — meant she didn’t feel comfortable sharing too many details with her friend. Because of these reasons, “I did not get the best medical care, and probably got the original incorrect dosage [for the first attempt].”
“I was relieved to find medication from a friend within the state, so I didn’t have to travel. I know that self-managing abortion can be very safe, and I appreciate the autonomy of self-managed care. I would have liked to have been honest with a physician, and SB 8 limited my options and the scope of choices.”
Most people who have abortions also face structural racism exacerbated by increasingly draconian restrictions and obstacles. Of the interviews with Texas residents from the TxPEP study, approximately 46% identified as Hispanic/Latinx, and 23% as Black.
“Other people of color, immigrant families who fear encounters with police and border enforcement, parents who have limited childcare options, and minors who cannot involve a parent in their care–are among those who face the greatest challenges traveling out of state,” the researchers wrote.
Jaylynn flew over 1,500 miles to obtain care. The logistical and financial planning can be overwhelming. “I was thinking, if I have money for a flight next week, I also need money for a hotel. Am I going to have to rent a car? I didn’t want everyone to know I was home and deal with the [added weight and stress] of others’ opinions. I just wanted privacy and to feel safe,” she says.
Jaylynn’s experience was so injurious and exhausting, she decided to leave her job and join Fund Texas Choice in the wake of her abortion. Seventy-three percent of clients of Fund are BIPOC.
Given the long wait times at some locations due to higher patient volume and staffing shortages related to COVID-10 case rates, many participants could not get an appointment at the nearest out-of-state facility and were forced to travel similar long distances like Illinois and Washington.
26 states have trigger laws that would prohibit abortion if Roe is overturned; this includes three of the four states that border Texas. Almost half of Texans who traveled out of state between September and December of last year obtained abortion care in Oklahoma, which approved a copycat ban this week that would go even farther than SB8.
Abortion patients from Texas made up more than half of the total number at Oklahoma Planned Parenthood centers, compared to less than 10% from September to December 2020.
“I just feel terrified over ever getting pregnant again. I don’t know how to live my life normal anymore, knowing that if I ever needed another abortion, I’d have to go through this all over again or travel even farther,” Daniela says. The Supreme Court is expected to hand down a decision in Dobbs by late spring or early summer.
For Jaylynn, her abortion granted her deeper confidence in her relationship and the financial security to start a family if and when she wants to.
“I am proud of my decision and thankful for the opportunities it has afforded me. Forcing someone to remain pregnant when they would much rather not continue the pregnancy is a dehumanizing and cruel thing to do.”