With Texas abortion law, out-of-state clinics expect surge of patients

When Kat, a 23-year-old living in Central Texas, discovered they were pregnant, it was five days before a law that bans nearly all abortions after six weeks was to go into effect.

"I was stuck with this reality that I was pregnant days before one of the worst abortion bans that I’ve seen in my life gets implemented in Texas," Kat, whose gender pronouns are they/them and who asked that their last name not be used, told "Good Morning America." I was scared."

Kat said that after estimating they were likely between four and six weeks pregnant, they feared not having access to an abortion after Sept. 1, the day the law, Senate Bill 8, went into effect. They also learned the two abortion providers in town were "completely booked" due to the pending deadline.

"I thought I can’t be pregnant right now. I don’t want to be pregnant. I don’t have the time or money to travel out of state [for an abortion]," said Kat. "I knew I had to do what was best for me and my best option was to have an abortion at home."

Kat said they went through with a self-managed abortion at home and while medically safe, the experience felt terrifying.

A self-managed abortion is one that occurs outside of a clinical setting. It is typically done by taking medication that induces a miscarriage.

"The reality is that I was at home alone having an abortion," they said. "I was worried about going to the hospital, worried about complications and didn’t have anyone there with me because of COVID."

Kat's experience is one that abortion rights advocates worry will become all too common across Texas, the nation's second most populous state with now the most restrictive abortion law in the nation.

The law, enforced after the U.S. Supreme Court failed to intervene, does not make exceptions for pregnancies resulting from incest or rape. It allows anyone to sue a person they believe is providing an abortion or assisting someone in getting an abortion after six weeks.

When a person is six weeks pregnant, it typically means the embryo started developing about four weeks prior, based on the formula used to figure out when a person will give birth. People don't often realize they are pregnant until after the six-week mark.

Cardiac activity is typically first detected five to six weeks into pregnancy, or three-four weeks after the embryo starts developing.

"A lot of people don’t think about abortion access until they need an abortion," said Joan Lamunyon Sanford, executive director of the New Mexico Religious Coalition for Reproductive Choice, which provides financial and logistical support for people who travel to New Mexico for abortions. "There are likely people in Texas that don’t know they’re pregnant yet today but will find out they’re pregnant next week or the week after and will call their local clinic and find out that they can’t be seen."

Lamunyon Sanford's organization and others that help cover the costs of travel for people to seek abortions say they are already seeing an increase in services needed, and bracing for more.

"We anticipate it’s going to really start increasing next week or the week after, but we're ready," said Lamunyon Sanford. "Instead of the shame or stigma that people may have faced in Texas, we’ll make sure that they are able to follow through and get the health care that they need."

There are currently less than two dozen abortion clinics in Texas, home to more than 6 million people of childbearing age, as of 2019. As the clinics in Texas have stopped scheduling abortion-related visits for people more than six weeks pregnant, the lengths people have to go in order to access abortions has multiplied exponentially.

The new law has increased the average miles a Texan must drive one-way to seek an abortion from 12 miles to 248, according to the Guttmacher Institute, a reproductive rights organization.

A trip from Texas to Wichita, Kansas, for someone seeking an abortion is, on average, 650 miles roundtrip. People have been making that trip with increasing frequency already this week, according to Ashley Brink, clinic director of Wichita's Trust Women clinic.

"Yesterday I felt like our phones were constant. Multiple phone lines lit up and ringing," said Brink. "We have already seen an increase."

Brink said she has been preparing for the influx for weeks, making sure the clinic has enough supplies and trying to get more physicians in the clinic, a difficult task in Kansas, where she says over 90% of counties don’t have an abortion provider.

In Oklahoma City -- more than 460 miles from South Texas -- the Trust Women clinic there typically receives calls from three to five people from Texas per day. On Tuesday and Wednesday, as the law went into effect, the clinic scheduled 80 appointments, and of those, as many as 55 were patients from Texas.

"That’s just going to increase as people from farther away start to look to see where they can get access," said Zack Gingrich-Gaylord, communications manager for Trust Women Clinics. "Throughout the Gulf [Coast] and the I-35 corridor, the center of the country and the Southwest, that’s all going to radiate and start to have a lot of strain put on those clinics and people are going to have to travel farther and farther."

"If you had to travel overnight to go see a dentist, you would think that’s ludicrous," he said. "But it’s expected of people seeking abortion care, that they are going to have to significantly disrupt their own lives."

Adding to the difficulty of seeking abortion care outside of their home state is the fact that abortion is difficult emotionally and physically, and time sensitive, according to Dr. Iman Alsaden, an OBGYN in Missouri and Kansas and medical director for Planned Parenthood Great Plains, which provides care in Arkansas, Kansas, Oklahoma and Missouri.

"It’s absolutely devastating that people are being forced to leave their communities to seek safe, essential health care outside of the state," said Alsaden, also a fellow with Physicians for Reproductive Health. "It’s heartbreaking to think of all of the people who may not be able to make it to a desired appointment to receive abortion care."

Alsaden said her clinics have seen an "influx of patients" from Texas over the last few weeks, noting, "We have adjusted our schedules to ensure that we can take care of as many patients as possible, no matter where they’re coming to us from."

Lori Williams, a nurse practitioner and the clinic director at Little Rock Family Planning Services in Little Rock, Arkansas, described the patients her clinic is seeing from Texas as "frantic."

"Many didn’t realize that this was coming or didn’t know that they were suddenly not going to be able to obtain care," said Williams, also chair of the National Abortion Federation Board, a membership association of abortion providers. "I had patients today driving seven hours to see us and Arkansas has a [72-hour] waiting period so that means these patients will have to travel twice."

Williams said she worries that as many patients from Texas as the clinic expects to see over the coming weeks and months, she knows there will be just as many, or more, who cannot access care.

"We know there are patients that tell us, ‘I don’t have a car that can make it that far,’ ‘I can’t get off work that many times,’ and these are the challenges we’re trying to have our patients navigate," she said. "It’s the time off work, the child care, the expense, all the things that go along with this, which makes this an economic crisis for women, in addition to an access to care crisis."

The rates of unintended pregnancy in the U.S. are highest among low-income women, women aged 18 to 24 and women of color, according to the Guttmacher Institute.

Meanwhile, people denied an abortion are more likely to experience long-term economic hardship and insecurity than people who received an abortion, according to a 2018 study published in the American Journal of Public Health (AJPH).

"The women who have the means will obtain the care, but the women who were already struggling financially, who are socioeconomically disadvantaged are the ones who are going to be impacted the most," said Williams. "There are going to be women out there who are forced to carry a pregnancy than they don’t want to."

"This is really going to have an impact more so than the abortion providers are going to see," she said.

Maleeha Aziz, a community organizer with the Texas Equal Access Fund, one of Texas’ nearly one dozen abortion funds that provide support to women seeking abortions, said it cost her about $1,500 to travel from Texas to Colorado for an abortion eight years ago.

Her organization and other abortion funds in the state are now working to raise additional funds and figure out the logistics needed for people in Texas to travel farther distances for care.

"While it’s a lot harder, we’re going to do whatever we can legally, even if that means flying someone out of state," said Aziz. "We are going to need so much more money because the cost [is high]."

Adding to the financial and logistical challenges is the fact that Texas is surrounded by states that have also have laws limiting abortion access. Those laws, called targeted restrictions on abortion providers, or TRAP laws, by abortion rights advocates, have been implemented in mainly conservative states to avoid being overturned in court and still limit abortion access in a variety of ways.

In the four states with which Texas shares a border, Arkansas, Louisiana, Oklahoma and New Mexico, there were just 21 facilities providing abortions combined as of 2017, according to the Guttmacher Institute.

Robin Marty, operations director at the West Alabama Women's Center, said the clinic is bracing for a trickle-down effect of patients from Texas making their way to Alabama because of a lack of access in other states.

"I believe that for people who are pregnant in Texas, I believe that a lot of them, if they were in early pregnancy, probably thought that they could just hold on for a while and see how everything's sorted out," she said. "So I expect next week to be the point at which things are really going to become clear what this does to the landscape, because people are going to start first calling Louisiana, where they're probably going to find out that there is a very long wait, because there already is, and then they're going to try to go next to Mississippi and will find mostly the same thing. And by that point, we're talking, when you come to Alabama, that's an eight-and-a-half hour drive."

Adrienne Mansanares, chief experience officer for Planned Parenthood of the Rocky Mountains, which provides health care in Colorado, New Mexico, and Las Vegas, said that while their clinics are already seeing the immediate impact of Texas's law, they are also planning for the long road ahead.

"That last bit of hope that there would be a solution, that there would be a backstop, that there would be protections for this procedure, that being gone has really shook a lot of us," Mansaneres said of the Supreme Court's 5-4 decision to not block the ban.

"With that, we are absolutely prepared for and doing the really dark, hearty work of trying to figure out what does this look like for years to come, and if it’s not just this law in Texas, what other laws can it be and what other states across the country are going to be this emboldened to continue with these really hostile bans," she said. "Unfortunately, it's looking very dark."

ABC News' Alexandra Svokos contributed to this report.