December 1, 2023

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Texas Women Face Limited Options when Seeking Abortion Care

On October 6, 2021, Madi arrived at the Pink House in Jackson, Mississippi for her abortion procedure. After a nearly month-long process that forced her to miss time in class and at her internship, the 21-year-old had been finally able to secure an appointment. As soon as the procedure finished, she turned around to hop on a plane back home to Houston.

At the time, abortions were illegal in Texas after six-weeks into the pregnancy but were still available in Mississippi (that door has since closed). Now in Texas, abortions face a near-total ban, following the U.S. Supreme Court’s decision to overturn this constitutional right in June 2022.

This has left Texas women with no legal choice to obtain an abortion without traveling outside Texas. Even if they want to use abortion pills, under present Texas law they are not allowed to do so legally in the state. Instead, they must pick them up in the states that still allow them.

But before they do that, patients have to navigate through a maze of online telemedicine providers, as organizations like Planned Parenthood Gulf Coast cannot even give referrals, let alone distribute the medication.

One of the few groups that can provide abortion pills directly is Whole Woman’s Health. This is because their facilities are in states that permit telemedical abortion care. Their five in-person clinics are in Minnesota, Indiana, Virginia, and Baltimore. They also provide telemedical services in New Mexico, where they are planning to open a clinic soon.

“Our providers meet with the patient in a video conference to have a full visit with medical history and counseling,” Amy Hagstrom Miller, founder of Whole Woman’s Health said. “The doctor or nurse practitioner then calls the medication into the pharmacy and ships that medication to the address that the patient provided in the state where they have access to it.”

Although these pills have been FDA-regulated since the early 2000s and are declared safe to use, anti-abortion leaders would like to see even this method of abortion stopped.

Amy O’Donnell, a public policy team member of Texas Alliance for Life, supported legislation that placed restrictions on the access and usage of abortion pills. According to her, this medication could pose significant health complications. “I would imagine that the more women become aware of the risks the more we will see those numbers drop,” O’Donnell said.

After these restrictions were passed which included banning use of abortion pills seven months into pregnancy, the American College of Obstetricians and Gynecologists stated that the measures taken by the Legislature stemmed from scientifically unsupported claims.

For Texas women who want abortions, unless they can get mail order pills delivered to them undetected at their homes, travel is their only option.

Fewer and fewer options

As of December 1, 2021, Texas Senate Bill 4 established jail time and fine penalties (of up to $100,000) for any organization, company or individual that prescribes medical abortion pills by telehealth or email.

The bill goes even farther to limit the information that some reproductive health care clinics and providers can share with patients seeking this option.

“Patients sometimes say, ‘I saw this website or a friend of mine told me I can get pills from this company,’ and we are not allowed to verify that information or to refer people to websites that may offer these services,” said Dr. Bhavik Kumar, medical director for primary and trans-care services with Planned Parenthood Gulf Coast.

Because Whole Woman’s Health closed the doors to its Texas clinics and now only operate clinics out of state, they are allowed to provide information and even distribute the pills to their patients. Again though, these cannot be directly mailed to addresses in Texas.

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A patient checking in to a Whole Woman’s Health Clinic.

Photo by Whole Woman’s Health Alliance

The abortion-inducing medication most clinics provide comes in a two-pill package. The first, Mifepristone, stops the pregnancy from growing and is taken immediately. The second, Misoprostol, works to empty the uterus which causes cramping and bleeding and is usually taken 24-48 hours after Mifepristone. Mifepristone and Misoprostol can be self-managed and do not require health care professionals to be present when they are used.

Plan B One-Step and other types of morning-after pills are not abortion-inducing medications. Unlike Mifepristone and Misoprostol, which work together to terminate an existing pregnancy, Plan B One-Step prevents pregnancy by blocking ovulation and fertilization.

The FDA not only regulates these medications, but also approves who is allowed to provide and distribute these prescriptions. When asked for an interview to discuss this approval process, the FDA declined the Houston Press request.

One gray-area when it comes to the distribution of this medication involves one of the biggest telemedical abortion-providers: Aid Access. Aid Access operates outside of the United States meaning that U.S. enforcement does not have jurisdiction over them, according to Kelly Krause, associate director of media relations at the Center of Reproductive Rights.

Despite this, in 2019, the Trump Administration went after Aid Access and the FDA sent a cease-and-desist letter to the company citing that the organization was violating U.S. law by providing these pills. It is unclear whether Aid Access did discontinue shipping this medication to U.S. residents living in states where these prescriptions are not allowed.

The status of this alternative option to surgical abortion could be reconsidered in the upcoming 2023 Texas legislative session, along with other abortion-related restrictions. One of the laws that has been pre-filed is House Bill 61 which would prohibit any government entity from providing logistical support to an individual having an abortion.

Additionally, two laws that the Texas Freedom Caucus are considering for prefile would impose criminal penalties on employers covering elective abortions in their health insurance and allow private citizens to sue anyone who financially assists a Texas resident to receive an out of state abortion.

What’s left for Planned Parenthood to do

Legislative restrictions at the federal and local level on reproductive rights is nothing new for Texans. When the Supreme Court’s decision was made, Senate Bill 8, or the “Heartbeat Bill,” had already made all abortions past the six week-mark, illegal.

“When I heard Roe v. Wade got overturned, I was just heartbroken,” said Madi, who declined to have her last name published.  “I mean we all had a feeling it was coming because of past legislation; we just didn’t want it to, and we thought something may stop it, but nothing did.”

Senate Bill 8 affected Madi the most, as she was told at her first Planned Parenthood appointment that she was 10-1/2 weeks pregnant.

“My heart just dropped, I just started crying and sobbing honestly,” Madi said. “I thought I was going to graduate college a semester behind, I didn’t think I was going to have to pause my life for weeks to go states away to get the health care that I deserved.”

She had to make two trips to Mississippi, one via car with her father for her dating sonogram, and one with her mother via plane for the actual procedure.

In response to the state’s changing abortion laws, Planned Parenthood Gulf Coast has set up a patient navigator program.

“Our patient navigators are helping patients think through where they can go, the logistics of travel, taking time off of work and what state may be the most feasible for them to get to,” Kumar said.

This program has helped 700 patients so far and has had 10-20 percent of patients that are in Texas and Louisiana follow up for after-abortion care at a Planned Parenthood clinic in their home state.

After-abortion care can include confirming the pregnancy is nonexistent or handling any complications that could have arisen from the abortion. These two services are the only abortion-related care Planned Parenthood Gulf Coast is allowed to provide at this time.

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Patient in a consultation with a Planned Parenthood doctor.

Photo by Frank Rogozienski

Running the gauntlet

As choices surrounding reproductive healthcare continue to dwindle and organizations continue to fight to provide abortion-related care, patients like Madi are left with no option but to sacrifice time and money to obtain the healthcare they need.

“Some people actually think that women use abortion as birth control, this is such a villainizing thought,” Madi said. “It is also outrageous because it is so expensive and illogical, no one wants to go through this and put their body through this. This is not an easy decision.”

Madi was on birth control; she had done all the right things to keep her from being pregnant at 21. The second she knew she was pregnant, Madi knew she was not in the position to have a child.

But she wasn’t in the position to have an abortion either. At least not in Texas.

Madi remembered the physical and emotional exhaustion, she was able to get a bit of relief on the plane back to Houston from Mississippi, as she was able to sleep for the first time in a while.

She tried to catch up in school but after all the time she missed, she failed a class. She is set to graduate at the end of this fall semester.

“I feel like Texas legislators don’t respect reproductive rights and they don’t respect anybody that wants to put their future first,” Madi said. “My body is not their property and I’m sick and tired of them treating it like that.”