Abortion Laws in Texas Restrict Doctors in Providing Abortion Care

Abortion bans disproportionately affect the most marginalized groups in the United States. The majority of states that have banned or are poised to ban abortion—those in the South and in the Midwest—are also some of the states with the highest numbers of Black, Hispanic, and Indigenous women. Further, abortion bans disproportionately affect people with low incomes, disabilities, and limited English proficiency. Doctors such as Andrea Contreras care for these underserved populations and witness the devastating consequences of restrictive laws; Texas’ regime of criminalization and punishment of abortion and reproductive health care, for example, has made it that much harder and scarier for patients experiencing dire pregnancy complications to seek and receive lifesaving care.

Andrea Contreras is pictured in April 2023. (Photo credit: Andrea Contreras)

Dr. Andrea Contreras is a third-year OB-GYN resident in South Texas. Her hospital often treats patients from underserved and undocumented populations, many of whom experience barriers to health care such as low incomes, limited English language proficiency, and limited access to transportation. Many patients struggle to afford an annual gynecologic exam, pap smear, or a necessary biopsy.

In Andrea’s second year of residency, the U.S. Supreme Court issued its Dobbs v. Jackson Women’s Health Organization decision, which overturned the federal right to abortion. But prior to Dobbs, Texas enacted S.B. 8, also known as the “Texas Heartbeat Act.” This law allows for civil action against any individuals who provide abortion care or support such care via provision of funds or transportation by effectively deputizing residents. As Texas residents were already dealing with the fallout from S.B. 8, the Dobbs decision exacerbated confusion and fear among patients and providers.

In the wake of S.B. 8 and Dobbs, Andrea said she saw two significant shifts: 1) More women delaying care for common pregnancy complications out of potential legal repercussions, which could result in dire and preventable issues such as life-threatening bleeding or infections, and 2) a fear among providers due to seemingly intentional legal ambiguity, which led to delays in care with potentially catastrophic results. Because of this, providers like Andrea often face limitations in their ability to provide specific types of care. For example, a second-trimester pregnancy with ruptured membranes is considered high risk for infection, sepsis, and even death. Andrea also said she often questioned the legality of care when attempting to provide evidence-based management options for patients in the middle of an ongoing pregnancy loss. Meanwhile, patients presenting with early pregnancy bleeding were scared about possible legal repercussions, as any person could bring a lawsuit against them for suspicion of an induced or elective abortion.

Although Andrea’s practice is certified to dispense mifepristone for miscarriage care, despite some recent steps forward, aspects of the certification requirements for the drug’s use present yet another unnecessary administrative hurdle for health care providers that reduces access. Mifepristone is used in medication management of early pregnancy loss, which includes diagnoses such as missed abortions and early embryonic demise. Andrea said she fears that without mifepristone, patients already mourning a pregnancy loss will face more difficulty accessing critical health care, longer labor induction process, and potentially more complications.

One thing is clear: Abortion bans are harmful to people everywhere, and they make it more difficult for people to receive lifesaving care. The Biden administration must take action to ensure that providers and patients get the support and protections they need.