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With Amy Coney Barrett now on the Supreme Court, the ruling that legalized abortion nationwide decades ago may be on its last legs. But during the coronavirus pandemic, Texas already gave a sneak peek at what could happen if Roe v. Wade collapses.
In late March 2020, Republican Gov. Greg Abbott issued an executive order postponing all abortions that weren’t “immediately, medically necessary”—which his attorney general defined as including nearly all abortions. Supporters of abortion rights promptly sued, but the order—and the legal tussling over it—intermittently cut off access to abortion until the end of April, when it finally expired.
That delay had steep consequences for Texas, as well as its neighboring states. The number of people who fled the Lone Star State to undergo abortions skyrocketed, as did requests for the abortion pill, according to two separate studies. And after Abbott’s order expired, the number of second-trimester abortions performed in Texas also shot up, one of the studies found.
What happened in Texas may hint at what lies in store for the U.S. as a whole if Roe were overturned—a real possibility now that a 6-3 conservative majority dominates the Supreme Court. Without Roe, each state would once again be free to regulate abortion as it sees fit, and the nation would dissolve into a patchwork of states that ban the procedure and those that do not. People who live in conservative states would likely flee to more liberal states for abortions, just as they did in Texas.
In April 2020, the month after Abbott signed his order, abortions at 18 Texas clinics fell 38 percent compared to April 2019, according to a paper published Monday in the Journal American Medical Association. That same month, 947 Texans underwent abortions at clinics in six other states. In February 2020, just 157 Texans did the same.
But having to leave the state to get an abortion wasn’t the only likely consequence, according to researchers. In May, after Abbott’s executive order expired, second-trimester abortions in Texas spiked by 61 percent, according to the study, which was conducted by researchers from the University of Texas at Austin and University of California, San Francisco. (One of the study’s authors, Robin Wallace, was one of the abortion providers who sued the state of Texas over Abbott’s order.)
The increase in second-trimester abortions, researchers wrote, “likely reflects delays in care among those who waited for an appointment and facilities’ limited capacity to meet backlogged patient need.”
“Although abortions later in pregnancy are very safe, they are associated with a higher risk of complications and may require additional visits,” they added.
During the confusion and fighting over over Abbott’s executive order, patients’ abortions were sometimes rescheduled three or four times, Marva Sadler, director of clinical services for three Texas-based abortion clinics run by the national company Whole Woman’s Health, told VICE News last month.
“There were couple of days in our clinics when we were not able to see patients at all and then there were some days that we were only able to see medication abortion patients,” she said, referring to a type of abortion that can be induced with pills. “There was also a time that our three Whole Woman’s Health clinics, along with another independent provider, were the only clinics that were seeing patients at all.”
Another January brief, compiled by researchers at the University of Texas at Austin’s Texas Policy Evaluation Project, interviewed 10 people who reached out to an abortion clinic while Abbott’s order was in effect. Of those, five people were able to get abortions and four continued their pregnancies. One was still unsure of their plan.
“The participants who ultimately resolved to carry their pregnancy to term cited economic barriers that further contributed to delays in care,” the researchers wrote. “Despite attempts to get care early in pregnancy, the executive order made it too difficult for these participants to obtain an abortion.”
One woman who was interviewed by researchers was unable to find work due to the pandemic. She said that she couldn’t pull together enough money to afford an abortion, thanks in part to abortion restrictions in Texas that predated the coronavirus.
Another woman did end up getting an abortion—after traveling more than 700 miles one way to New Mexico. Her fetus had what the researchers called “significant anomalies.”
In yet another study, researchers led by the University of Texas at Austin found in July that Aid Access, a international group that ships abortion-inducing pills to the U.S., saw the number of requests for pills from people in Texas increase by almost 94 percent between March 20 and April 11.
Texas is far from the only state that used the pandemic to hack away at abortion access. In the spring of 2020, 10 other states also tried to ban at least some types of abortions by labeling the procedure nonessential, according to the Guttmacher Institute, which tracks abortion restrictions. That triggered a cascade of lawsuits, although all of the efforts to block abortion eventually fell apart, thanks to court orders and executive orders expiring.
In the event Roe is overturned, 21 states already have laws on the books that could be used to restrict abortion’s legality, according to the Guttmacher Institute. Thirteen states and Washington, D.C., have laws that protect the right to abortion.
“Access is already a problem,” said Mercedes Sanchez, the communications director of the Seattle area-based Cedar River Clinics. Between 2015 and 2020, her facilities saw patients from more than 30 states.
If Roe falls apart, she continued, “states where abortion would remain legal would be overwhelmed by the numbers of people needing to travel to get care.”