The Texas law (S.B. 8) that prohibits abortion after about six weeks of pregnancy went into effect on September 1. Mounting evidence illustrates that the negative effects of this law have been immediate and devastating—including new survey data from Guttmacher showing an increase in Texans obtaining abortions in far-flung states like Illinois, Maryland and Washington.

S.B. 8 bans abortion at a point so early in pregnancy that many people do not yet know they are pregnant. Combined with other factors—like navigating intentionally burdensome restrictions and raising the money to pay for an abortion— the new law makes it impossible for many to get care in Texas. And even those who have the means to travel outside the state have encountered overloaded clinics in the four states bordering Texas (Arkansas, Louisiana, New Mexico, Oklahoma).

Texans Seeking Care in Nonadjacent States

The Texas abortion ban and the resulting increase in patients at clinics in adjoining states has forced some Texas residents—or at least those who have the resources to do so—to travel even farther for care.

Between October 22 and 29, Guttmacher researchers asked a sample of abortion clinics across the United States how many Texas residents they had provided abortions to in August and September 2021. As of November 8, we have data from 120 clinics in 28 states and the District of Columbia. Excluding the four states that border Texas, we found that 11 states and DC had an increase in the number of abortions provided to Texas residents. These included states that are hundreds, and even thousands, of miles from the Texas border, such as Illinois, Washington, Ohio and Maryland.

Other preliminary findings include:

• At least one clinic in each of these jurisdictions reported seeing additional patients from Texas: Alabama, Arizona, California, District of Columbia, Georgia, Illinois, Indiana, Kansas, Maryland, Ohio, Tennessee and Washington.
• Clinics that responded to our survey expect the increase in calls and visits from Texas residents seeking abortion to continue despite many who inquire finding out-of-state care to be cost prohibitive or too logistically challenging.
• One site in Tennessee reported that since S.B. 8 went into effect, it had twice as many patients from Texas as during all of 2020—six in September compared with three in the entire previous year.
• Some providers in states bordering Texas also reported a domino effect, in which the influx of patients from Texas has decreased the availability of appointments for in-state residents, pushing some residents to travel out of state for care themselves.
• One clinic in a state adjacent to Texas indicated that more than 25% of Texas residents who obtained abortions at the facility in September and October were more than 12 weeks pregnant—when only 13% of abortions in Texas to state residents occurred at that number of weeks or later before S.B. 8 was implemented. The need for some Texas residents to leave the state for abortion services is likely contributing to delays in obtaining care and the timeframe could lengthen even further for those traveling to states farther away from Texas.

Our survey did not include all clinics in the United States and is not a representative sample. Among clinics that responded, the number of abortions provided to Texas residents in any one facility was typically fewer than five. In some cases, a clinic had an increase in patients from Texas from zero to one. Still, there was a consistent pattern of reports indicating that Texas residents are traveling elsewhere to access abortion care and that clinics across the country are seeing an increase following the state’s six-week abortion ban.

Clinics in Neighboring States Overwhelmed

Media coverage has documented a substantial decrease in abortion caseloads at Texas clinics, with some reporting declines from 30 abortions per day to three or fewer. New research conducted by the Texas Policy Evaluation Project documented a 50% decline in abortions at Texas clinics after the law went into effect—almost 2,200 in September 2021 compared with 4,300 in September 2020.

With abortion services in Texas severely restricted, many pregnant Texans—those who have the resources or can get support to overcome the many logistical and financial challenges—are going out of state for care. But even that can be a difficult undertaking. According to a Guttmacher analysis, the drive time for Texans to reach a clinic if they have to travel to another state increases the trip by an average of nearly 3.5 hours each way. Media reports have found that abortion clinics in the four neighboring states of Arkansas, Louisiana, Oklahoma and New Mexico have experienced a large increase in the number of Texas residents obtaining abortions. 

The clinics in states that border Texas do not have the capacity to meet the need for all Texans seeking abortion care. In fact, the total number of abortions typically provided in all four of those states combined is equal to 41% of the annual number of abortions provided in Texas before the law went into effect. The clinics in states bordering Texas clearly do not have anywhere near the capacity to meet the need for all Texans seeking abortion care.

Uneven Impact Worsens Existing Disparities

Many Texas residents needing an abortion do not have the resources to travel hundreds or thousands of miles for services. Prior to S.B. 8’s passage, 59% of people obtaining abortions in Texas were in their 20s, 74% were Black, Indigenous or other people of color (most commonly Latinx, 37%) and 61% had at least one child; as of 2014, 44% had family incomes below 200% of federal poverty guidelines.

These statistics suggest that many seeking abortion care are young people of color taking care of the children they already have, and are doing so with limited resources. In addition to the cost of the abortion ($550 at 10 weeks, on average), these individuals would have to find money to pay for transportation, negotiate time away from work or school and arrange child care to cover the multiple days of travel to obtain the abortion.

Although abortion providers, abortion funds and practical support organizations are working at their maximum to help patients obtain care within and outside of Texas, it is unlikely to be feasible for thousands of Texas residents to overcome these barriers. Individuals should be able to obtain abortion care at any stage of their pregnancy—ideally in their own community or nearby, and certainly within their state of residence. In the absence of accessible abortion care, Texas residents who cannot travel to other states may self-manage their abortion or else carry the pregnancy to term.

As expected, S.B. 8 is proving to be a heavy burden for Texans seeking abortion care and is likely to be an insurmountable one for many. It is becoming clear that disruptions to abortion care in one state will spread, increasing caseloads in clinics and affecting access to abortion care in other states, while eroding reproductive health and autonomy across the country.