The 31-year-old from Houston knew she did not want another baby. She already had three — her youngest, a boy, was just 6 months old. And she had just been laid off from her job in a medical billing office, another casualty of America’s growing unemployment crisis.
So she scheduled an abortion at a local clinic. But when she arrived for her appointment four weeks ago, the doors were locked and a sign was taped inside the glass: The clinic was closed.
Abortions in Texas were off after the state included them on a list of medical procedures that were not essential and needed to be postponed during the coronavirus pandemic.
The woman, who asked that her name not be used to protect her privacy, walked back to her car, took out her phone and immediately started Googling her options.
Her search would eventually involve four states and six clinics. Last week, she was 18 weeks pregnant and considering driving nine hours to a clinic in Wichita, Kan., with her infant son in the back seat.
“I’m just kind of overwhelmed and frustrated and stressed,” the woman said last week. “I just know I can’t handle another baby. I just know. I know physically, emotionally, financially.”
The fight over abortion rights, rather than receding into the background during the pandemic, has intensified as several states banned the procedure in recent weeks as part of emergency measures to fight the virus.
In six states, Alabama, Arkansas, Ohio, Oklahoma, Tennessee and Texas, state authorities have included abortion as a nonessential medical procedure, arguing that postponement is necessary to preserve medical and protective equipment. Abortion rights groups say the pandemic is being used as a pretense to restrict abortion, and have sued five of the states to stop them.
On Saturday night, the fight in Texas reached the Supreme Court, with the clinics asking for relief.
“We believe that merely delaying abortion procedures a few weeks is reasonable and necessary,” Joe Pojman, executive director of the Texas Alliance for Life, said on Monday. “Abortion providers should not get special treatment that puts health care providers fighting Covid-19 and their patients at unnecessary risk.”
But the clinics, and much of the medical community, say that abortion is time-sensitive and that it could be months before emergency measures are lifted.
Getting an abortion, not easy in many states under ordinary circumstances, has become even harder in recent weeks.
Women following social distancing rules now wait in their cars for appointments at clinics, where anti-abortion protesters sometimes yell at them. Many are recently out of work and no longer have child care, which means that getting to appointments — and paying for them — is more difficult. Women in states or cities with stay-at-home orders are nervous they will be stopped by the police on the way to clinics.
Out of the states trying to limit abortion, only Texas had been successful; the others have been blocked by judges, but that could change. Even in Texas, several weeks of legal back-and-forth have caused confusion for patients and their doctors.
In a surprise move late Monday night the U.S. Court of Appeals for the Fifth Circuit reversed itself on medication abortion, which involves taking two pills early in pregnancy, and is a significant portion of abortions in Texas.
The appeals court’s reversal allows, for the time being, many more women access, they say, but does nothing to lift the ban on most surgical abortions, which make up a substantial share of abortions in the state.
Dr. Amna Dermish had just finished a surgical abortion in a Planned Parenthood clinic in Austin when she got a call from her administrator saying that the governor’s order, which had been blocked briefly by a federal judge, was back in effect. The 261 patients they had called to cancel appointments — and then in attempts to reschedule — had to be reached again in less than 24 hours.
“I had to sit down when I got that call,” Dr. Dermish said last week. “I couldn’t believe it.”
Dr. Dermish said she had to tell the 10 remaining patients at the clinic, all waiting for ultrasounds, that she could not schedule their abortions. One woman had a diagnosed fetal anomaly. Another was starting school to become an ultrasound technician. Dr. Dermish said they referred women to clinics outside the state, but also warned them that travel during the pandemic could be risky.
In Texas there is another scenario where an abortion is still allowed: women who would be past 22 weeks gestation, the legal limit in Texas, by the time the governor’s order lifts. But that would mean waiting until the last minute to have the procedure, something few women do. About 88 percent of abortions in the United States are performed in the first 12 weeks of pregnancy, according to the Guttmacher Institute, a research group that supports abortion rights.
Overwhelmingly, abortions happen in clinics, not hospitals, but the clinics have also changed their rules to account for the coronavirus. A 24-year-old college student from Arlington, Texas, said in court papers that before an ultrasound she sat alone in her car in the parking lot of a Fort Worth clinic for two hours. She said protesters stood about 10 feet away with signs “and screamed at me and other patients.”
The night before she was scheduled to go in for her medication abortion, she got a call from the clinic saying her appointment had been canceled. She ended up driving 12 hours to Denver with a friend and wiping down surfaces in the cheap Airbnb they stayed in. On the way back they drove into the night.
“We didn’t want to take breaks or rest because I was worried about having my abortion in the car,” she said in court papers filed by lawyers for clinics in Texas.
Not every clinic closed right away. The Houston mother found one that squeezed her in for an ultrasound. But when she parked in front of another clinic early the next morning, hoping to be seen for an abortion, it never opened.
She had tried to be careful. In December, she had her tubes tied. But last month, a home test showed she was pregnant.
When the pandemic began, she had been trying to find her feet financially. She had signed up for weekend classes toward her real estate license, hoping to earn extra income to supplement child support from the father of her children, who works in a plumbing supply store.
But now here she was, more than 15 weeks pregnant, making dozens of calls a day to apply for unemployment — last Tuesday her cellphone showed 40 calls by 9 a.m., mostly met with busy signals — while looking for an abortion clinic in another state.
Other women seeking abortions said they could not afford to travel out of state and were looking for ways to end their pregnancy on their own — by illegally buying an abortion pill online. An 18-year-old in San Antonio who is pregnant and wants an abortion said her job at Kentucky Fried Chicken was reduced to 10 hours a week, from more than 40.
“I am barely able to get the basics,” she said on Facebook Messenger, declining to give her name to maintain her privacy.
She said she was sheltering in place with her grandfather, who was in ill health and did not know she was pregnant.
“I can’t tell anyone about my situation because it’s just too scary at this point,” she said. “I’m not sure what to do. I feel mostly stuck, lost and alone.”
When abortion stopped in Texas last month, Julie Burkhart, the founder and chief executive of Trust Women, which operates abortion clinics in Oklahoma City and Wichita, received a flood of new patients.
On Tuesday, March 24, her two clinics had a total of 90 appointments, she said, up from about 25 on a normal day. About half the patients were from out of state, she said, many from Texas.
“Our phones started ringing off the hook,” she said.
One of the calls was from the mother in Houston. She was worried about finding a clinic. But she was also worried about the virus.
She looked at West Virginia, which had an abortion clinic, and not very many virus cases. But it was too far and too expensive to fly. She settled on Oklahoma City because she could drive there in six hours. But as she was talking to Ms. Burkhart’s clinic, Oklahoma followed in the footsteps of Texas. (A judge has since allowed most abortions to continue in Oklahoma, and the state has appealed.)
So the Houston mother scheduled an appointment at the Trust Women clinic in Wichita for 8 a.m. days later. But she knew she would need someone to drive with her, so she could tend to her 6-month-old. Wichita was nine hours away, too far for her mother. Her sister, who was still managing the night shift at a vitamin plant, could not take time off.
“I was going in circles,” the woman said. “Every time I tried something, it’s like I found a solution, and then it was like, nope.”
Last week she found a fund that would help pay for her travel. On Wednesday, she, her mother and her 6-month-old flew to Louisville, Ky., where there was another clinic willing to take her.
At noon on Friday, she had her abortion.
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