Shortly after nine o’clock on the morning of June 24th, a woman in her forties, whom I’ll call Luisa, arrived for her appointment at an abortion clinic in Texas. Inside the waiting room, a space bedecked with posters of women rendered in white, red, and blue, she filled out a series of mandated forms, and was escorted to the back of the facility, where dozens of other patients waited. A single mother of three who moved to the U.S. several years ago, Luisa had visited the clinic the previous day to get a sonogram, which revealed that she was less than six weeks pregnant, the legal limit to have an abortion in Texas at the time. Per state law, however, she needed to wait at least twenty-four hours before the procedure could take place.
Minutes after Luisa’s arrival, the Supreme Court issued its ruling overturning Roe v. Wade. Few of the patients knew that the Justices had the authority to take away women’s right to abortion. But when the clinic’s staff broke into tears, it became clear that the morning would not unfold as planned. Sitting alongside other patients, in a row of chairs set against a wall, Luisa looked around nervously. She spoke English haltingly and had never heard of Roe v. Wade. When one of the nurses kneeled by her side to offer an explanation, Luisa froze, in disbelief. Despondent, she left the clinic. As she waited for a ride outside, Luisa recalled that a friend of hers had told her, “If things don’t work out at the clinic, you can always call this man.” Luisa’s friend gave her his number and said that she had gotten an abortion at home with pills that he had provided. Already struggling to support her children, she felt that she was running out of options.
Since the fall of Roe, six months ago, at least sixty-six clinics in fifteen states have closed, limiting the choices of nearly twenty-two million women of reproductive age who reside in them. People from Texas who have the financial means have flown to states like New York or California, where abortion remains legal, to receive the procedure. Others, with fewer resources, have driven to New Mexico, Kansas, or Colorado, nearby states where abortion is also legal. But, for undocumented women, who do not have the resources to travel long distances, the fear of being criminalized, and potentially deported, has become far greater—and so has the need to use underground abortion networks, where the risk of exposure is less.
Several days after Roe was overturned, Luisa picked up her phone and called the man with the pills. She said that he initially asked for a hundred and fifty dollars, then raised the price to a hundred and eighty and eventually to two hundred. All Luisa knew about him was that he was from Mexico, but she agreed to pay the full price and gave him her address. At Luisa’s home, the man handed her seven pills, instructed her to take five of them orally and place two more in her vagina. She said that he offered to do so himself, but Luisa declined. She didn’t know if the man was a doctor or if he had any kind of medical training. After handing him the cash, she inserted some of the pills vaginally, then took the rest that same day. (The man, who declined to be interviewed, denied selling Luisa the pills.)
At first, Luisa felt nothing and went to sleep, but by the next morning she could barely walk. Her vision was cloudy, and she felt weak and dizzy. At home with two of her three children, she lost consciousness. Luisa didn’t know it at the time, but the man’s instructions deviated from those of the Food and Drug Administration. A medication abortion typically involves taking two hundred milligrams of mifepristone, which blocks progesterone, on the first day. On the second or third day, the patient follows up with eight hundred micrograms of misoprostol, which causes uterine contractions. The F.D.A. recommends that the pills be taken until ten weeks of gestation and under the supervision of a health-care provider. Luisa had no idea what medicine, nor what amount, she had taken.
Sitting at home on a recent Tuesday, Luisa recalled how it took her two days to fully recover, and the heavy bleeding continued for two more weeks—far longer than it should have. After a medication abortion, many women experience heavy cramps and bleeding for a few days. If the bleeding persists, or if they experience prolonged nausea, fever, or diarrhea, it is recommended that they visit a doctor to rule out any serious complications. But, with the overturning of Roe, people in Luisa’s situation fear that calling a doctor or visiting an emergency room could result in their arrest.
Luisa also lacked the money to pay a doctor. Beyond rent, her salary primarily went to paying someone to watch her children during the holidays: a woman who charged twenty-five dollars a day per child and, in addition to caring for Luisa’s sons, looked after three others. With her child tax credit, she had bought a used midsize car, and, to make ends meet, she and her children had recently moved to a small apartment in a complex where residents had complained of flooding and busted pipes, moldy surfaces, termites, bedbugs, and rats.
When I visited Luisa and her children in their new apartment, there were some boxes left to unpack, but she had just finished assembling the furniture that she had brought from her previous home—faux-leather sofas, a button-tufted headboard, two king-size mattresses and a glass dining set—which she had paid for in monthly installments over several years. The walls were decorated with large, glittery canvases inscribed with phrases printed in cursive: “Be Daring My Darling” and “She Lived a Life She Loved.” When I asked Luisa if she understood their meaning, she responded with an amused smile: “No.”
Her limited command of English made it hard for her to help her eight-year-old son with homework. This year, his school had nearly expelled him; he constantly disobeyed his teacher’s orders and seemed to be learning next to nothing in class. At home, she spent most of her evenings trying to get him to obey her. As we spoke, the boy, with brown eyes and a curly undercut, repeatedly stormed out of the apartment after she ordered him to stay home.
Halfway into our conversation, Luisa’s phone rang, and she rushed to answer the call. “What are you up to? Aren’t you coming?” she asked, in a hushed voice. When Luisa hung up, she explained that her boyfriend was the one on the other line. They had been dating for almost two years. At times, their relationship felt unsteady, she said. Having the child was never an option for her, but her boyfriend was of a different opinion. “He wanted it, as long as it was a girl,” she said. “But how could I have another child?” She let the question hang before adding, “Not in these conditions.”
A woman whom I’ll call Rosa has the benefits of citizenship, as well as family support. At twenty-seven, she still lives with her parents in the home where she grew up, in Texas. Her sisters, Rosa told me, were her confidantes. Every time she went on a date, they waved her goodbye with a “Cuídate”—“Take care of yourself.” So, when Rosa began to feel ill in mid-July, and nearly fainted at work, she asked her older sister for a pregnancy test. Sitting on the toilet of her home, her eyes fixed on the test’s results window, she watched two red lines emerge. It cannot be, she thought. She hoped that the test might have been too old to use, even though its expiration date had not passed. Rosa asked her sister, who was waiting outside the bathroom, to bring another test. The results were the same. Ya me chingué, she told herself—I’m fucked.
Rosa initially considered raising the child by herself, but she and her siblings had been on welfare as children, and those years weighed heavily on her. “I did not want to rely on the state’s help,” Rosa told me. “I’ve already lived through that.”
Rosa and her sisters huddled around her laptop, typing searches for abortion providers outside of Texas. They had considered trying to buy pills, but they were convinced that their sister could end up in jail, or be considered a murderer, for having an abortion in her home state—so convinced that they closed the laptop after a few minutes, out of fear that their searches would be tracked. Even typing the word “abortion” online seemed like a risk. What better way, the sisters thought, to go after women in Rosa’s situation than to follow their digital footprint.
An arrest in Texas terrified Rosa and her sisters. Lizelle Herrera, a woman roughly their age, had been briefly jailed in April, two months before the overturning of Roe, and charged with murder for causing “the death of an individual by self-induced abortion.” The hospital where Herrera had checked in after taking abortion pills had reported her to the sheriff’s office. In a county where the median household income was roughly thirty-three thousand dollars a year, Herrera’s bond had been set at half a million dollars.
The local district attorney eventually concluded that Herrera could not be prosecuted under Texas law for obtaining an abortion. After a few days, the charges against her were dropped, but fear and confusion surrounding the law remained. “It’s a feeling of helplessness,” Rosa told me. “A feeling of knowing that you have no place to go, so you begin to panic and ask yourself, Who do you trust? Where do you turn to? Who do you seek help from?”
Together with her sisters, Rosa agreed that crossing the border into Mexico and trying to obtain an abortion there was the best option. But the youngest of them had heard rumors that Texas law-enforcement officials were now planning to perform pregnancy tests at border crossings. The rumor, which turned out to be false, caused Rosa to panic. “I’m going to get caught,” she told her sisters, her voice breaking. “What happens if they find out?”
The following day, after a full night’s sleep, Rosa decided that being subjected to a pregnancy test at the border wasn’t as threatening as she feared. That afternoon, she and her older sister crossed the border and visited a Mexican doctor who confirmed that she was five weeks pregnant. When Rosa asked him if he could perform the abortion, the doctor shook his head and declined to name anyone who would, but offered some advice: “If you’re thinking about doing it, do it now.”
Rosa returned home, ultrasound results in hand, feeling ready to share the news with her parents. There was only one problem: she could not confidently say whose child it was. Rosa had recently broken up with a longtime boyfriend and started seeing someone else. To her knowledge, neither man was thinking about fatherhood, so she was at a loss for words when the first question her parents asked was “Y el papá?” For days, her parents refused to speak to her.
Rosa briefly considered going back to Mexico, where she could walk into what her friends called “narco-pharmacies,” which sold abortion pills without a prescription. The thought of travelling to another state, like New Mexico or Colorado, also crossed Rosa’s mind, but the costs of gas, food, and a place to stay seemed prohibitive. Plus, she wondered, what if she got pulled over in Texas and detained along the way? “Money was always the problem,” Rosa recalled. The only money that she had managed to save this year was her tax refund—eight hundred dollars—which she had set aside to straighten her teeth.
Now Rosa planned to spend all of it on her abortion. The problem was that most clinics she found charged six hundred dollars or more for a medical abortion—and that did not include travel costs. Rosa didn’t want to put a strain on her parents’ budget, and borrowing from a friend didn’t feel right either. Everyone she knew in the area lived paycheck to paycheck, and she worried that someone “who happens to be strapped for cash” could file a lawsuit against her, even though the laws in place did not target pregnant women. A Texas statute known as S.B. 8 encourages private citizens to sue individuals who provide, aid, or abet an abortion, and, if successful in court, rewards them with a bounty of at least ten thousand dollars.
Rosa’s oldest sister had heard of a clinic in Mexico City where surgical abortions were performed for less than three hundred dollars. She and Rosa figured that they needed a thousand dollars in total to cover their round trips and accommodations, plus a few hundred more for unforeseen expenses. With her savings, Rosa could only afford part of the trip. So she reached out to the man she was seeing at the time, who agreed that she should get the procedure and covered the rest. The two sisters quickly planned their journey: it was a night-long bus ride to Mexico City, so Rosa decided that they should leave a day early.
After crossing the border by foot, Rosa and her older sister boarded the bus, which made multiple stops along a route that spanned hundreds of miles. Upon their arrival, the sisters headed straight to a small Airbnb, where they spent the night. The following day, they went to a clinic downtown, where nurses prepped Rosa for the procedure and gave her an I.V. She donned a hospital gown and was asked to count to sixty before the anesthesia kicked in. When Rosa woke up, she was on her way to a recovery room where dozens of other patients rested. No one at the clinic questioned or judged her decision. After about an hour, as is typically the case after a surgical abortion, Rosa was discharged from the clinic and went straight back to the Airbnb with her sister to get some rest.
A day later, they boarded a bus back to the U.S. Around three in the morning, heavy abdominal cramps awakened Rosa. The painkillers that she had been given in Mexico City seemed to have worn off. “I kept turning and turning, but it made no difference,” she recalled. “I felt like using the bathroom, but I could barely stand up.” The bumps along the road made it hard to rest or move. And so did her mother’s warning that thieves, who often pose as passengers, could rob the bus at night and strip her of her belongings. Rosa tucked the little cash that she had left inside her bra and eventually fell asleep. By the time she and her sister arrived at the border, it was noon the following day. It took them two hours to cross through a U.S. checkpoint by foot—a wait that only intensified Rosa’s fear. She was carrying the clinic’s paperwork with her, but American immigration officials only asked her cursory questions; no pregnancy tests were ever performed.
At home, Rosa found her bed exactly as she had left it: with a line of pillows meant to ease her discomfort at night. She lay there alone for an hour, as tears streamed down her face. Rosa’s emotions were mixed. Part of her felt like grieving, but she also resented that the state had had a say in one of her most intimate decisions. “How are you feeling? Do you want to take a shower? Will you come eat with us?” her older sister asked, via text, from her own bedroom.
Rosa knew that she was lucky compared to friends who had lived through an abortion alone. Some looked online for instructions on how to take the pills and did so safely on their own. Others ran into complications, because they had used the wrong dosage or didn’t know what to expect. Rosa remembered one call, in particular, from a friend who had reached out to her in a panic, after purchasing pills across the border, before the overturning of Roe. Her friend had taken a set of abortion pills, started bleeding profusely, and worried that she could be hemorrhaging. But she didn’t dare tell anyone else. She, too, had heard of the arrest of Lizelle Herrera and was terrified of going to jail. Instead, she sat in her bathtub alone for several hours to relieve her pain. “Imagine,” Rosa said, “if women refused to seek care during those times, when the clinic was still open, what will become of them now?”
Inside Texas hospitals, doctors and medical personnel are also weighing the legal risks they now face. Shortly after the overturn of Roe, a nursing student who I’ll call Sandra enrolled in an obstetric-care class. Her professors explained how to perform a dilation and curettage, or D. & C., after a miscarriage, but rarely did they mention the word abortion. When state lawmakers visited the school grounds, students were told to not get into politics. “There were things we were not allowed to talk about, things we were not allowed to ask,” Sandra said.
In October, Sandra realized her period was two days late. Immediately, she feared that she was pregnant. Sandra had six months left before she would graduate from nursing school. For years, she had planned to attend law school and specialize in medical cases. After spending the better part of her twenties in an abusive relationship, she became a mom, went through a divorce, and managed to get her career back on track. She had also just started dating a man who was good-natured and shared her passion for health care. When Sandra told him that she had missed her period, he didn’t hesitate to go to the pharmacy and buy her a pregnancy test.
An hour later, in her boyfriend’s bathroom, the couple debated what to do about the test’s positive results. Neither of them felt capable of going through with the pregnancy. Combined, their student debt amounted to half a million dollars, and they had been in a relationship for only three months. Sandra’s boyfriend offered to order abortion pills online, so she didn’t have to leave her home for the procedure. But Sandra was keenly aware that anti-abortion laws in Texas targeted those who assisted pregnant women, and her boyfriend risked facing felony charges and life in prison for providing pills. “We can lose everything,” she warned him.
This was also not the first time that Sandra had faced an unexpected pregnancy: as a teen-ager, she had had an abortion without her parents’ knowledge. As a senior in high school, she felt woefully unprepared to have a child. She also feared her parents’ reaction. At the time, Texas law required minors to have the consent of their parents before undergoing an abortion, so Sandra decided to keep it a secret and wait a few weeks until she turned eighteen. By then, Sandra was past her tenth week—the recommended limit for medication abortions—and she had to find a clinic that would provide a surgical abortion. After a cursory Google search, she found one: a crowded, rickety building, where Sandra waited for half a day to get treatment.
Afterward, the doctor who performed the abortion sent Sandra home with a prescription for antibiotics. But she feared that, if she went to the pharmacy and handed over her insurance card, her parents might be notified. So Sandra decided to forgo the medication. Within a week, she came down with a high fever, and her parents rushed her to the emergency room. There, doctors diagnosed Sandra with a kidney infection. It took two weeks for her to recover from it and be discharged from the hospital. “It was traumatic,” Sandra told me of the experience.
Her understanding of reproductive care had since evolved, but her options were more limited now. Any doctor or person who performed a surgical abortion or provided abortion pills in Texas now faced the possibility of years in jail. Fearing prosecution, she and her boyfriend decided that they were better off travelling to a neighboring state where abortions were still legal. Including the procedure, driving or flying would cost them about a thousand dollars. “It’s a drop in the bucket compared to what we could lose,” Sandra recalled thinking at the time. When she called Planned Parenthood, she learned that the earliest appointment at a clinic in Kansas or New Mexico was weeks away. They suggested a smaller provider in southern New Mexico who offered better news: a doctor could see her within days.
Sandra made plans to fly to El Paso. From there, the couple would rent a car and drive to the clinic just across the border, in New Mexico. Before leaving, Sandra decided to get an ultrasound to confirm how far along her pregnancy was. She chose a clinic that someone she trusted recommended for its free services. After walking in, Sandra was reminded of the home she had grown up in. Abstract paintings hung on the walls, and the waiting room was neatly decorated with velvet sofas and cottage table lamps. A warm-looking woman greeted Sandra, holding her patient file in her arm.
As the woman took notes in a consultation room, Sandra explained to her why this was not the right time for her to have a child. “We’re bleeding money,” she recalled saying, referring to her and her boyfriend’s vast student debt. What would Sandra’s parent think of the abortion, the woman asked. What about her six-year-old son—did he know? Sandra was surprised by the questions, and she felt unsettled when the woman described an abortion that she had had at age twenty as the worst decision of her life. “It haunted me,” Sandra remembered her saying. Sandra was then instructed to lay supine on a table for an abdominal ultrasound. In an instant, the machine started emitting what the woman described as the embryo’s heartbeat.
Confused, Sandra wondered how this could be, since it appeared that she was five and a half weeks pregnant and she had learned in nursing school that health-care workers don’t usually try to detect an audible heartbeat until after the tenth week. And, to add to the confusion, a vaginal ultrasound would typically be used to obtain optimal images at that stage, not an abdominal scan. Sandra wondered, Is it my heartbeat that they’re hearing? She discreetly took her own pulse. “I felt like it was the same as what they were reading,” she said. It was only after Sandra left the office, and the staffer handed her a Bible and a collection of anti-abortion leaflets, that she learned the clinic was run by a Christian group. It was one of dozens of clinics in Texas that lure in unsuspecting women with offers of free medical care but are, in fact, operated by anti-abortion organizations.
Days later, Sandra and her boyfriend boarded a morning flight to El Paso. They drove to the clinic in New Mexico and arrived early for their eleven-o’clock appointment. After half an hour, they left the clinic carrying a set of abortion pills. Sandra took the first pill in New Mexico, before entering Texas. By the time their return flight landed that evening, Sandra had just started to feel the symptoms. “It feels like bad period cramps,” she recalled. Contrary to the predictions of the woman in the anti-abortion clinic, Sandra didn’t hate herself for the decision. It wasn’t a cause for celebration, either, but it felt like the right choice—her own choice. Within three days, she had fully recovered.
Until this year, Sandra had never registered to vote, and never felt that her ballot would make a difference. The Supreme Court’s decision to overturn Roe changed that. “It just represents women losing their right to make decisions on their own,” Sandra told me. “It feels like we’re going backwards in time.” She and her friends in nursing school had often wondered how much farther abortion restrictions in Texas would go and what other rights women might lose. After the Supreme Court’s ruling, the hands of medical providers in Texas were tied. They could no longer assist patients seeking abortions; it wasn’t even clear whether they could prevent the loss of a mother’s life due to pregnancy complications. For the first time in her life, Sandra voted, casting a party-line ballot of her own creation: all candidates that support a woman’s right to choose. ♦
