Texas abortion access crisis will only get worse without federal action

Last week, the U.S. Supreme Court heard oral arguments in a case challenging Texas’ recent abortion law, Senate Bill 8 (SB8), which prohibits abortions after approximately six weeks of pregnancy, before some people even know they’re pregnant.

For more than 60 days, this blatantly unconstitutional law has been in effect because Texas delegated enforcement of SB8 to the general public as a means of circumventing legal challenges. The court should act quickly and allow the law to be blocked before it further harms Texans’ health and well-being and irreparably damages the network of care. 

SB8 is part of a decade-long legislative strategy aimed at limiting abortion access in Texas. At the Texas Policy Evaluation Project, my colleagues and I have repeatedly seen the profound consequences that result from these policies. Last year — at the onset of the coronavirus pandemic, Texas Gov. Greg Abbott’s March 2020 executive order prohibiting most abortions led to a 38 percent decrease in the number of abortions during the 30-day period that the order was in place.

Our new research shows that SB8 has had a more devastating impact on access to abortion care. We documented a 50 percent decrease in the number of abortions at Texas facilities during September 2021, compared to September 2020. 

This decrease in the number of abortions in Texas could have been much steeper given the many other obstacles Texas policymakers have put in front of abortion providers and patients. However, prior to the law’s implementation, facilities worked to maximize the number of appointments so that more eligible patients could be seen for state-mandated consultation visit — required at least 24 hours before their abortion — and return as soon as possible. Additionally, a swell of donations has been critical for paying patients’ costs, which are not covered by private insurance or Medicaid in Texas. Without this assistance, patients — the majority of whom are living on low incomes — are often forced to delay care until they can secure sufficient funding. 

These numbers do not reveal the law’s impacts on the lives of those who are denied in-state care. They do not show the anxiety patients feel wondering if they will be able to get an appointment before it is too late or the devastation they experience after finding out they are not eligible and now need to decide if they can afford to travel hundreds of miles to another state — or alternatively, continue an unwanted pregnancy.

The numbers cannot convey patients’ fear after learning that their medical condition will worsen if they remain pregnant — but it is not considered “life-threatening” enough to qualify as a medical emergency under SB8, or the despondence of a minor who has been raped and has no choice but to continue the pregnancy. 

Texans who are able to travel are overwhelming abortion facilities in Louisiana, New Mexico and Oklahoma. Combined, these states have half the number of facilities compared to Texas, and they simply cannot serve a large influx of Texas patients. Pregnant people are facing waiting times of one to three weeks in neighboring states, pushing them further into pregnancy — an outcome we have seen time and again after Texas enacted other abortion restrictions. Ironically, a law intended to limit abortion later in pregnancy instead may have the effect of increasing second-trimester abortion among Texans obtaining care elsewhere. 

Proponents of SB8 may argue that they have at least prevented some Texans from getting an abortion. But the well-documented health and economic 

consequences of being denied abortion care will largely fall on those who are the most vulnerable and who are unable to travel for health care that should be available in their community — including teens, immigrant families who fear encounters with police and border enforcement, as well as parents who have limited childcare options.

The crisis response taking place at facilities in Texas and neighboring states is not sustainable, and the number of abortions will likely decline further if SB8 remains in effect. The stream of financial support for patients will dry up as this story becomes yesterday’s news. Texas clinics will likely be forced to reduce the number of days they are open and lay off dedicated, compassionate staff, leaving people with even fewer options for in-state care. As we have seen before in Texas, once the network of care is dismantled, it cannot easily be rebuilt.  

Each day that the court does not intervene, Texans’ health and wellbeing — and the systems they rely on for care — are at stake. Accessing essential reproductive health care should not be a crisis. It is time to stop the persistent political attacks on abortion taking place in many states and pass federal legislation, such as the Women’s Health Protection Act, that will ensure people can access abortion care — regardless of where they live. 

Kari White is an associate professor in the Steve Hicks School of Social Work and Department of Sociology at The University of Texas at Austin and principal investigator for the Texas Policy Evaluation Project.

This piece has been updated.