Texas is the state with the most cities that are more than 100 miles away from an abortion clinic. Those who have the resources will always be able to get the support they need, while marginalized people continue to be disproportionately affected. The state lost more than half its abortion providers following the 2013 passage of HB2—which imposed medically unnecessary requirements on providers and has since been overturned, though many clinics haven't re-opened.
What Texas state law says about abortion:
The state bans abortions after 20 weeks of pregnancy unless the pregnant person has a life-threatening medical condition, or if the fetus has a severe abnormality. But some cities, like El Paso and Waco, only have providers that perform abortions until 16 weeks; leaving many with no choice but to travel to get the care they need.
Lawmakers based the gestational limit on the inaccurate idea that a fetus may feel pain by 20 weeks. But the American College of Obstetricians and Gynecologists says that there is no evidence supporting this idea before viability—which occurs around 24 weeks—and ACOG says that the ability to distinguish pain from touch wouldn’t develop until well into the third trimester.
Under The Woman’s Right to Know Act, enacted in 2003 and amended in 2011 and 2017, people are forced to receive biased in-person counseling. The law also requires that:
- Patients receive inaccurate information about abortion and the development of pregnancy; like a risk of breast cancer, infertility, and the ability of a fetus to feel pain. They must also receive information about alternatives to abortion, including parenting and adoption, as well as their right to receive child support.
- Patients wait 24 hours between getting the state-mandated counseling and having the abortion, which means most people have to visit the clinic two or more times. (Those living more than 100 miles away from their nearest clinic can have the waiting period waived.)
- Providers force people to have a mandatory ultrasound 24 hours before the abortion, too—despite this being medically unnecessary for most people. During the ultrasound, the provider must describe what is shown on the screen, and give the pregnant person the option to view the image and/or listen to the heart tone if available.
- The same doctor who performs the ultrasound must perform the abortion, too, which means people aren’t able to bring an ultrasound they’ve received from their primary care physician or OB/GYN first, and if the abortion provider suddenly becomes unavailable after performing the ultrasound the process must start all over again with a new doctor.
- Abortions performed beyond 16 weeks must take place at an ambulatory surgical center—which have to adhere to different standards than other abortion clinics, like regulations concerning buildings, equipment and staffing.
- People under 18 must have parental consent from one parent or legal guardian on the day of the abortion (not the ultrasound), unless they get a judicial bypass from court; a complicated process that must be done in a person’s county of residence. The process can also take weeks, and involves proving to a judge that you are capable of making this decision on your own. (For help getting a judicial bypass in Texas, teens can call or text Jane’s Due Process at 1-866-999-5263.)
Public funding for abortion (including state health plan coverage) is already banned in Texas—except in cases of rape, incest, or life endangerment. But most people can’t use their private health insurance to cover their abortion either, so they pay for the costs completely out of pocket. This is thanks to a 2017 law that banned coverage for “non emergency abortions” and with no exceptions for rape, incest, or fetal abnormalities. People can purchase a costly premium through their private health plan for coverage, but millions of Texans are unable to afford basic insurance as it is. Recent data shows that, for the second year in a row, Texas has the highest rate of uninsured people in the nation.
What it’s like seeking an abortion in Texas:
This is one person’s story.
Nick, who is trans, was 26 when they needed to access an abortion in Houston, Texas. As a storyteller with We Testify Texas—a leadership program that centers the voices of those who have had abortions—they’re committed to ending stigma and shifting the narrative surrounding abortion in the U.S. Nick also volunteers with Clinic Access Support Network (CASN) where they provide transportation to those needing an abortion in the Houston area.
They knew right away abortion was the right decision
“I immediately knew I wasn't in a position to be pregnant at the time—not emotionally, not financially, and in practical terms I just knew right away,” Nick told VICE. They say the experience taught them a lot about what they wanted for their life; helping them re-examine how they felt about having children. “While I grew up thinking I’d never have an abortion...when the time came, I knew exactly what was right for my life. But I also knew the government wouldn’t make it easy for me,” they said.
They had to call multiple clinics to get an appointment
Nick found out they were pregnant on a Sunday, and the next morning, they immediately called Planned Parenthood. “Planned Parenthood was the first clinic that popped into my head, but they weren’t able to schedule my first ultrasound appointment until the following week,” they told VICE. Although there were multiple abortion clinics in Houston at the time, Nick says they were only able to find two on Google. “The second clinic I called was able to get me in for an ultrasound the next day,” Nick said. “I made sure to read the clinics’ website thoroughly, because I knew about crisis pregnancy centers and I wanted to go somewhere legitimate.”
They were scared of being misgendered
“I told the clinic right away that I’m trans, but I ended up crying on the phone because I was so afraid of being misgendered,” Nick told VICE. They said the patient advocate who answered the phone was completely understanding, and said she’d note everything in the system so the clinic staff was aware. But while people across the gender spectrum have abortions, Nick says gender-affirming care is still a new concept for clinics—even though it’s such a necessary part of healthcare. “For me, I experience gender dysphoria brought on through social settings, which means that the way I’m treated within my community—like being misgendered, or seeking care in a gendered setting—can have a direct impact on how I feel about my body. And in turn, this can actually cause me to experience physical dysphoria, as well, because the way I look is causing people to treat me this way,” Nick said.
They charged the procedure on a credit card
Nick says they paid a total of $550 for the ultrasound, sedation, and the procedure itself—which is around the average cost for a first-trimester abortion. Nick put it on their credit card. And while they didn’t know about abortion funds that could help lower the cost, Nick says they wouldn't have taken the money. “I know for some people, the cost of an abortion can have devastating effects—some may get caught up in a payday loan cycle, and others may not be able to access the abortion they need at all. For me, it meant paying it off over time. But I wouldn’t want to take away the assistance someone else may need, when—luckily—I had a credit card I could charge it to,” Nick said.
They delayed the appointment until they could get a ride to the clinic
“I actually didn’t know about CASN at the time, and they could have provided me with transportation support. But even though I did struggle with how to get there, I really needed to be around someone I knew and trusted, so I decided to push the appointment for my abortion back a few days so my partner could drive me,” they said. Nick had their abortion about a week after finding out they were pregnant, which is the average time it takes Texans following the passage of HB2, according to one study.
Their counselor was helpful despite having to provide biased information
“My counselor was really great, but it was frustrating that because of regulations, she had to tell me inaccurate information surrounding the procedure,” they said. Nick says their counselor had to provide materials that claimed abortion increased the risk of breast cancer and infertility, but that she went over the materials quickly and still emphasized that abortion is safe. (In fact, it’s 14 times safer than giving birth.) “She respected my name, used my correct pronouns, and really created a safe space for me during a vulnerable time,” Nick said . The counselor also gave them a brochure that the clinic created in response to protestors harassing patients outside. “It said even though the protestors are yelling at me, they don’t know my life or my reasons for being here, and I was a good person who was making the decision that felt right for me.”
The protestors were awful and the ultrasound was humiliating
“The protestors were awful—I always thought that if I was being harassed that I would give them the finger or yell at them. But being in such a vulnerable position where I'm seeking out this really personal medical care, and having half a dozen strangers harassing me, it’s not so easy to shrug off.” They also say the experience made them realize just how invasive and downright abusive abortion laws in Texas actually are. “It’s humiliating to be told what’s on the ultrasound, as if I don’t already know what’s inside my own uterus. It’s humiliating to look a counselor in the eye and listen to things you both know aren’t true. It’s humiliating to feel like I’m put in time out for 24 hours in order to make a decision I already know is right for me.”
They hope for a future with trans-inclusive abortion care
“There’s a lot of language in the pro-choice movement that calls for more inclusive framing, but we also need to focus on making abortion care gender-affirming,” Nick said. Healthcare providers have "dead-named" them, or used their birth name, and while Nick doesn’t believe it’s intended maliciously, they feel providers could still make changes in order to prevent this.
“I’ve visited a doctor’s office that used forms with fields for our preferred name, legal name, and pronouns. It’s a small change that can improve the experience other trans and non-binary folks have—especially for those who experience gender dysphoria that is brought on by social interactions, like me,” they said. Nick also believes providers could consider the messages in their office; specifically the waiting room where decor is often found. Is there gendered imagery in the waiting room, or are there things more neutral as well? Is there an emphasis on women’s services, or is there more inclusive language about reproductive health being used?
On a larger scale, Nick believes providers need to have more conversations with trans folks, including those who experience physical gender dysphoria; which can be influenced by having a vagina or carrying a pregnancy. “Not every trans person is going to feel the way I do, and it’s important to learn more about these experiences in order to make the appropriate changes,” they said.
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