Texas abortion ban foreshadows the potential fate of half the nation

As physicians, we know how important it is for people to get the health care they need when they need it. That care should be timely, affordable, accessible and free from stigma. This is not the current reality for many people. And, unfortunately, things are getting much worse. 

As leaders of two national organizations committed to evidence-based policymaking and ensuring the autonomy and dignity of those seeking abortions or other reproductive health care, we know how dire the situation has become. 

Just listen to the stories providers and patients share every day. In effect since Sept. 1, Texas’ six-week abortion ban, SB 8, is forcing many people to drive hundreds of more miles each way for abortion care. Recent data has shown that abortions in the state have declined by half. But this doesn’t mean that people have stopped working to access abortion care.

In fact, the opposite is true, and the impact is staggering. Texans have had to seek abortion care in at least 11 distant states, including as far away as Maryland, Washington, and Illinois. Our colleagues in Oklahoma, Arkansas, Colorado and many other states have seen a dramatic increase in Texans receiving care in their clinics. In Oklahoma for example, Texans previously represented approximately 10 percent of the patients seen in abortion clinics. In the wake of SB 8, that figure has jumped to roughly 80 percent. Not only are people making day-long drives to get this safe, essential health care, sometimes having to stay overnight, but there are real impacts for residents of surrounding states who are now having trouble getting appointments in their communities. The ripple effects are immense. This is unacceptable. 

Abortion access is only part of the story. While the burdens of seeking abortion care are unimaginable for those who must navigate them, for many, these burdens are insurmountable. These are the stories we haven’t yet heard. What will happen to the health and wellbeing of pregnant people and their children in Texas who were unable to access abortion care and are also unable to access quality prenatal and maternity care as a result of laws and policies that have decimated the social safety net? Moreover, as physicians specializing in providing care for people with complicated or high-risk pregnancies now fear offering medically necessary care — even in emergency situations — because of the ban, how will that impact the health outcomes of pregnant people and their infants? 

Alarmingly, the situation in Texas and surrounding states gives us a glimpse of what could be in store for nearly half of the nation.

Tomorrow, the Supreme Court will hear a case about a Mississippi 15-week abortion ban that challenges Roe v. Wade. Depending on how the Supreme Court rules, millions of people could lose their right to get abortions in their home state. Access for people in states where abortions remain available is likely to also be affected by burdens like increased wait times.  

A Guttmacher Institute analysis finds that 26 states are certain or likely to ban abortion if Roe is weakened or overturned, and millions of people in those states would have to travel significantly farther to get an abortion. Only those who have the financial resources, social support, childcare options and paid time off to travel such long distances would be able to access abortion care. Like other restrictions on access to reproductive health care, abortion bans deepen health, economic and societal inequities — affecting the least resourced while having little effect on those with means.  

Day in and day out, colleague physicians see firsthand what research has long shown: Barriers to abortion care have a disproportionate impact on people already facing multiple layers of discrimination — those with low incomes, people of color, young people, immigrants, LGBTQ individuals and people who live in rural communities are disparately impacted by these barriers.

This is not accidental or coincidental. Restriction of reproductive health care is part of a long legacy in this country of efforts controlling people’s bodies, families and freedoms, especially when they don’t align with the identities of those who have been prioritized by systems like white supremacy, patriarchy and capitalism. 

Abortion care doesn’t exist in a vacuum. When abortions are restricted and this care is criminalized, we see far-reaching impacts on the health and wellbeing of all aspects of pregnancy care. Pregnant people are more likely to face criminalization in any instance of pregnancy or fetal loss. And because of layering systems of oppressions including barriers to equitable access to safe communities, economic resources, being targeted for criminalization and lack of access to health care, Black and Brown pregnant people will bear the brunt of these life-threatening circumstances.  

Although overturning Roe would unquestionably do harm, the truth is that Roe alone has never been enough to ensure equitable access to abortion. Not when the Hyde Amendment denies abortion coverage to people insured through Medicaid; and not when states have heaped abortion restrictions one on top of another, placing care effectively out of reach for those without means. 

As long as people who need and provide abortion care are controlled, stigmatized, targeted and harassed, true access to abortion care remains an aspiration but not a reality. If people are fleeing their communities to seek basic health care, can we say health care is a right?

Policymakers must do more. Congress should pass the Women’s Health Protection Act — legislation that would block many of these state-level abortion restrictions. Congress should end the Hyde Amendment allowing people to use their health insurance, including Medicaid, to pay for abortion care. State legislators must expand access to comprehensive reproductive health care. As communities at large, we must discuss abortion as a normal, essential part of health care. We must invest in community resources that create more equitable access to care.

We are at the crossroads of reproductive freedom. We must be on the side of science, human rights, equity and justice.

Dr. Herminia Palacio is the president and CEO of the Guttmacher Institute, a research and policy organization that advances sexual and reproductive health in the United States and globally. Dr. Jamila Perritt is the president and CEO of Physicians for Reproductive Health. PRH mobilizes and organizes medical providers to ensure access to equitable, comprehensive sexual and reproductive health care.