By Samuel Dickman, M.D.
The Guardian, October 6, 2021
I’m a Texas abortion provider. Since the state’s new anti-abortion law – known as Senate Bill 8 – went into effect three weeks ago, my job transformed from physician to dystopian travel agent for a journey that, for most of my patients, will probably never happen.
SB8 is not just a set of roadblocks but rather a near-total ban on abortion. Politicians have rendered abortion care impossible to access for people who can’t afford to travel hundreds of miles out of state. Many of those who can’t get an abortion will be pushed deeper into poverty as a result.
I’ve written previously about the ways that the US, and Texas especially, segregates care by class and race. This abortion ban is no exception: wealthy Texans will find the means to obtain safe abortion care, as they always have. But patients I care for, who are mostly low-income and people of color, can’t afford enormous travel expenses to get medical care. They can’t afford to take multiple days off work, usually without pay. They can’t afford the additional childcare or elder care. They can’t afford the gas money, or the bus fare. They can’t afford a safe place to sleep overnight. These costs are on top of the actual fee for the procedure, often $500 or more out of pocket, a sum that for many patients takes weeks or months to save. Most of my patients now can’t afford to get an abortion – but they also can’t afford not to.
Last week, I had to tell a young woman already seven weeks pregnant that her only option for an abortion was an eight-hour drive to New Mexico. (I’ve changed patient details to protect confidentiality.) She has no car and no access to a checking account. She sobbed as she explained that her father, whom she lives with, would probably become violent if he found out she got an abortion. Less than a month ago, I could have provided a medical intervention that protected her autonomy and privacy, in a way that kept her safe from an abusive father. Imagine me now: bearing witness to her plight, powerless to help – not for lack of tools but because of legal obstruction – and having to tell her about her limited options. Now imagine being her and having to hear them.
In the last days before SB8 went into effect, I provided an abortion for a patient whose pregnancy was the result of being raped. I was able to help her end her pregnancy safely, and privately. If a patient like her came to see me today, there would be no legal option to get an abortion in Texas. And because of the enormous cost of getting care outside of Texas, they would very likely end up having to carry that pregnancy to term.
This fight is not just about Texas. As other states pass copycat laws, the US will quickly become a patchwork of abortion deserts, further isolating low-income patients like mine. Research shows that people denied an abortion are far more likely to experience serious adverse financial events like evictions and bankruptcies.
Enough. We must guarantee access to abortion care at the national level by passing the Women’s Health Protection Act, which would prohibit state-level bans and unnecessary restrictions on providers. We must also eliminate the Hyde amendment, which senselessly prohibits all federal programs like Medicaid from covering abortion care, once again targeting those with the lowest incomes. And in the long term we must work to provide coverage of all reproductive health services, including contraception and abortion, through a universal health program.
Healthcare shouldn’t be a luxury available only to the rich – and that includes abortion.
Dr. Samuel Dickman, an internist, is an abortion provider and health policy researcher in Texas.