Texas: Abortion and Reproductive Care in the Lone Star State

Here on The Pulse, we are doing this tour of the United States to explore the differences in reproductive law from state-to-state, as it applies to abortion, pregnancy care, and related matters. This whole thing started back in June, 2022, when the Supreme Court of the United States (SCOTUS) decided on the Dobbs versus Jackson Women’s Health Organization case on abortion. The Dobbs case involved a Mississippi law prohibiting abortion after 15 weeks of pregnancy. This means 15 weeks counting from the first day of bleeding of the last menstrual period. Six of nine SCOTUS justices voted to uphold the Mississippi law, and five of those six also joined onto a majority opinion written by Associate Justice Samuel Alito overturning the 1973 Roe v Wade decision that protected the right to choose. In the aftermath of Dobbs, the US is now a patchwork of different situations, when it comes to the legality of abortion and access to abortion. In places where the right to choose abortion is not protected, there also are implications for pregnancy care overall. In some cases, fertility treatment is being threatened as well.

While numerous states, such as New York, Connecticut, New Jersey, Illinois, Oregon, New Mexico, Washington, Kansas, and North Carolina, not only support abortion rights, but are becoming destinations for abortion seekers from elsewhere, and while state court systems have kept abortion afloat in states like Montana, Ohio, and Alaska, other states hang in the balance. Florida, for instance, allows abortion, but only until 15 weeks gestation and has numerous political forces pushing to end abortion there. Meanwhile, because of the Dobbs decision, there are many states with laws extremely hostile to abortion, and with it reproductive health overall. Such states include Mississippi, Tennessee, Georgia, Alabama, Arizona, and Missouri, and sadly they also include today’s highlighted state, Texas.

The Lone Star State does not allow abortion at any time, and not even in cases of rape or incest. It is a complete ban, with exceptions, only if the mother’s life is in danger, and there is uncertainty about what constitutes saving the mother’s life. Back in 2021, thus prior to Dobbs, Texas passed its so-called “fetal heartbeat” bill. While this put a six week limit on abortion that no longer applies, due to the full ban now in effect, the bill also deputized private citizens to bring trouble to anyone who assists and abortion seeker. This could apply to healthcare providers, drivers who transport the patient, and anyone who provides financial assistance. The law allows any private citizen in Texas to sue those who help someone obtain an abortion. On account of this law going into effect, even before the Dobbs decision, the Guttmacher Institute reported data showing a “14-fold increase in driving distance” for abortion seekers in Texas.

Due to the situation in Texas, the focus of reproductive care organizations, such as Planned Parenthood, is now to help abortion seekers find care out-of-state. This includes helping to connect you with assistance on funds for fuel and for air travel, travel, meals, and childcare expenses. Additionally, some abortion-friendly states offer travel and lodging assistance to out of state abortion seekers. Distances from Texan population centers to anywhere out-of-state is great if you travel by land, but states nearby Texas where you can travel include New Mexico, Colorado, and Kansas. Of these three states, Kansas has a very limited number of clinics, so it’s not an optimal abortion destination from Texas, unless you have family or friends offering you a place to stay in a particular Kansas location with a clinic that knows that you’re coming.

You should leave no stone unturned when it comes to producing a plan to obtain your abortion out—of-state. However, if you wind up in a situation in which the only thing you can do is to have a telemedicine visit with an out-of-state abortion provider, who can send medication in the mail for a medication abortion, you need to be very cautious. While not legal in Texas, medication abortion is medically possible and permitted, if you will not be more than 77 days (11 weeks) pregnant (counting the first day of bleeding of your last menstrual period as day 1) by the time that you begin the treatment that will be mailed to you. You must not mention what you are doing to anybody who assists you with anything, include someone who picks up the mail, because of the Texas law allowing private citizens to sue those who help with abortions. If you have a nosy, anti-choice neighbor, you need to be careful about that.

In most cases, women who undergo medication abortion, guided by telemedicine providers, do not need any in-person care. Understanding of the medications and the abortion process is advanced enough that asking you about your symptoms, and asking follow-up questions, via phone or videoconference reveals enough to be sure that all of the products of conception have been expelled and that you are not in any danger. In a certain fraction of cases, however, there may be persistent symptoms, such as extensive bleeding and/or a fever, making an ultrasound exam necessary to make sure that the products of conception have indeed been entirely expelled. Some recipients of medication abortion also may want to visit a healthcare facility for reassurance. Given the hostility of Texas to abortion, the health care providers will not be able to discuss your induced abortion with you. Medically, the abortion that you would experience as a result of the medication would be indistinguishable from a spontaneous abortion (miscarriage). Doctors and nurses know this and most of them want to help you and don’t have any objection to you terminating your pregnancy. But they don’t want to be prosecuted by the state, nor do they want to get sued by some anti-abortion activist. Wink back and forth with them all that you want, but don’t actually say or otherwise reveal that your abortion was induced. Doing so can get both you and the healthcare providers into a lot of trouble. Just go with the story that you has miscarried, spontaneously. Even in the event that there is an antiabortion activist among the healthcare workers, that person will not be able to prove anything, so long as you never admit to taking medication. Just be consistent about saying how you are miscarrying and leave it at that. It is horrible that the situation is so bad for people to have to lie, but that’s why you should do everything that you can to travel outside of Texas for your abortion, and when doing so be very discrete when involving Texas residents who help you.

David Warmflash
Dr. David Warmflash is a science communicator and physician with a research background in astrobiology and space medicine. He has completed research fellowships at NASA Johnson Space Center, the University of Pennsylvania, and Brandeis University. Since 2002, he has been collaborating with The Planetary Society on experiments helping us to understand the effects of deep space radiation on life forms, and since 2011 has worked nearly full time in medical writing and science journalism. His focus area includes the emergence of new biotechnologies and their impact on biomedicine, public health, and society.

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