The day before a federal judge blocked enforcement of Texas' restrictive new abortion law, the parking lot of Hope Medical Group for Women in Shreveport, La., was filled with Texas license plates. Women held the door open as the line spilled out onto the sidewalk and into the grass.
"I drove 6 hours and 58 minutes," said M. from Corpus Christi, who didn't want to give her full name for privacy reasons. "I got here at 8:55 a.m. this morning. So I have not ate, we can't bring in anything to drink. My boyfriend's in the car asleep."
M. is 20 years old and a college student. She says she worked double shifts at her service job all weekend to be able to afford the trip.
"Whenever we found out [about the pregnancy] ... I was five weeks and five days," she said. "So I was like, OK, I can, I'm under six weeks and everything. But it had a heartbeat." Under Texas Senate Bill 8, no clinic in the state could perform an abortion at that point in the pregnancy.
So she and her boyfriend told her family they were taking "a little trip" and drove through the night to make her first consultation at Hope Medical. She says her parents wouldn't support her decision, but she knows it's the right one for her.
"I feel like right now, I feel like I'm so mentally unstable, financially unstable," M. said. "It was really, really a hard decision. I just feel like it would have been a really big life-changing thing that I don't think that I could possibly get through right now."
Louisiana law also sets strict abortion requirements
For Texas women like M., Louisiana has become an unlikely backup plan for abortion services. And no one is more surprised than Hope Medical Clinic Administrator Kathaleen Pittman. Between answering a phone that scarcely stopped ringing all morning, Pittman said fighting for reproductive rights in Louisiana is a constant struggle.
"It's kind of ironic, really," she said. "Because aside from SB 8, our regulations are so horrific."
Currently, Louisiana law allows surgical abortion up to 20 weeks (5 months) into a pregnancy. The state also requires mandatory ultrasounds, state-directed counseling that may discourage an abortion and a 24-hour wait period before the procedure can be performed — a procedure which requires two separate appointments.
"We're doing a lot of reshuffling and trying to rearrange," she says. "We've increased our hours on consult days to try to accommodate as much as we can."
The same week SB 8 was enacted, Hurricane Ida was slamming into Louisiana's southern coast. Clinics in New Orleans and Baton Rouge were closed for several weeks, causing increased demand for Pittman and her staff. And they're still struggling to absorb the surge, especially as Texas clinics figure out what they can do.
"The Texas law does have the provision that people can sue abortion providers retroactively, even if the law is temporarily suspended, like it is now," said Michelle Erenberg, executive director of Lift Louisiana, a nonprofit that advocates for abortion access. "So I think that may make it difficult for some clinics and some providers to feel confident in starting to provide care to people that have pregnancies past the sixth week."
SB 8 allows individuals to file lawsuits against abortion providers or anyone else involved in illegal abortions in Texas. Penalties for violations start at $10,000. And that provision has made this law more difficult to challenge because it's harder to know who to target with pre-emptive legal action — since anyone can sue.
For now, this federal decision basically instructs state officials to have nothing to do with enforcing SB 8. The state of Texas said it would appeal.
Meanwhile, calls to several clinics in Texas had long wait times and a hold message stating that they were still complying with SB 8.
"Our facility will not be able to provide abortions to patients who have pregnancies with detectable embryonic or fetal cardiac activity, which typically starts at 6 weeks from the person's last menstrual period," says the automated message for Southwestern Women's Surgery Center in Dallas.
Traveling far for an abortion increases financial burdens
Sherie, a nurse at Hope Medical who is also not sharing her full name for privacy and legal reasons, says she sees the whole thing as an "unnecessary hardship" for so many families, especially if they have to travel a long distance.
"I don't know how they're doing this," Sherie said. "Because the payment itself is a great big lump sum of money. This is people's rent, their car payment, might be their groceries for the month, having to take off work, the travel, the expense."
And the stigma around abortion can be both emotionally and financially straining. Sherie says a lot of fathers can't or won't contribute to the cost. Like M., families can be unsupportive or just totally in the dark. So without the option to ask loved ones for help, many people take out pricey loans or sell personal belongings.
Even then, Louisiana's own strict abortion laws means the clinic can't help everyone. An available appointment may be too late for the 20-week mark. And in a state that consistently faces some of the highest poverty and maternal mortality rates in the country, the prospect of continuing a pregnancy is more than just inconvenient.
Sherie, the nurse, was herself a patient at this clinic 30 years ago. She said she can't imagine what she would have done if Hope Medical hadn't been able to help her then. So she feels the patients' pain when she has to tell them they can't get the procedure.
"To see the look on their faces — it's tough," Sherie said. "Sometimes you just want to cry with them."
Hope clinicians said that one of the most urgent concerns when talking to a desperate patient is making sure they don't resort to anything dangerous. Pittman says she's always worried that women may hurt themselves or try dangerous methods of self-induced abortion.
But the widest-reaching result of these legal hurdles and restrictions, she said, is that a lot of children will be born to parents who can't afford or aren't ready to raise them.
"My biggest concern is the extreme poverty we will see," she said. "If people can't access care one way or the other, they're going to have larger families that they struggle to take care of."
As M. headed into the clinic for her appointment, she said she knows her family will have questions when she and her boyfriend return home in a couple of days. "Then again, it's just like, I kind of live my own life already," she said, more to herself than anyone else.
That choice is exactly what Pittman said she is working hard to protect. And even with the legal stay of SB 8, she said there's always a dark cloud hanging over her work.
As her phone continued to ring with hopeful patients from both Texas and her hurricane-ravaged home state, she turned and read aloud a poster hanging on her office wall. An artist made it for her a few years ago, quoting Pittman herself:
"The coastline of Louisiana is not eroding nearly as fast as a woman's right to choose her own outcome."
AILSA CHANG, HOST:
For the past five weeks, most people seeking abortions in Texas have had no option but to travel out of state. Last night, in response to a request from the Biden administration, a federal judge blocked SB 8. That law banned abortions after about six weeks of pregnancy. That's before many women even know they're pregnant. NPR's Sarah McCammon is in Shreveport, La., where many Texans have been traveling to an abortion clinic just over the state line. One patient from Texas allowed us to sit in while she talked with one of the clinic's patient advocates.
SARAH MCCAMMON, BYLINE: Any nervousness, anxiety towards the process?
GABBY: I think my nervousness that I have comes just from ignorance at the moment...
GABBY: ...Because I don't know, like, what the procedure entails. Also, I'm traveling, too. So that's another thing that I'm also, like...
MCCAMMON: OK, yes.
GABBY: ...Kind of unsure.
MCCAMMON: Going through something you've never been through before.
MCCAMMON: This is a whole process. This has already been more of a process than you should have to deal with.
CHANG: Sarah McCammon joins us now from Shreveport. Hi, Sarah.
MCCAMMON: Hi, Ailsa.
CHANG: So I want to talk about what you have been hearing from people at the clinic this week. But first, can you just very briefly explain what does this new order do exactly?
MCCAMMON: Well, at least for now, it blocks SB 8. In his decision, federal Judge Robert Pittman writes that women have been prevented by this law from exercising their constitutional rights. He says, quote, "this court will not sanction one more day of this offensive deprivation of such an important right." Now, the state of Texas said very quickly that it's appealing that decision. So reproductive rights advocates say while this is a victory for them, it may be a temporary one.
CHANG: Right. OK, so as long as this restraining order is in place, can abortion clinics in Texas just go back to the way things were and start offering abortions to people who are more than six weeks pregnant?
MCCAMMON: It's not quite that simple. A spokeswoman for Whole Women's Health, which operates four clinics in Texas, says they're trying to restore abortion services up to 18 weeks as soon as possible, but that will not happen right away. There are a lot of uncertainties right now. Michelle Erenberg is with a reproductive rights advocacy group here in Louisiana called Lift Louisiana, and she says it's partly because of the way the Texas law is written.
MICHELLE ERENBERG: The Texas law does have a provision that people can sue abortion providers retroactively if the law is temporarily suspended like it is now. I think that may make it difficult for some clinics and some providers to feel confident in starting to provide care to people that have pregnancies past the sixth week.
MCCAMMON: So that's one of several issues reproductive rights lawyers are sorting through.
CHANG: Right - so much to sort through. OK, so what does all of this ultimately mean for patients in Texas right now?
MCCAMMON: Well, the reality on the ground is about like it was before. For many women, the only option has been to travel to neighboring states like Louisiana. We spent the past couple of days in Shreveport, La., reporting on the impact of this law at a clinic here, about 25 minutes from the Texas border. That clinic is called Hope Medical Group for Women, and I visited yesterday.
I'm outside the Hope clinic now, and patients are coming in. They're lining up, really, out the door. And just looking around the parking lot, it's full of Texas license plates. I'm just looking here - Texas, Texas - a couple of cars, I can't see their plates - Texas again, Texas, Texas. Here's one from Louisiana. Here's another from Louisiana, another Texas. The vast majority of people here are from Texas.
Gabby, a patient who asked us to use just her first name to protect her privacy, came here from Austin. She says she found out she was pregnant just as SB 8 was about to take effect.
GABBY: The end of August, like, right at the beginning of September is around the time that I found out. I think around, like, the 26 or the 28 of August is when I took, like, an at-home test.
MCCAMMON: Just a few days later, starting on September 1, SB 8 banned abortion in Texas after any type of early cardiac activity could be detected, usually around six weeks or so. By the time a woman realizes she's pregnant, it's often too late under the law. Gabby says she started calling clinics in neighboring states until she could get an appointment at the Hope clinic. She drove close to three hours from Austin to Houston a couple of days ago to meet a friend, and they made the four-hour trip to Shreveport early yesterday morning. Another patient, a 20-year-old from Corpus Christi, asked us to call her by her middle initial, M, because her family doesn't know why she's here.
M: Whenever we found out, I was five weeks and five days. So I was like, OK, I can - I'm under six weeks and everything, but I had a heartbeat. So I was not able to do it anywhere, and I was scared. I feel like - right now I feel like I'm so mentally unstable, financially unstable. I just - it was really, really a hard decision.
MCCAMMON: The clinic's administrator is Kathaleen Pittman - no relation to Judge Robert Pittman.
KATHALEEN PITTMAN: Hope Medical. This is Kathaleen. May I help you?
MCCAMMON: She says it's been all hands on deck the past few weeks trying to take calls from women in Texas while still meeting the needs of patients here in Louisiana.
PITTMAN: We've gone from scheduling women who are, say, in a 200-mile radius to much further out. So we're doing a lot of reshuffling and trying to rearrange with increased hours on consult days to try to accommodate as much as we can.
MCCAMMON: As one of a shrinking number of clinics providing abortions in the region, Hope Medical has long served a large area. Pittman estimates about 2 in 10 patients normally come from Texas, but now it's well over half. And Planned Parenthood's clinics in neighboring states are also reporting an influx. Even if patients can get an appointment, Pittman says the cost of traveling out of state is insurmountable for some.
PITTMAN: The problem there is most of the women we normally serve don't have the means for all this travel since some women, unfortunately, will be bearing children that they cannot afford and were not ready to have.
(SOUNDBITE OF TELEPHONE RINGING)
MCCAMMON: Gabby is between jobs right now, but she's spending more than a thousand dollars - money she saved from her last job as a bartender.
GABBY: Between 7 and 900 for the procedure. Traveling - honestly, like, that's probably about 80 to a hundred and twenty bucks. Hotel is about a hundred bucks for the night that I'm here. That's not including if I have to stay longer.
MCCAMMON: Gabby says she's grateful she has the money, and she's worried about women who don't. M, the patient from Corpus Christi, told NPR producer Lauren Hodges that she was determined to find a way here because she's sure she's not ready to be a parent.
M: I drove six hours and 58 minutes, so I got here at 8:55 this morning. So I haven't even checked into my hotel yet. My boyfriend's in the car, asleep.
MCCAMMON: Was it hard coming up with the money to come all the way out here? That's such a long trip.
M: Yeah. I had to work. Well, I'm a college student, so I had to work doubles throughout the weekend because that's the only time I can work.
MCCAMMON: Some get help with the cost from abortion funds set up to help lower-income patients. But there's often more to figure out than just the money. M says she's worried about what her family might ask when she gets home from what she told them was just a little trip. That's a concern for many patients, says Cherie, a nurse at the clinic who asked us to call her by her middle name to protect her safety.
CHERIE: And they're having to say, I need you to watch my children for me for a few days. How do you explain that? What do you do? Your family's going to be suspicious.
MCCAMMON: Louisiana state law requires patients to wait at least 24 hours between their first consultation at the clinic and the procedure itself, further prolonging the time away. Cherie tries to offer as much support as she can. She tells the women about the abortion she had here at this very clinic about 30 years ago. Some come in and find out they're already past 16 weeks, the latest doctors at Hope will perform an abortion.
CHERIE: To see the look on their faces - you know, it's tough. You know, sometimes you just want to cry with them.
MCCAMMON: Kathaleen Pittman says between restrictive abortion laws and an increasingly conservative judiciary, this work has gotten more difficult over the three decades she's been here. She reads from a poster on her wall made by an artist who was quoting Pittman herself.
PITTMAN: The coastline of Louisiana is not eroding nearly as fast as a woman's right to determine her own outcome.
MCCAMMON: She says it's ironic that Louisiana, a state with a history of restrictive abortion laws, has become a place where women flock to exercise that right. Not long ago, this clinic was at the center of its own case before the U.S. Supreme Court, challenging a state law imposing new requirements on abortion providers which threaten to shut down clinics like hers. The court overturned that law, but Pittman says she knew the larger fight was far from over.
PITTMAN: I never thought it would get easier. I thought I would have more breathing room before it got worse.
MCCAMMON: The Supreme Court is set to hear a case from another neighboring state, Mississippi, later this year, which could further erode abortion rights.
UNIDENTIFIED PERSON: I'm sorry.
PITTMAN: No, you're good.
MCCAMMON: But when we went back to the clinic this morning, Pittman was feeling cautiously optimistic.
PITTMAN: The birds are chirping louder than usual this morning, it seemed. I was like - I woke up, and I was, like, in a good mood.
MCCAMMON: So you are feeling good about this.
PITTMAN: For now, yes. I'll take what I can when I can. You know, it's so rare for us to get good news.
MCCAMMON: But Pittman says nothing is changing today. She's still taking lots of calls and making no plans to scale back to normal hours.
You've been in this position before of waiting forever.
PITTMAN: Correct. Yes.
MCCAMMON: Have you not? I mean, how does this limbo feel?
PITTMAN: I'm afraid to say this, but almost normal because that is how providers spend their lives - in limbo, in a wait-and-see mode for so much of the care we provide. So it's almost normal. I would love to go back to a world where we can concentrate on simply providing care and not worrying about the latest judgment or the latest law.
MCCAMMON: Gabby, the patient from Austin, says she worries about other states taking cues from Texas.
GABBY: That's the very sad world, like, women live in that we have to experience and be challenged with. It's frustrating, you know?
MCCAMMON: Gabby says nothing has changed for her, either. After the decision was announced last night, she texted to say she's happy that other women in Texas could have the opportunities she didn't, and she was planning to move forward with her procedure today.
Sarah McCammon, NPR News, Shreveport, La.
(SOUNDBITE OF PHIL FRANCE'S "THE SWIMMER") Transcript provided by NPR, Copyright NPR.