Our patient, “Elena” answered the open-ended question, “How are you doing?” with tears. She said the last 24 hours were the worst in her life. She had to change her plans from getting abortion care five miles away to nearly 500 miles away. She was short on money and afraid of losing her job. As we talked, she answered a cell phone call from a school nurse that her daughter was sick and needed a pick-up.
SB8, a Texas law that went into effect on September 1 bans abortion after six weeks—before most people know they’re pregnant. It is not the first ban of abortion at six weeks; but it is the first to take effect in the United States. The bill is also unique in relying on and encouraging enforcement by private citizens. Providers, abortion funds, or individuals that help a patient access abortion care passed the six-week cutoff may be sued and, if successful, would have pay at least $10,000 plus attorney’s fees to the plaintiff, incentivizing bounty hunting. While similar legislation has been blocked, the courts, including the Supreme Court, declined to respect established legal precedent and allowed SB8 to go into effect. Even if eventually overturned, clinic closures in Texas are likely to continue. And troublingly, many other states are planning similar legislation.
Unlike New Mexico, Texas has a number of barriers and restrictions including: state-mandated biased and scientifically debunked counseling, forced parental consent for minors, and a state mandated 24-hour delay between patient counseling and procedure. Texas limits private and public insurance coverage for abortion care. Over the past decade, the layering on of abortion restrictions resulted in a drastic reduction in clinics and SB8 essentially eliminated access in Texas overnight. And the ability for any person to sue anyone for supporting someone who gets an abortion—neighbors, roommates, providers, clergy, family—has caused such fear, confusion and chaos that the availability of the remaining legal abortion care is tenuous at best.
Importantly, this new Texas abortion ban disproportionately affects people of color, people who are have low incomes and people who live in rural communities, like our patient “Elena.” Although Elena was able to get the care she needed, many will simply not be able to overcome the major financial and logistical challenges of finding abortion care out of state. The ban and its undemocratic enforcement mechanism—using citizens as vigilantes—is designed to intimidate and stigmatize abortion providers whose first priority is to offer compassionate and equitable care. SB8 tramples on the right of pregnant people to make their own decisions in the context of the patient-provider relationship without political interference.
We provide judgment-free, equitable, compassionate and essential health care. And we have already seen the impact of SB8 firsthand this week. We are saddened and angered by the countless barriers our patients from Texas face. We have always served patients from Texas, particularly rural West Texas, but not like this week’s surge. Patients arrive for care, hundreds of miles from home with stories of fear—telling no one about their journey to avoid violating the law or incriminating a loved one—and stories of profound heartache like Elena. We help our Texas patients process the raw emotions of losing vital healthcare—their tears, their outrage, their fear. And we observe the strength and resilience of individuals with the courage and the means to choose bodily autonomy. We know countless other Texans cannot make those decisions. Providers in New Mexico offer compassionate judgment-free care to all. We will continue our work, including for Texas patients like the one who wrote us last week: “You have a unique way of making others feel truly cared about—and thank you so much for helping me when my home state wouldn’t.”
A Medical Student Perspective
As a medical student, I felt privileged to provide abortion care on September 1st. Over the following week, nearly every abortion I completed was for a Texan patient. Now, as I apply for residency in OB-GYN, this experience has made me wonder more about my next steps—do I pursue residency where this work is supported, as in New Mexico or do I go to a state, like Texas, where I am needed to be an advocate to change the status quo? Regardless, restrictive legislation that hurts patients only makes me want to work harder as an advocate and provider and makes my future as an abortion provider even more certain.
A Fellow Perspective
As a Complex Family Planning fellow physician, it is my job to provide comprehensive reproductive healthcare and it is an immense privilege to provide abortion care to my patients. SB8 and its impact on Texans and their access to abortion care, particularly individuals of color and folks with low incomes, is unacceptable and unthinkable. The onset of SB8 has reaffirmed my calling of providing equitable care to all patients. Hearing my Texan patients and their fear of not being able to access vital healthcare makes me even more determined to be a safe haven for them to access the care they need.
A Resident Perspective
During medical school in Florida, my first experience with abortion was with a 19-year-old woman who had been gang raped and was now pregnant; she was suicidal and placed in the behavioral unit. Our team saw she was devastated; she did not want to continue the pregnancy. It was simple; this traumatic, unforgivable experience would ruin her life. I was disappointed to see the reluctance to offer the care she needed. Only one physician, a newly graduated physician who trained in LA, immediately offered her care. His care could change her future and offer her some peace of mind for her mental and physical turmoil. I wanted to become the physician that would not back down, would show up and would be present for a patient in her time of need. When I applied to residency, I knew I wanted a program that offers training in abortion care.