A year after Dobbs decision, Texas has settled in to a post-abortion reality

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When the U.S. Supreme Court overturned Roe v. Wade, many in Texas, the largest state in the nation to ban nearly all abortions, began to cycle through the stages of grief.

There was denial and anger, as thousands poured into the streets, promising to never stop fighting to turn back the clock and restore abortion access. There was bargaining, in the form of a last-ditch lawsuit to keep clinics open a few weeks longer, and depression, when it failed to change the new legal norm.

Now, a year after the Dobbs v. Jackson decision, an uneasy acceptance has settled over Texas, as even the most ardent abortion advocates acknowledge these new laws aren’t changing anytime soon.

“I don’t see the legal landscape of our state shifting in a major way, certainly not in the short-term future,” said Neesha Davé, executive director for the Lilith Fund for Reproductive Equity, an Austin-based abortion fund. “And so, unfortunately, we have had to figure out how to navigate the current legal landscape, if for no other reason than there are people who need abortion care today, yesterday, tomorrow.”

There are ongoing court challenges to Texas’ laws, but they are narrow and could drag through the courts for years. There is still momentum around meaningful political change, but that is the work of decades and much of the focus has shifted to shoring up the social safety net as a stop-gap measure.

Meanwhile, despite exceptions to the law, the number of monthly abortions in Texas has dropped into the low single digits. Women are nearly dying from pregnancy complications, or actually dying after having to travel out-of-state for abortions, or facing million-dollar lawsuits for helping friends acquire abortion medication. An unknown number are having babies they never planned for.

A year after the U.S. Supreme Court ruled in Dobbs v. Jackson that there is no constitutional right to abortion, some long-time advocates see hope in the hopelessness. They’ve been sounding the alarm about the overturn of Roe and its consequences for years, and finally, people are forced to pay attention.

“There are so many more conversations happening about abortion today than there were two years ago,” Davé said. “I do think a tide is turning. It just takes time.”

Clinics closed, but abortions continue

Dr. Alan Braid first started performing abortions in Texas shortly after Roe v. Wade was decided in 1973. Over the last 50 years, he built two clinics, raised a family and merged the two after his daughter, Andrea Gallegos, came in to help run Alamo Women’s Reproductive Services in San Antonio and Tulsa.

Together, this multigenerational Texas family business weathered protesters and lawsuits and ever-increasing restrictions from the Legislature. But on June 24, 2022, that all came to an end.

Immediately, the clinic stopped performing abortions. A few weeks later, they closed their doors for good. And one year later, Braid has moved to Albuquerque, New Mexico, and Gallegos is preparing to move her family to Carbondale, Illinois, each to run one of the two new Alamo clinics.

“This is my home state, and I feel like I’m abandoning it, in some sense,” Gallegos recently told The Texas Tribune. “But on the other hand, all we can do right now is to provide a viable option, even if it still feels crazy to say that a clinic that is 10, 13 hours away is a viable option.”

The New Mexico clinic primarily sees people driving and flying in from Texas, while the Carbondale clinic mostly gets people driving from Indiana, Missouri, Kentucky and other southern states, Gallegos said. But even there, 10 hours from Dallas and two hours from the nearest airport, they see some Texans.

“People are making journeys that long to get to us, and they’re incredibly grateful for it,” Gallegos said. “But, of course, I will always be most concerned about the folks that cannot travel and … the many more patients we don’t see.”

People who have abortions tend to be low-income and already have at least one child, national statistics show. Many of their patients struggled to find time off of work, child care and transportation to make it to a local clinic, Gallegos said, let alone a multiday, out-of-state journey.

As abortion restrictions have tightened over the last few decades, grassroots abortion funds have popped up across the state, helping Texans pay for the procedure and related costs. When Texas banned nearly all abortions after about six weeks of pregnancy in September 2021, these funds became the main infrastructure helping Texans to seek abortions in nearby states.

But immediately after the ruling came down in late June, many of these groups stopped distributing funds, citing the legal uncertainty about their work.

A group of these funds ultimately filed a federal lawsuit, asking a judge to clarify whether their work in-state that helped people travel out of state could make them vulnerable to prosecution.

“Because we’d faced threats of criminalization from anti-abortion state leaders, we knew we couldn’t resume our key work, this core part of our mission, with this uncertainty,” Davé said.

While they awaited a ruling, many of the abortion funds focused on funding other reproductive health care and distributing emergency contraception. Finally, six months after the suit was filed, a judge granted a temporary injunction and the abortion funds tentatively resumed paying for out-of-state abortions and travel.

Davé said re-opening their funding hotline has revealed how much confusion persists, a year into this new landscape.

“I had a caller recently who did not realize they couldn’t access abortion care at a clinic in Texas,” Davé said. “I was the one who had to tell them that.”

Davé walked her through her options, and ultimately Lilith Fund helped pay for a sonogram with a health care provider in Texas. The caller said there was just no way she’d be able to get time off of work for a last-minute, out-of-state trip.

“It’s just staggering and overwhelming to figure out for most people,” Davé said. “We’re thrilled that we can support people as they’re navigating these barriers, but it’s still incredibly difficult.”

Such barriers are creating ripple effects, even for those who are able to travel out of state. In one particularly shocking case, a 26-year-old Dallas woman who traveled to Colorado to terminate her pregnancy was shot and killed by her boyfriend upon her return.

“It is believed that the suspect was the father of the child,” the affidavit said. “The suspect did not want the complainant to get an abortion."

It’s almost impossible to know the true number of Texans who are terminating their pregnancies despite the restrictive laws. While some are traveling to out-of-state clinics, others are quietly obtaining abortion-inducing medication — at pharmacies just over the U.S.-Mexico border, through newly created whisper networks or by ordering the drugs online.

Aid Access, an international telemedicine abortion provider, saw a surge in demand for the two-drug regimen since the decision came down, according to research from the University of Texas at Austin.

Most of this is happening out of the public eye, but the ease of access has infuriated anti-abortion groups, who are seeking ways to crack down on the medication.

In Galveston, three women who helped a friend obtain the medication are facing a million-dollar wrongful death lawsuit brought by their friend’s ex-husband. Two of the women have counter-sued. The ex-husband is represented by prominent anti-abortion lawyers, including former Texas Solicitor General Jonathan Mitchell and state Rep. Briscoe Cain, R-Deer Park.

In a wider-reaching effort to stop the proliferation of the medication, a group of anti-abortion doctors and medical associations filed a lawsuit last year seeking to revoke approval of mifepristone, a common abortion-inducing drug. U.S. District Judge Matthew Kacsmaryk of Amarillo, formerly an anti-abortion religious liberty lawyer himself, agreed to stay the medication’s approval, effectively removing it from the market; the U.S. Supreme Court has put his ruling on hold temporarily.

But while many people are finding ways to circumvent Texas’ laws, an unknown number are likely deciding to just follow through with their pregnancies. In a state with high, and increasing, maternal mortality, staggering uninsured rates and persistent housing issues, advocates say Texas is not prepared to support these parents.

A 2022 study from the Commonwealth Fund found that states that restricted abortion access after the overturn of Roe already have worse maternal health outcomes, greater health care inequities and more maternity care deserts than states that have protected abortion access.

Impact on wanted pregnancies

Lauren Miller didn’t know it yet, but on the day Roe v. Wade was overturned, a clock started ticking. June 24, 2022, was the first day of her last period before she got pregnant, the date doctors use to calculate gestational age.

She didn’t realize she was pregnant until about six weeks later when she started having “frat boy burps” at her son’s 1-year-old checkup.

“That was my first symptom with my son, so my husband started teasing me like, ‘you’re pregnant,’” she recalls. “It had taken us a while to get pregnant the first time, so I didn’t think so, but I took a test and, yep, sure enough.”

Her excitement was immediately replaced with horrible nausea and vomiting, unlike anything she’d ever experienced before. Within a week of that pregnancy test, she’d thrown up more than her entire first pregnancy combined. Eventually, she had to go to the emergency room for dehydration.

There, she learned she had hyperemesis gravidarum, an extreme form of morning sickness, and she had it for two — she was pregnant with twins.

“I was just in complete shock, but then started getting really excited,” she said. “I’ve always wanted three, so it was kind of like ‘buy one, get one free’ at the Miller house.”

She told everyone and started planning a celestial-themed twins nursery. But soon, it became clear that “baby B” wasn’t developing as quickly as his twin and had large fluid masses growing where their brain should have been.

They did more tests and learned the situation was far worse than they initially thought. “Baby B” had Trisomy 18, also known as Edwards’ Syndrome, and was developing without a proper brain, heart or stomach.

Everyone Miller spoke to — the doctors, the specialists, the genetic counselors — told her this baby wouldn’t survive outside the womb.

“And they all said the same thing: Every day that he continues to grow, it puts his twin and yourself at greater risk,” she said.

But time and time again, that’s where the conversation stopped. After presenting her with the problem, her doctors seemed frozen when it came time to discuss the solution. She saw the fear in their eyes as she peppered them with questions, trying to parse the silence to figure out what her next steps might be.

Miller knew what was holding them back. While her pregnancy might eventually endanger her life, and the other life she was carrying inside of her, she wasn’t yet on the brink of death, trapping her doctors in legal limbo. Eventually, one specialist stopped yet another test, ripped off his gloves, threw them in the trash and turned to Miller and her husband.

“He said … ‘This baby isn’t going to make it to birth. You need to go out of state,’” she said. “It was really refreshing that he was so blunt because nobody had been to that point.”

The Millers got together the money to buy a last-minute flight to Colorado, as well as child care for their 1-year-old. Five months pregnant with twins, still horribly nauseous, Miller shoved herself into a middle seat next to a man eating Whataburger and thought about what had brought her to this point.

“Instead of being able to do this 15-minute procedure in my doctor’s office and go home, I’m sneaking out of Texas to do this shadowy thing,” she said. “I felt like the property of the state of Texas, just because I was carrying a baby that wouldn’t even survive.”

At a hospital in Colorado, she took one last ultrasound photo of her two boys together, then had a selective fetal reduction. She considers it an act of love for all three of her sons, including “Baby B,” who they named Thomas.

“This was the most mercy we could give him,” she said. “And I don’t intend to ever hide it from my boys, that Henry had a twin and if we hadn’t gotten an abortion, he may not have made it either, and for Logan, you may not have had your mommy.”

But when they returned to Texas, that openness seemed fraught. Miller was too scared to talk with a therapist about her decision, and even at her next doctor’s visit, they all seemed to speak in code. Eventually, she connected with the Center for Reproductive Rights, which was assembling a lawsuit on behalf of women who had suffered pregnancy complications as a result of Texas’ abortion laws.

“They gave me my voice back,” she said. “I was nervous about speaking and being public, but I am in a place of privilege and I recognize I have to use that. … The way the law is in Texas right now, layers of privilege determine who has access to health care. And it shouldn’t be that way.”

The lawsuit asks the court to clarify Texas’ abortion laws, which currently say abortions are allowed only to save the life of the pregnant patient. Miller is one of 14 women, including her own OB/GYN, who say the vagueness of the law led to them being denied medically necessary procedures.

The lawsuit does not ask the court to block the laws more widely, however. Molly Duane, senior staff attorney at the Center for Reproductive Rights, said they have to be “realistic” about what is achievable through the courts right now.

“We are cognizant of the fact that any lawsuit seeking to expand abortion access in the state of Texas will be an uphill battle,” Duane said. “I want to emphasize that this lawsuit is the beginning, not the end.”

Miller, who has always wanted three children, said this whole experience has made her and her husband very wary about getting pregnant again. In that sense, she said, these laws are having the opposite effect — discouraging people from having wanted pregnancies by diminishing the quality of care they feel they can receive in Texas.

“If you want babies, you need obstetricians,” she said. “Who’s going to want to come practice in Texas with these laws and this risk? That should scare every Texan, no matter how you feel about abortion.”

Disclosure: University of Texas at Austin has been a financial supporter of The Texas Tribune, a nonprofit, nonpartisan news organization that is funded in part by donations from members, foundations and corporate sponsors. Financial supporters play no role in the Tribune's journalism. Find a complete list of them here.

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