Before and after Dobbs, questions of ‘when and where’ affect abortion access

Stigma, patchwork of laws complicate decision for those short on time, money

By: - January 30, 2024 5:45 am

DakotaRei Frausto, 19, traveled 11 hours from their hometown of San Antonio, Texas, in April 2022 for an abortion after their contraception failed. (Courtesy of DakotaRei Frausto)

DakotaRei Frausto was 17 years old and 12 weeks pregnant when they had to travel 11 hours by car from San Antonio, Texas, to New Mexico to terminate a pregnancy after contraception failed them.

The appointment was April 1, 2022, about six months after Senate Bill 8 initially took effect in Texas, banning abortions after about six weeks. “I had a lot of health issues that played into me wanting to get an abortion, but those very issues made it difficult for me to realize I was pregnant in the first place,” said Frausto, who was eight weeks along by the time they discovered they were pregnant.

Among them: chronic nausea, anemia that causes dizziness and fatigue, and premenstrual dysphoric disorder — better known as PMDD — which causes severe mood swings and other symptoms often associated with premenstrual syndrome, including a missed period.

“Those are big signs of pregnancy early on, and I did not see those at all,” they said.

Although Roe v. Wade established a federal right to abortion prior to fetal viability in 1973, obtaining an abortion over the next five decades was still difficult for many, depending on where they lived. Abortion can be a complicated decision fraught with health issues for both the pregnant person and the fetus, and individuals often need emotional and financial support.

The stigma around making that decision can be especially heightened in certain regions of the country — prior to Roe’s passage, Texas consistently had the highest illegal abortion death ratio and rates in the United States, according to research.

Then and now: Texas abortion laws

Texas abortion law is largely the same in 2024 as it was in 2022, despite numerous challenges in court. Performing an abortion is punishable by five to 99 years in prison, although the pregnant patient is not subject to criminal prosecution. For providers, it also results in the mandatory revocation of a medical, nursing or pharmacy license, and the Texas attorney general can seek civil damages of no less than $100,000.

In addition, Texas has a separate civil penalty law that allows almost anyone involved in obtaining an abortion to be sued by individuals for at least $10,000.

In early January, the U.S. 5th Circuit Court of Appeals ruled that federal law does not require emergency room physicians to provide an abortion in the case of a medical emergency, when the patient’s health may be deteriorating from an infection or another condition but their life is not yet in immediate danger.

States have had varying levels of access since 1973, but following the Dobbs decision in June 2022, when regulation of abortion changed from a constitutional right to a procedure that could be restricted at any stage at the state level, the fragmented nature of access became much more significant. Fourteen states have banned abortion in nearly all cases, while others expanded rights through constitutional amendments and other state laws. But even over the past year and a half, those restrictive laws have shifted, sometimes multiple times, through legislative action and ongoing court cases at the state, appellate and federal levels, creating confusion and chaos for patients and providers alike.

Today, States Newsroom begins “When and Where? Abortion access in America,’’ an occasional series that will profile individuals who have navigated the patchwork of laws around reproductive health care in the U.S. before and after Dobbs.

Health care environment in Texas didn’t feel welcome to all

Texas’ laws were at the heart of the Roe court case, and in the years following the original U.S. Supreme Court decision, the state continued to pass laws meant to limit access, including the requirement of parental notification for minors seeking abortions, requiring admitting privileges for providers, and then the 2021 law allowing lawsuits from family members against anyone who provided or “aided and abetted” an abortion after fetal cardiac activity could be detected.

For Frausto, being a nonbinary, Indigenous person seeking care in Texas presented even more challenges. They told States Newsroom the general attitude toward reproductive health care where they live played a major role in the unwanted pregnancy, because they wanted to be tested for any complicating health conditions, such as endometriosis, before starting hormonal birth control and got the brush-off from their provider. They also got the message that only one type of person was welcome in the clinic.

“You walk into the waiting room and it’s just pictures of babies and mothers everywhere, and at the one I went to there was even Christian music playing,” Frausto said. “It just felt like I was boiled down to my reproductive organs, and told that my job was to be a mother (rather than being treated as a whole person). That played a major role in not accessing hormonal birth control and having my contraceptives fail.”

A 2016 survey from the National Center for Transgender Equality showed 23% of more than 27,000 respondents said they did not seek health care due to fear of mistreatment, and 33% reported incidents of mistreatment from a provider within the past year. A 2020 study found that transgender and nonbinary people in the South experience increased oppression and stigma, with as much as 50% of trans people reporting suicidal ideations. Texas also passed a law that went into effect Sept. 1 banning transgender youth from accessing gender-affirming care.

“I never really felt like I was treated as a human until I got my abortion, which was the craziest experience for me. Even before I was pregnant, just living here in Texas, I was told abortion was horrible, and painful, and the worst experience of your life, but then I would say my abortion saved my life and showed me that it was possible to have compassionate and adequate health care.”

– DakotaRei Frausto

Frausto and their partner had been together almost two years at that point and talked about safe sex. They talked about not wanting children, and using contraceptives to ensure that didn’t happen. It was never treated as a taboo with their family either — but the contraceptives failed and Frausto ended up pregnant anyway.

“As much as I knew I wanted an abortion, I of course still considered the possibility … but I cannot in good conscience bring a child into this world with these social and political conditions,” Frausto said.

Two-day trip and procedure cost nearly $1,500

Frausto called Planned Parenthood and remembers being told several states that normally would have been an option for them were hesitant to take out-of-state patients because there were fears that abortion access nationwide would soon be overturned by the nation’s highest court. The two best options seemed to be New Mexico and Oklahoma. They chose New Mexico because of family ties.

Between Sept. 1 and Dec. 31, 2021, Planned Parenthood clinics in Oklahoma experienced a 2,500% increase in patients from Texas compared to the previous year, according to Axios, while Colorado saw a 1,000% increase and Louisiana took in nearly 350% more. New Mexico saw a 100% increase in patients from Texas during that time.

The first appointment Frausto could get in New Mexico was four weeks out, putting them at 12 weeks of pregnancy. Oklahoma likely would not have been an option as the state passed its own abortion ban that started at conception during the same timeframe.

“I found out that the day I was having my abortion … people who were in the waiting rooms of those clinics were told they could no longer be given the procedure and had to leave,” Frausto said. “I felt extremely grateful to be in a place where it was still accessible to me.”

The procedure was $600, discounted to $525 through donor support. Food and gas cost between $600 and $700. Lodging for the night was somewhere around $300. Through the goodwill of strangers online, Frausto raised $400 to help offset the costs.

Frausto was still in high school, as was their boyfriend, and their mom was a full-time student as well, so they couldn’t afford a longer trip. They drove out on Thursday, arriving at the hotel in the wee hours of the morning, went to the appointment at 9 a.m., then drove back to San Antonio a few hours later while Frausto dealt with the cramps, bleeding and nausea in the back seat of the car.

Every other person in the clinic who was there for an abortion was from Texas, Frausto said. Patients from Houston, Dallas, Austin, one of whom was also 17 years old and getting on a plane right after her appointment.

“In the recovery room there was this girl who was talking to me after her abortion, and she was saying she came there alone, she flew there alone, and immediately after she had to catch a flight back to Texas all by herself,” Frausto said.

‘My abortion saved my life’

Two months later in June 2022, the U.S. Supreme Court issued its decision to topple Roe v. Wade, and more than a dozen states implemented near-total abortion bans. Frausto started telling their story through Planned Parenthood’s Patient Advocacy Storytelling Program, and in February 2023, they started an abortion support group on Facebook to help dispel myths around abortion, decrease its stigma and connect people with resources. The group gained 531 members over the course of four months, but toward the end of the year it was shut down by Meta, the owners of Facebook. Frausto said they weren’t given a reason for the action, but their other chats that did not have the word “abortion” in the title went untouched.

But Frausto continues to be active with advocacy work and open about their story, which they said breaks apart a lot of stigmas around abortion.

“When people think about me and see me, their immediate thought is, ‘promiscuous young woman,’ and I am able to tell them that I stayed with my fiancé and it made us stronger,” they said. “I tried to take the steps to be proactive about my reproductive health care, and I was dismissed.”

It’s important to Frausto that people see they are confident and fearless about telling their story, because it wasn’t until the experience at the New Mexico clinic that they actually felt seen, cared for and embraced. At the same clinic, Frausto was offered a hormonal birth control implant to be placed for free, which was possible because of state funding that wasn’t available in Texas.

“I never really felt like I was treated as a human until I got my abortion, which was the craziest experience for me,” they said. “Even before I was pregnant, just living here in Texas, I was told abortion was horrible, and painful, and the worst experience of your life, but then I would say my abortion saved my life and showed me that it was possible to have compassionate and adequate health care.”

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