Nicole began her morning with a simple prayer: “Please let my car start today.”
She had already gotten the mandatory ultrasound, scrounged up $595 and taken time off work. But at that moment – with her pregnancy at exactly six weeks – getting an abortion in her home state boiled down to her hatchback’s temperamental engine turning over.
On that Friday morning in early October, as heavy rains and flash floods swept through Houston, Nicole was cornered into making a painful decision on a hairline timeframe. She was one of thousands of Texas women feeling the impact of a new state law banning abortions after embryonic cardiac activity is detected, usually around six weeks of pregnancy – often before a woman even realizes she is pregnant.
As the clock ticked away, with what felt like the world working against her, Nicole finally got her car to start. Soon, she ran across a wet parking lot into Aaron Women’s Clinic for her morning appointment.
If she’d had more time to think, she said, she may not have gotten the abortion at all. But without the flexibility to plan her future, or the resources to go to another state for the procedure, the mother of two said she made the best decision she could in the limited window she was afforded.
“I just had to honestly just make the decision quickly and say you know what, I’m 33 years old, I have a week and a half to kind of decide this, and it’s just going to be a ‘yes,’ honestly, at this point,” Nicole, who asked that her last name not be used, told CNN minutes before having the procedure.
As Texas’ law hurtles toward the US Supreme Court, women in Nicole’s shoes have been forced to make rushed decisions or travel hundreds of miles to access health care. The choice presents women with a staggering list of logistical challenges, including what to do about child care, how to cover the cost of travel and whether they can miss work – which, for many women, prove insurmountable. The restrictions not only control where women can receive abortions, but also impact both the type and timeliness of the procedure. And, for some, it means not receiving care at all.
The struggle transcends Texas. A wave of restrictive abortion laws is moving through legislatures across the United States, increasing barriers and mileage between women and abortion providers.
What’s more, some legal experts say there is a very real possibility that by next year, the conservative majority on the Supreme Court could overturn Roe v. Wade – the 1973 landmark decision that affirmed the constitutional right to abortion nearly a half-century ago. To do so would trigger abortion bans across a vast swath of the country and, in essence, strip away a constitutional right that has protected women’s choice for an entire generation.
As law professor Joanna Grossman put it, “It’s just a really scary time to be a woman.”
‘They are just in panic mode’
At Aaron Women’s Clinic – an abortion facility sandwiched between a pair of auto shops in north Houston that has been in business since a year before Roe v. Wade – Linda Shafer, the clinic administrator, peered into the beige waiting room. Small paintings of flowers hung on either side of 11 empty chairs, bringing a little burst of color to the otherwise drab room, where the blinds were fully drawn. Nicole barely kept her appointment that morning, but five others missed theirs.
Maybe it was the flash floods, maybe they couldn’t come up with the money in time, or maybe they just changed their minds. Regardless, rescheduling would not be an option. Shafer clutched the gold cross around her neck, knowing that come Monday, all five women would be too far into their pregnancies for the doctors at her clinic to help – and, if they still needed abortion providers, she would have to tell them to go out of state.
In her 22 years at the clinic, she’d borne witness to change after change in the state’s abortion laws – with restrictions steadily chipping away at her ability to serve patients. At this point, she said, women seeking abortions are often in tears while she’s resigned to a sense of helplessness.
Around the six-week mark, the patients “don’t know where to go, they don’t know what to do, they don’t have the funds,” she said. “They are just in panic mode.”
The new law has dramatically transformed Texas women’s access to abortion into an hourslong odyssey across state lines. Before the ban went into effect, women of reproductive age in the state – between 15 and 49 years old – had to drive a median distance of roughly 19 miles to the nearest abortion clinic, according to a CNN analysis. Now that Texas clinics are turning most pregnant women away, they are forced to drive a median distance of 243 miles to the nearest out-of-state clinic.
For some women in the Rio Grande Valley on the US-Mexico border, the nearest out-of-state clinic in the United States is 600 miles away, in Shreveport, Louisiana – a 10-hour journey each way.
One study examining Texas data found that a more than 200-mile increase in driving distance to the nearest abortion clinic can cut the abortion rate by as much as 44%.
“Throughout history, we have seen that patients of color, patients who live in rural areas and patients who have less economic means – they are the patients who are disproportionately affected by any barriers in health care,” said Kristina Tocce, medical director at Planned Parenthood Rocky Mountains, which includes New Mexico, Colorado and southern Nevada. “History is repeating itself,” she said.
A few organizations – including the Lilith Fund and Fund Texas Choice – help women by providing financial support for travel. But for some, that’s not enough.
“There are people who, it don’t matter how much money we give them, they can’t leave the state,” said the Rev. Katherine Ragsdale, former president of the National Abortion Federation.
For most women in Texas, the nearest providers across the border are clinics in Shreveport and Oklahoma City, according to a CNN analysis of census data and driving distances.
In September, Planned Parenthood clinics in nearby states saw more than 11 times as many patients from Texas than they had in previous years, the organization said. The only clinic in Shreveport told CNN that Texas patients now comprise 50% of its roster, up from 20% before the ban.
In search of available appointments, some patients are traveling even farther to see a provider sooner, said Emily Wales, interim president and CEO of Planned Parenthood Great Plains, which includes Oklahoma.
“They’re coming to other states, but the majority, I think, are actually waiting longer to stay closer to home,” she said.
Planned Parenthood reported seeing women from Texas at its clinics in Kansas, Colorado, Nevada and even as far as New York.
Most of the women the Aaron Women’s Clinic serves probably won’t make it out of the state, according to Shafer. She said most of her patients are from minority communities and often don’t have the resources to travel for an abortion. At the same time, she added, they can’t afford to have a baby.
All she can do sometimes, she told CNN, is pray for her patients.
“Lord, if it be your will … women need help too,” she said. “Don’t forget about us.”
Legal maneuvers leave women in limbo
As Gov. Greg Abbott signed the new law in May, he declared that “our creator endowed us with the right to life and millions of children lose their right to life every year because of abortion,” and said the bill would “work to save those lives.”
While Abbott echoed rhetoric used by anti-abortion activists for decades, the law he signed was unprecedented: It allows private citizens to sue abortion providers, in a novel method to evade judicial review.