Long before Texas’s Senate Bill 8 (S.B. 8) went into effect on Sept. 1, making it the most restrictive abortion ban in the country, abortion rights advocates, providers and funds have been trying to interpret what the measure could actually mean for them, especially its most unprecedented provision: Private citizens, even people who live outside the state, are empowered to sue anyone they think may have “aided or abetted” someone getting an abortion after six weeks — before most people know they’re pregnant.
Many believe that, for those trying to access abortion care, anyone within their support system — from the doctor who administers the procedure to the fund that pays for their fees, and even the person who drives them to the clinic — could be liable for a civil suit for $10,000 for each abortion.
“That vagueness is definitely on purpose to confuse people and deter them from accessing the resources that they need, including calling clinics or abortion funds for their services,” said Nancy Cárdenas Peña, Texas state director for policy and advocacy at the National Latina Institute for Reproductive Justice (Latina Institute).
Antiabortion groups have praised the law as progress for their movement. “To have a significant piece of pro-life legislation that takes effect when it was scheduled — that almost never happens,” John Seago, legislative director for Texas Right to Life, the antiabortion organization that helped draft the bill, told The Lily when the law went into effect. “It’s a phenomenal victory for our movement.”
While the right to an abortion is still protected by Roe v. Wade, abortion rights advocates fear that S.B. 8 will effectively isolate a pregnant person from receiving abortion care in Texas — eliminating abortion rights for 85 to 95 percent of all birthing people in the state, according to providers. What’s more, advocates say, people of color, who already experience higher rates of unintended pregnancy, higher maternal mortality rates, and unequal access to quality reproductive care and social services, will bear the burden of this law.
“Black womxn live in a state where there is already little to no support to provide care for any newly created family units,” said the Dallas-based Afiya Center in a statement. “[Temporary Assistance for Needy Families] and [the Supplemental Nutrition Assistance Program] are already overburdened and not fully funded for 100-percent participation. The [Child Protective Services] system is overloaded. Communal support is overextended. And lawmakers have decided that the best course of action is to make the ultimate decision on whether or not to have children.”
For Indigenous, immigrant and undocumented pregnant people, who represent some of the most marginalized groups in Texas, access to abortion is deeply entangled in other structural and historical issues. Many already experience some form of abortion prohibition, according to advocates, and S.B. 8 only serves to further cement this reality.
The main barrier to abortion access for these groups before S.B. 8 was financial, according to advocates. Since 2017, Texas law has forbidden insurers from covering abortion in both state-regulated and private plans (unless the patient is in danger of death or serious physical injury), leading pregnant people seeking the procedure to either purchase separate abortion insurance or pay out of pocket. Abortions typically cost between $300 and $800 for a medication abortion and between $300 and $1,500 for a surgical abortion, according to the American Civil Liberties Union of Texas — a burdensome fee for low-income pregnant people, especially considering additional costs, such as travel and child or elder care.
Some pregnant people are instead forced to carry unwanted pregnancies to term even when they can’t afford to. The annual cost to raise a child in this country is around $15,000. For those who cannot bear the expense — who are more likely to be people of color, given the country’s racial wage gap — it can trap them in a cycle of poverty.
Indigenous women and gender-nonconforming people have long been subjected to a de facto abortion ban, advocates say. Many Indigenous people cannot afford private health insurance, so they rely on the federal Indian Health Service (IHS), which serves as the main health-care provider to about 2.5 million American Indians and Alaska Natives. IHS was a provision born from treaties Native peoples entered into with the United States, for land seized. As a federal agency, it’s subject to the Hyde Amendment, which blocks federal funds from covering abortion services. That has historically made abortion for low-income pregnant people — especially people of color — a privilege, not a right.
“We’re the only race in the country that is denied access to abortion merely because of our race,” Charon Asetoyer (Comanche), founder and executive director of the Native American Women’s Health Education Resource Center on the Yankton Sioux reservation in South Dakota, told Indian Country Today. “We access health care through the federal government, and the federal government prohibits funds for abortion services.”
For Native women, limited access to abortion care can be devastating, advocates say. (According to 2012 Justice Department statistics, 1 in 3 Indigenous women is raped or is a victim of attempted rape.) Nearly half (46 percent) of Native women have their first child before age 20, and American Indian and Alaska Native women are 2½ times more likely to suffer a pregnancy-related death than White women.
“Indigenous peoples have been treated as if we don’t know how to manage our own land and families, thus having the government do it,” said Rachael Lorenzo (Mescalero Apache, Laguna Pueblo and Chicana), the abortion access lead at Indigenous Women Rising, via email.
Indigenous Women Rising is the only abortion fund in the country dedicated to assisting Native women and is culturally sensitive to their specific needs, according to Lorenzo. For example, many live in multigenerational households, where mothers are also caregivers of their parents or other elders, which, in Texas, could make it difficult for them to leave to access abortion services potentially hundreds of miles away. Indigenous women and queer people also suffer from extraordinarily high rates of violence, so the group is mindful of how and when it engages callers. “We are intimately familiar with the unique circumstances our community members are in,” said Lorenzo.
Abortion is not covered by Medicaid in Texas (unless in cases of rape, incest or life-threatening conditions — and S.B. 8 outlaws two of those three cases after six weeks of gestation), but it is in New Mexico, the only state neighboring Texas that doesn’t have a “heartbeat” law and where Indigenous Women Rising is based. That partly explains why most callers are from out of state, especially from conservative states, according to Lorenzo.
When S.B. 8 went into effect, the group anticipated an influx of calls from Indigenous people in Texas who would need abortion care, Lorenzo said: “We have spent the last week letting abortion funds and clinics nationwide know we are open and have funding to help.”
For low-income immigrants, accessing affordable health care can be extremely difficult. Most lawful permanent residents must wait a minimum of five years to be eligible for Medicaid, and that’s only if they meet all other eligibility criteria; in 2019, 25 percent of lawfully present immigrants and 46 percent of undocumented persons were uninsured, compared with 9 percent of U.S. citizens.
And while Medicaid does not cover abortion services because of the Hyde Amendment, it can be a crucial means of accessing contraceptives or other family planning services. Nearly half of uninsured Asian Americans are not citizens, and because undocumented community members are barred from Medicaid or buying insurance through the Affordable Care Act marketplace, those in financially vulnerable positions may have no other avenues to affordable health care.
“Immigrant women experience much higher rates of uninsurance than U.S.-born White Americans,” said Sung Yeon Choimorrow, executive director of the National Asian Pacific American Women’s Forum (NAPAWF), one of the only groups in Texas speaking to Asian American and Pacific Islander (AAPI) communities specifically about reproductive health, in an email. “Without insurance, contraceptives become expensive to afford.”
What’s more, language barriers present their own challenges. Community members with limited English proficiency are less likely to have a primary care doctor they see regularly or a usual place they go to for their health-care needs and emergencies, Choimorrow said.
“S.B. 8 will further isolate low-income and immigrant AAPI’s by putting abortions out of reach in terms of cost and accessibility,” she said.
There’s also the issue of documentation.
In Texas’s Rio Grande Valley, only one abortion clinic remains open today, to serve a population of more than 1 million. With S.B. 8, it’s a race against time for patients in the region to secure an appointment before the six-week mark. Many are anticipating to travel out of state for care (if they can afford the travel costs), but for those who are undocumented, travel can be risky; and for those in mixed-status families, who already have children, that risk may simply be too great.
“Transportation may seem as simple as going from point A to B, but that conversation is very different here in the Rio Grande Valley,” said the Latina Institute’s Cárdenas Peña.
Border wall funding has also meant increased militarization of the Valley, including increased surveillance, according to Cárdenas Peña. Not only are undocumented persons subjected to internal immigration checkpoints, but additional checkpoints are sometimes set up at random, which, Cárdenas Peña argued, has deterred people from going to their abortion care appointments.
“It isn’t only legislation around abortion access that affects someone’s access to abortion,” Cárdenas Peña said.