Low-income and ‘landlocked’ undocumented women may have difficulty accessing care in the state, stoking fears that self-induced abortions will increase

This article is more than 5 years old

This article is more than 5 years old

Fewer Latinas are seeking care at a dwindling number of Texas abortion clinics, amid fears that the amount of women attempting self-induced abortions may be rising, according to researchers and advocacy groups.



The warnings arrived in the aftermath of a federal appellate court decision on Tuesday to uphold the most restrictive provisions of a law that could leave the second-largest state in the US with as few as seven abortion clinics.

Court upholds Texas abortion law that could leave state with only seven clinics Read more

“The implementation of … [this bill] will impact women throughout the entire state of Texas,” said Ana DeFrates, Texas director for policy and advocacy at the National Latina Institute for Reproductive Health. “We know it’s going to hit hardest for Latina communities, because those communities face formidable barriers to care to begin with.”

Texas governor Greg Abbott hailed the fifth circuit court of appeals’ upholding of an anti-abortion bill as a victory for “our most vulnerable – the unborn”.

But amid calls from doctors that low-income and undocumented women would be affected the most, opponents of the Republican-backed law have said they will ask the US supreme court to consider powers which they say could leave women across the vast expanse of Texas with access to just a handful of clinics, forcing them to travel more than 100 miles to seek an abortion.

DeFrates said undocumented women are unable to travel across the state for abortion care, because passing through internal border checkpoints outside cities such as Falfurrias, Del Rio and El Paso means they would risk deportation.

“Undocumented families are literally landlocked,” DeFrates said. “When you eliminate clinics that were south of those internal checkpoints, you limit access to care.”

By requiring that abortions be performed only in Ambulatory Surgical Centers (ASCs), the law has already forced the closure of all but a handful of clinics in Texas. A non-ASC border clinic in McAllen, Texas, is being provisionally allowed to stay open, but the El Paso clinic must close. Women in El Paso must either cross a state or national border to access abortion care, or drive 550 miles to an ASC in San Antonio.



The concerns about the restrictive law disproportionately affecting Latinas is backed by research from the Texas Policy Evaluation Project (TxPEP), a group that assesses the everyday impact of the state’s reproductive health legislation.



Daniel Grossman, on obstetrician and TxPEP co-investigator, said his team has found that fewer Latinas and fewer low-income women are seeking care at Texas abortion clinics. In the period just after the implementation of the bill last summer, Grossman said, “very, very few women were coming from the Rio Grande Valley” to Central Texas clinics. “They simply weren’t traveling there.”

Grossman also led a survey of women whose abortion appointments were cancelled after sudden clinic closures. In a survey of 20 such women, Grossman found that a majority suffered “significant delays” in trying to access care elsewhere, particularly as they had to scramble for transportation across the state, childcare and lodging.

Several women’s procedures were delayed into the second trimester of pregnancy, Grossman said, and two women were forced to carry their pregnancies to term.

Being forced to carry an unwanted pregnancy to term often pushes women and children into poverty, according to Diana Foster, an associate professor at the medical school of the University of California at San Francisco.

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In her research on women who are denied abortion care, Foster found women forced to carry unwanted pregnancies were more likely to live below the federal poverty level and more likely to receive public assistance than women who received abortions – even though the two groups had identical incomes at the time of seeking abortion care.

TxPEP researchers are conducting cross-sectional studies on women who seek care at Texas abortion clinics. They compile and analyze these women’s stories, but also collect demographic data about patients’ age, race, ethnicity and income.



In Texas, 3,767 women called the Lilith Fund for Reproductive Equity last year, seeking financial assistance for abortions. A full 83% of callers were women of color.

“People with means in Texas will always be able to get abortions,” said the group’s president, Susy Hemphill. “The demographic we serve mirrors the demographics of poverty.”

With so many clinics closing, and Ambulatory Surgical Centers acting more like operating rooms – with elaborate procedures and lengthy cleanings between patients – advocacy groups worried that the clinic substitutes would not be able to pick up the slack.

TxPEP has found a 70% reduction in medical abortions – abortions by pill – since the restrictive Texas bill was implemented. Because medical abortion was much more common in some border counties than in other parts of Texas, this reduction does not affect all women equally, said Joe Potter, the group’s principal investigator.

“Other people can get on a plane,” he said.

A 2012 TxPEP study published in the journal Contraception found that 12% of women seeking abortions along the Texas-Mexico border had attempted to self-induce before seeking care at a clinic. Statewide, 7% of women had. By comparison, a 2008 nationwide survey found that only 2.6% of women attempted to self-induce.

Grossman fears that these numbers will rise in Texas, and his team is working to document the data and the stories of Texas women who try to self-induce abortion. “Many women are using methods like herbs,” Grossman said, “but we’re hearing stories of women hitting themselves in the stomach or throwing themselves down the stairs.”

On Wednesday, police in Georgia dropped murder charges against a 23-year-old woman after she allegedly took a pill that terminated her pregnancy.

Georgia woman who took abortion pill has murder charges dismissed Read more

For undocumented women, said Hemphill of the Lilith Fund, “taking a 100-mile journey to access basic healthcare feels very dangerous. People will self-terminate”.

A Latina-led grassroots network of women training each other to self-induce abortions may be forming in Texas, while national pro-choice groups take the state’s fight to the nation’s highest court.

“While devastating and depressing, it does mobilize our community,” said DeFrates, of the National Latina Institute for Reproductive Health. “It’s moving us forward with conversations about abortion. Those conversations over time help eliminate stigma, and they help get people involved.”