On the morning Texas’ restrictive new abortion law took effect, an ultrasound examination of Marva Sadler’s first patient showed fetal cardiac activity, rendering the woman ineligible for a legal abortion.
Sadler, senior director of clinical services for Whole Woman’s Health, said the woman was a single mother of two and had just started a new job. She didn’t have anyone to take care of her children and couldn’t take off work to travel to another state to get an abortion.
“It was the first real blow of 'I really can’t fix this.' How do you answer that? And that conversation quickly took over to us figuring out how to get her prenatal care,” Sadler said.
In the 48 hours leading up to Sept. 1, Whole Woman’s Health in Fort Worth, Texas, provided 66 abortions a day on average. But during the first three days of the law being in effect, the clinic provided 11 abortions a day on average.
“The women who not only live in this state — but who work, pay taxes, vote, pray and are raising the future leaders of this community — are being denied their very basic right to health care,” Sadler said.
In Houston, Doris Dixon, director of patient access at Planned Parenthood Gulf Coast, said call centers for abortion services have turned into help lines, where staff members are “walking patients through this new law” and helping “them navigate where they can go.”
“Patients are struggling, and the staff is struggling,” Dixon said.
Since the law took effect, Dixon said most of the patients she has observed seeking care at Planned Parenthood Center for Choice in Houston are ineligible for an abortion.
“Some of this is just outside of our ability to help," Dixon said. "There are no babysitting services for people to send their children to while they go out of state, and there's no guarantee that they won't lose their jobs because they would be gone for two or three days. The issue is a lot bigger than even just finding resources for them to go elsewhere."
“People will fall through the cracks and wind up having to carry their pregnancies to term," she added.
The new law forbids abortions once cardiac activity is detected, usually at around six weeks of pregnancy, before most people know they are pregnant. The law allows no exceptions for rape or incest. Texas is the first state to effectively outlaw abortion at this point in pregnancies since Roe v. Wade.
Many won't be able to get an abortion outside of Texas because of financial or circumstantial challenges, including the cost of travel, difficulty taking time off from work or securing child care.
Abortion-rights advocates and providers say Senate Bill 8, as the new law is known, will probably lead to an increase in patients carrying unwanted pregnancies to term. Consequently, many will feel the financial and health impacts of being turned away from a clinic for years to come.
Denial of abortion leads to economic hardship
While people of all socioeconomic and ethnic backgrounds get abortions, about half of all individuals who obtain one live below the federal poverty level. When someone already struggling financially is denied care, it puts them in an even more difficult economic situation, said Diana Greene Foster, a professor in obstetrics, gynecology and reproductive sciences at the University of California, San Francisco.
Foster is the leader of the Turnaway Study, a nationwide project that examined the long-term effects of either having an abortion or being turned away. The study found that people who were denied an abortion had almost four times greater odds of being below the federal poverty level.
When individuals are blocked from obtaining care, she said, they are more likely to struggle to afford basic living expenses like food, housing and transportation.
Meanwhile, people who carried an unwanted pregnancy to term experienced a 78 percent spike in debt that was a month or more past due after the time of birth and an 81 percent increase in reports of bankruptcies, evictions, and tax liens, compared to others who had access to abortion care. Individuals who are denied an abortion are also three times more likely to be unemployed than those who obtained one.
"Laws that limit abortion access have a huge economic impact," said Kate Bahn, director of labor market policy at the Washington Center for Equitable Growth. "It's not just the year-over-year financial hardship associated with having children, but it also affects people's career trajectories."
"If you don't have certainty over family planning, you're much less likely to move into a higher-paid occupation and complete education," Bahn added.
A likely increase in mental and physical health consequences
Being denied an abortion can significantly increase mental health issues such as anxiety, depression and low self-esteem in the months after abortion denial and may cause life-threatening physical health outcomes that last years.
Before the law took effect, Dr. Bhavik Kumar, a staff physician at Planned Parenthood Center for Choice in Houston, typically saw 20 to 30 abortion care patients a day. On Sept. 1, he saw only six, and half were past the new legal limit and had to be turned away.
Kumar cautioned that the patients denied care could face "lifelong consequences."
"The folks that will suffer are going to be low-income folks that already have poor access to health care, and people of color, especially Black women," he said.
One analysis of Turnaway Study data, which examined the physical health of those who did and did not terminate their pregnancy five years after seeking abortion care, found that patients who gave birth were more likely to describe their health as "poor" and reported higher rates of chronic pain.
The physical and mental toll of childbirth plays a role in those adverse health outcomes, said Dr. Nisha Verma, a fellow with Physicians for Reproductive Health and an OB-GYN who provides abortion care in the Washington, D.C., area. Those who carry to term could face excessive bleeding during delivery, postpartum depression, gestational diabetes and hypertension.
"When we're thinking about people's health care, their pregnancies and their lives, every person is different, and no law like [S.B. 8] can take each unique situation into account," Verma said.
Carrying an unwanted pregnancy to term is far riskier to someone's physical health than having an abortion. About 700 people in the United States die each year as a result of pregnancy or delivery complications, according to the Centers for Disease Control and Prevention, and the maternal mortality rate is 20.1 deaths per 100,000 live births. The total abortion-related complication rate is estimated to be about 2 percent, and death occurs in less than 1 out of every 100,000 abortions.
Domestic violence is also common among people seeking abortions, with between 6 percent and 22 percent reporting recent violence from an intimate partner. Those who are turned away from getting an abortion are more likely to stay in contact with a violent partner, and they are more likely to raise the child alone.
"These are personal, intimate decisions, and if the government interferes, it changes people's ability to take care of themselves, their children and even to have future children under better circumstances," Foster said. "It's not just political maneuvering; this is real people's lives."