How Texas has made it nearly impossible for low-income women to get an abortion. And how other states want to copy that.
Roe vs. Wade is expected to be struck down this summer, which would mean abortion will no longer be a federally protected right. If that happens, about half the states will probably ban abortion altogether, or make getting one a lot more difficult. But for those who live in Texas, especially in the Rio Grande Valley, it’s already hard to get an abortion.
Today, we look at how Texas has made it nearly impossible for low-income women to get an abortion. And how other states want to copy that. Read the transcript here.
Host: Gustavo Arellano
Guests: L.A. Times Houston Bureau Chief Molly Hennessy-Fiske
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Claire: I mean, I donated plasma, I did what I could. I pawned a lot of stuff. [deep sigh]
Abortion Series Mux in
Gustavo: Earlier this month, a draft opinion leaked from inside the Supreme Court itself… and stunned Americans of all political persuasions.
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Roe vs. Wade is expected now to be struck down to this summer and getting an abortion is no longer going to be a federally protected right.
If that happens, about half the states will likely ban abortions altogether or make getting one a lot harder.
< CLAIRE: Yea, that’s fine. Claire, C-L-A CLAIRE: …I-R-E Okay, and how old are you? CLAIRE: I’m 23.>> GUSTAVO: But for those who live in Texas, especially in the Rio Grande valley, it's already hard enough to get an abortion. CLAIRE: Thankfully I found this place. But I was still alone. That was probably the hardest part about it.>> GUSTAVO: I’m Gustavo Arellano. You’re listening to THE TIMES, daily news from the LA Times. It's Monday, May 16, 2022. < Before the Supreme Court announces its final decision, The Times is looking at the issue from a number of perspectives. Today... how Texas made it nearly impossible for low income women to get an abortion... And how other states... want to copy that. Mux bump to fade Gustavo: My L.A. Times' colleague and Houston bureau, chief Molly Hennessy Fisk, recently visited McAllen, Texas to report on the restrictions. And it's there that she met a young woman named Claire. Molly. Welcome to THE TIMES. Molly: Thanks for having me. Gustavo: So Claire, who is she? And what's her story? Molly: So Claire is 23 years old. She lives in the Rio Grande valley has lived there all her life grew up there. Claire: I'm a substitute teacher, and on weekends I'm a patient care tech. I'm a nurse. Molly HF: Oh, cool. Molly: And she's planning to start nursing school in the fall and eventually become a registered nurse. Claire: Yeah, I mean, right now I'm set up to start the LVN program in the fall, and I hope to keep going up until I get my BSN. I wouldn't mind furthering my education, but I think I'll wait until I see what path I like most. Gustavo: And you met Claire at this clinic called Whole Woman's Health. And it's the only abortion clinic in the Rio Grande valley in South Texas. Who does that clinic serve? Molly: That's right. Molly: So it's the only clinic for hundreds of miles along the border at this point, because over the years, restrictions in Texas have forced a lot of clinics to close. < Molly TAPE: So we're at Whole Women's Health clinic in McAllen, Texas. They've got 46 consults scheduled today. MUSIC beat It’s the afternoon and two got turned away because they didn't qualify under the state's new abortion law, SB 8. MUSIC beat Molly: So it's about 10 miles north of the border with Mexico. And it serves, uh, the Rio Grande valley region primarily, which is about 1.3 million people. Most of them, about 90%, are Latino like Claire. TAPE: They have about seven more patients before the end of today. We've been here since 8:00 AM and they're closing around five. < Molly: It’s pretty representative of the people who are getting abortions nationally. Most of the women, 75% of them, getting abortions are low income. And 60% of them are people of color, Black or Latino. Gustavo: Yeah. And the Rio Grande valley is like one of the most Latino, one of the poorest areas in all the United States. So what was Claire's situation at Whole Woman's Health? Molly: So Claire was aware of the new Texas law. She knew that she needed to come in within this narrow window of time. And the first time she came in, it was // a little bit too early. The ultrasound couldn't detect that she was pregnant. So they told her to come back again. Claire: So I came initially last week and it was still too early. Molly: And then she was nervous because she again was worried that she would come in too late. Claire: Um, today we found out that it was five weeks and six days. Molly: But, it turned out that she was right in time and she was still within the window. They couldn't detect any fetal cardiac activity. So she qualified to get an abortion there. Gustavo: And what are the Texas restrictions again? Molly: So basically, the latest law, which took effect last fall, says that doctors can't perform abortions, either medication abortions or surgical abortions if any kind of fetal cardiac activity is detected in an ultrasound, it's called the heartbeat law because of that. Because advocates, for the law said, you know, when there's a heartbeat, that's viability and you shouldn't be able to do an abortion. So the doctors have to look for that before they can do the procedures. Claire: I guess it doesn’t apply to me yet, because it's still super early, but I mean, I was scared because what if it was too late? Like if I'd been like last time, it would have been too late and I would've had to go out of state. Gustavo: ….this wasn’t Claire’s first time at the clinic… Molly HF: That's right. So the last time she was there was back in 2019, before this law passed and, uh, that requirement wasn't in place. And she actually came in later that time because she had become pregnant as a result of an assault. Claire: Okay maybe if I say it fast, oh my gosh. I was at a party with some friends. And there was this guy that was like, not drinking. He just looking at me down, like staring at me the whole time. I kind of blew it off, but I asked my friends and they were like, oh, he's just a friend of a friend. And I had just turned 21 cause it's 2019, it's my second time drinking. And I went all out because it was one of my friend's birthdays. Molly: She later passed out and when she woke up, she had been assaulted and she went to a hospital. She had a rape kit done. She reported it to the police. They never caught her assailant… Claire: And then some weeks passed and I mean, I was feeling sick and it happened. I mean, I didn't know who to tell or what to do. I didn't even know that there was like a clinic here despite living here my whole life. I never knew there was a clinic here. Molly: She went to the clinic. She was pregnant and she was able to get a medication abortion. Gustavo: In the two times she's gone, has she had much support from those around her? Molly: Not really… MUSIC IN Molly: like the other women that I talked to when I was at the clinic, um, she described coming from a conservative family, religious family. Claire: So both times I hadn't really told anybody Molly: Like in your family… Claire: No friends, no family. Molly: Why? MUSIC BEAT Claire: I personally feel kind of ashamed of it. I don't like talking about it. I feel like it's just too personal. I don't want people thinking differently of me. Molly: She said her dad, didn't approve of sex before marriage. Claire: I mean, even when he found out, like I was sexually active, he didn't talk to me for like a long time, he was super against it. Molly: And so, you know, having an abortion would be just a step too far. And she wasn't even sure how he would react. So she didn't tell him. And it's not just, feeling uncomfortable, telling people it's feeling uncomfortable asking for help, financial support, transportation, all the things that it takes to be able to get an abortion. So their options were, were even further limited because of the cultural norms in the valley. Claire: Yeah. And I mean, nobody really talks about it. I guess it's like the elephant in the room. 'Cause I know there's a lot of women who come and I'm sure I know somebody who's come before, but nobody really talks about it. < Gustavo: Molly, how much do abortions typically cost at the McAllen clinic and how does that compare to other places? Molly: At the McAllen clinic, medication abortions for the women I talked to technically costs, $700. They got assistance from abortion funds, nonprofit funds that help women cover the costs of both procedure, and in a lot of cases, transportation as well. The average cost of an abortion in California is about $300 for a medication abortion, about $900 for a surgical abortion. But that varies based on how late in a pregnancy you’re getting the procedure done or the medication. It, generally later abortions are much pricier in, in all different states. Gustavo: So in the states where the abortions are hard to get, like Texas, how do people usually pay for them? Like for Claire, for instance, I can't imagine it was easy for her to be able to pay for the procedures. Molly: No it wasn’t. And remember, Claire had an abortion back in 2019, and then this one. So back in 2019, one of those abortion funds that I mentioned helped her pay for it, but it only paid for about half. Claire: I did what I could. I found the money somehow for it. I think it ended up being $300 or $400. Molly: So she had to sell things, pawn her PlayStations. Music In Claire: Like one of my old instruments from like high school, like, uh, my saxophone. That got me enough at the time. Molly HF: This time around, abortion funds helped her cover the entire cost of the procedure because nationally, abortion funds are really focused on Texas and the needs there. Claire: So this time I don’t have to pay anything, thankfully. Very thankful for that. Mux in to take us to break Gustavo: Coming up after the break, the extra barriers that Texas is putting in place for women like Claire. Mux out - BREAK 1 Molly TAPE: So we're back at the clinic, and we've come to follow up with some of the patients who we met yesterday, who had their ultrasounds and, they were within the legal limits to get medication abortion. And so we're going to sit in with them as the doctor explains to them, how to take the medication abortion and the follow-up. Gustavo: Molly, because Claire was under that six week limit that Texas now requires for an abortion, because of that so-called heartbeat bill. She could come back to the clinic the next day and end her pregnancy by taking abortion pills. What exactly is the process? Molly: At the McAllen clinic, what we saw was women were given to abortion drugs, mifepristone and misoprostol. Blair Cushing: So, um, before we actually get started with the pills, um, the first thing that I always like to go through is just a couple of things that you're going to get from inside this white bag. Okay. Molly: And the doctor explained how to take the mifepristone first… Blair Cushing: Okay, so whenever you're ready, I'm going to pop this one out for you, and then you can just swallow it with water, just like you would a regular pill. Molly: And then later how they were supposed to put the misoprostol pills in their mouth and let them dissolve. Blair Cushing: So inside you’ve got the same four tabs. And what you do with these, if you recall, is that you're going to dissolve them. So take those four, and you’re going to place them two and two between your cheek and gum on the bottom and let them sit there… Gustavo: And the doctor that explained all this to Claire, uh, her name's Dr. Blair Cushing. She's actually from California. So what is she doing at McAllen? Molly: The McAllen clinic has had a lot of trouble finding local doctors who are willing to work, uh, at an abortion clinic. MUSIC IN Molly HF: Okay. So could you say your name again and your title and what you do at the McAllen clinic? Blair Cushing: Yeah. So, um, my name is Blair Cushing. Um, I am a family physician by training and I'm at the McAllen uh, site of all women's health… I'm one of the primary physicians offering abortions there. Molly HF: So Dr. Cushing, who went to medical school in Texas and is familiar with the region, has been flying in twice a month to help out for about three days, each rotation. Blair Cushing: I had really always intended to go back to Texas. While I was a medical student, I had done reproductive health elective working with an abortion clinic in the Dallas area at the exact same time when, um, HB 2 two went into effect, which was like sweeping abortion restrictions that happened in the fall of 2014, that led to the most clinic closures at that time. Molly: She has found a lot of similarities between the population she serves in, the central valley, and the Rio Grande valley. The biggest difference being the difference in, in the restrictions. Mux out Gustavo: I noticed that Claire had to go into the clinic twice to see Dr. Cushing. Is that a part of the Texas restrictions you were mentioning? Molly: Yeah, that's a big difference between Texas and some of these states with more restrictive laws, and states like California. You are required by state law to come in and get the medication abortion in person. A doctor has to provide it. And there’s a waiting period, just like there is for a surgical abortion. One important thing to remember about abortion access in Texas is that, as opposed to California, first of all, we've had a lot of cutbacks in women's healthcare overall. And so those cutbacks have influenced access to abortion because you've got fewer clinics. You've got fewer providers that low-income women can turn to, to even get medical care. Blair Cushing: So when I tell people about McAllen, I think one of the most important things to recognize is how challenging it is to even get basic care for anything. Right, like aside from abortion… Molly: We don't have Medicaid here like you do in California and other states. A lot of women in the Rio Grande valley are completely uninsured, haven't been in, even for routine things like pap smears. Blair Cushing: So, um, I usually tell people that you're dealing with a higher risk population just by virtue of that, that you're oftentimes seeing patients that like they haven't seen another doctor. Um, they might have chronic conditions that aren't known, like not previously recognized, not previously treated for a number of our patients. Molly: So you've got that. And then on top of it, you've got abortion restrictions that have passed over the years. Things like requiring women to come in in person for medication abortion that can only be administered by a doctor that's different in California and other states Blair Cushing: And none of this stuff is required there. They're like, this is so easy there that I can have a telemedicine visit with you and we like FedEx, you the pills, you never see me. You never get an ultrasound. None of that. Molly: In Texas, minors have to have parental consent. Doctors have to read a particular script. They have to show women an ultrasound, they have to have the ultrasound. So you add all of this on top of the lack of access and the fact that many aboriton clinics have closed and that really restricts access overall. Gustavo: There’s also that heartbeat bill that you mentioned earlier…Senate Bill 8….it gets around Roe v Wade and empowers private citizens to report people who not only seek abortions, but even help them to try and get one… and now…other states are copying it. Molly: That's right. Just last month, Oklahoma passed a copycat law of Texas’ so-called heartbeat law. CLIP: Abortions would be prohibited in Oklahoma after about six weeks of pregnancy when a heartbeat can be detected in the embryo. Molly: South Dakota's governor has introduced one… CLIP: The proposal will prohibit abortion once medical professionals can detect fetal cardiac activity and mimic the Texas law with private enforcement. Molly: And there's other states that actually passed them already, but they got suspended by the courts. If Roe V Wade falls, those laws would be allowed to take effect. Gustavo: What have these restrictions meant for abortion providers like Dr. Cushing? Molly: Dr. Cushing told me that since the Texas law took effect last fall, she's had to turn away about 40% of patients. And that’s after her staff at the clinic are already screening people out. So there’s already a lot of women who are being turned away and can’t get abortions in Texas. MUSIC IN Blair Cushing: Either they're too far along, sometimes they might be so early on that, like there was no pregnancy identifiable by ultrasound… Molly: But studies have shown like the University of Texas did some studies that showed a lot of women have been able to go out of state to get abortion. So while the number of abortions in Texas itself has been halved, the number of women in Texas, able to get abortions has only gone down about 10%. The clinic and Dr. Cushing also have to spend a lot more time counseling patients and helping them find other places to turn if they've been turned away. So for instance, she said, she spends a lot more time looking at flights… Blair Cushing: So, um, but I, I frequently will check the flights on my own to see like, where could you go? So some of the discount airlines fortunately have started offering direct flights to Vegas, Denver, Orlando from McAllen and Harlington. And so I tell people about that. Molly: She’s explaining to people, many of whom have never left the valley, let alone Texas, or gotten on a plane. How to avoid connecting flights, how to go to places like, like Las Vegas or Orlando so that people won't ask why they're traveling. Blair Cushing: And I also know that like, if you were to tell somebody that you're going to Vegas for the weekend or Orlando, they're usually just going to be like, oh, high five, have fun on your vacation. They're not going to say, why the hell are you going to Albuquerque? What are you doing in Louisiana? so yeah… BEAT Gustavo: But is crossing state lines really an option for many people looking for an abortion? That’s…after the break. Mux out Break 2 Gustavo: Molly, you were mentioning that Dr. Cushing arranges for women to be able to travel out of state to get abortions. But how realistic does she say that option is for people in the Rio Grande valley? Molly: It's very difficult. Just getting out of the Rio Grande valley to go somewhere else usually takes a full day of travel. Blair Cushing: It's just like an entirely different beast. Because you're not talking about a single day trip where I drive three hours across the border to Oklahoma, or can even get on a direct flight somewhere where there's even an option for me to come home again the same day. Molly: There's a lot of other barriers that she said when she goes back to California and talks to people about it, they just really don't understand how insurmountable it can be. Blair Cushing: I think of some of the critique, I guess, I've heard from people in California, like why aren't people in Texas fighting back and like, well, why don't they do this? Or why don't they do that? And people here in California, can't understand that this is a situation, where the wage, the minimum wage is less than half of what the minimum wage is in California. Molly: Studies show that women seeking abortions already have at least one child. It's difficult, like some of the women I talked to, you said to get time off from work… Blair Cushing: Nobody's guaranteed benefits. Like they aren't given sick time. They aren’t given paid time off. That's guaranteed by law… Um, everybody doesn't have the actual. To health insurance, abortion. Isn't covered by Medicaid there, the way that is in California. So there's so many different things. Molly: To ask for help from family who are going to be, one wondering where they're going, what they're doing. And so even getting an abortion fund or some other group to help them with the cost of the procedure and travel doesn't counteract all that other stuff that they face. Blair Cushing: Your life circumstances aren't just eliminated because somebody is helping to give money for a plane ticket or to pay for the abortion itself. You know? Gustavo: And then there's another route that more and more women in the area seem to be taking. You mentioned McAllen’s just basically right there on the US-Mexico border. Molly: Yeah, a lot of women I talked to at the clinic said their backup plan was to cross the border and see if they could buy abortion medication there. Claire thought about it. Claire: I was thinking of even going to Mexico. Cause it's like right here. Molly: She was worried about potential side effects or complications. Many of them know women who've done that and experienced complications like excessive bleeding and had to go to the hospital. Mux in Molly: After I talked to the women at the McAllen clinic, who had said that going across the border and getting abortion medication was their backup plan. I decided to cross myself and I went to Nuevo Progreso, which is one of these border towns in the Rio Grande valley. Because it's very popular for folks from Texas to cross, it's known as a very safe crossing, very touristy. Mux beat Molly HF: I'm here in Nuevo Progreso, Mexico. I just parked on the other side of the border crossing in Progreso, Texas, and walked across the bridge, spanning the Rio Grande. I'm about to go visit some of the pharmacies here. There's a lot of pharmacies and dentist offices. Molly: It is legal to cross the border and buy misoprostol in Mexico and bring it back. It's a weekend, a Saturday, so there's lots of people buying food, but also, uh, medicine, which is a lot cheaper here. And you can buy a lot of things without a prescription. Including a misoprostol, uh, a self-managed abortion medication. So I'm going to go around and talk to some of the pharmacists about how I could get that, how much it costs and what instructions I should follow if I take it. Mux out Gustavo: Women going to Mexico forabortion pills, you wrote about that in 2016. Did you notice any differences this time around visiting? Molly: Most definitely. There were a lot more pharmacies carrying the pills it seemed like. And they had more women coming in to get them, they said. But some of the instructions that I received were very inaccurate. Molly HF: So I went and talked to a number of pharmacists. One pharmacy worker said he couldn't give me specific instructions on how to use it for a self managed abortion. He said to look online, to Google it. And another guy told me to take one pill starting early in the morning, once an hour for six hours, and then to jump up and down, and then that would expel the embryo. Molly: He even jumped up and down to demonstrate. That is not correct. Gustavo: Wow. Any other concerns about these pills in Mexico? Molly: So Dr. Cushing says at the McAllen clinic, she sees a lot of women who come in, who have taken misoprostol, the abortion medication that they got in Mexico. But have had a high failure rate because of bad information that they got from the pharmacies in Mexico. She also said that she has been seeing, since the Texas law passed something new, which is women coming in, who had gotten an injection in Mexico called methotrexate, which is a drug that was used to perform abortions in the United States back in the ‘60s, but has fallen out of use because it's um not as safe as alternatives. Blair Cushing: The other scary thing about it is that if misoprostol doesn't work, the likelihood of that pregnancy now ending up with severe birth defects is like quite low. With methotrexate, it's quite high, especially with injectable methotrexate, which can see in your body for many, many months after the fact Gustavo: All these restrictions, Molly, all these obstacles, financials, cultural, all of this. What does that mean for the future of abortion and the Rio Grande valley and places like it? Mux in Molly: I think what we're seeing in Texas is what we're going to see across the country if Roe falls… Claire: And if they’re anything like me, like it's either financially, emotionally, they don't have like the support or something. Like it's hard. It's just more pressure. I feel like it's just taking away more of women's rights over their autonomy. Molly: If Roe falls, and all the surrounding states start banning abortion, a lot of low-income women are going to have to spend more money, travel further to get even medication abortions or else they're going to have to turn to medication from Mexico and they may suffer, pretty serious side effects. Mux beat Molly: And if they do, what we also will likely see is women going to hospitals and this issue of pregnancy criminalization. So last month in Texas, there was a woman, a young woman, Lizelle Herrera, who went to a local hospital after having a self managed abortion with abortion medication. And she was charged with murder because of the Texas abortion restrictions. And it was only because of protests outside of the jail and then on social media that the local district attorney was pressured to release her and drop the charges..But we've seen similar, um, pregnancy criminalization in other states with restrictive abortion laws. And we will likely see more of that if Roe falls. Mux out Gustavo: Molly. Thank you so much for this conversation. Molly: Thanks for having me. Blair Cushing: Any questions? Claire: Uh, no I don’t think so. Blair Cushing: Okay. You're all set then. So pills, prescription, everything else that we talked is in this white bag for you. So I’ll give you that. And then, um, are you parked in the parking lot? Yes. Okay. BREAK 3 Outro mux in Gustavo: And that's it for this episode of THE TIMEs, daily news from the LA Times. Kasia Broussalian was the jefa on this episode and our show is produced by Shannon Lin, Denise Guerra, Kasia Broussalian, David Toledo, Ashlea Brown and Angel Carreras. Our editorial assistants are Madalyn Amato and Carlos de Loera. Our engineer is Mario Diaz, Mark Nieto and Mike Heflin. Our editor is Kinsee Morlan. Our executive producers are Jazmin Aguilar and Shani Hilton. And our theme music is by Andrew Eapen. And by the way, THE TIMES and KCRW are co-hosting a debate with some of the top LA mayoral candidates later this month, and it's focused on homelessness. So if you have any questions you want me to ask them, I'll try. 619-800-0717, 619-800-0717.Call or text me with any questions you might want me to ask the mayoral candidates. And me, I'm Gustavo Arellano. We'll be back tomorrow with all the news and desmadre .Gracias.
Mr. Chief Justice, and may it please the court…