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."
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