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When Texans with disabilities came to abortion clinics, staff remembered them. They might have needed in-clinic amenities or American Sign Language interpretation, and they might have come infrequently. But they still came.
But more than a year after abortion became illegal in Texas, people with disabilities are a “missing population” at clinics outside the state that still provide abortions, said Amy Hagstrom Miller, CEO of abortion service provider Whole Woman’s Health.
“We’re not seeing them moving across the border,” Miller said, “They just represent a group of people that gets overlooked.”
Aside from internal statistics from some abortion providers, abortion funding groups that help pay for the procedure and transportation, and advocacy groups, there is no central data tracking how many Texans with disabilities have sought abortions.
But the groups agree that barriers to accessing abortions have increased for Texans with disabilities. They say the current system, which alternates between out-of-state appointments and procedures, or self-administered abortions at home with medication delivered by mail, makes it more difficult for people with disabilities to get an abortion.
The demand for access is still there: Whole Women’s Health’s helpline gets just as many calls from people with disabilities, said Grace McGarry, who manages the line, but those questions and conversations don’t translate into visits at the same rate.
McCarley said that while specific needs may vary depending on the nature of the disability, by far the biggest barrier is transportation: The potential need for accessible cars and drivers, combined with the fear of flying for people with disabilities, can make last-minute travel to get an abortion “near impossible.”
“Disabled people, by and large, are really used to the system screwing them at every turn,” McGarry says. “Many of them think this is just one of those things that’s going on. They often come into our conversations expecting it to turn out badly for them, and it’s with a sense of resignation and totally legitimate anger at the situation.”
Ground Access
Beyond travel barriers, people may simply not have the income to travel out of state, or their medical conditions may limit how long they can go without regular treatment.
In one case, a dialysis patient in Texas needed to have an abortion at a clinic but was unable to leave the clinic for more than two days because she was too sick to undergo dialysis, McGarry said.
As a result, McGarry said, Whole Woman’s Health had to spend time arranging for a patient to fly out of state immediately after her dialysis treatment to have the abortion first thing in the morning, then return home immediately after the procedure and make it to her dialysis appointment the next day. Dialysis, which uses a machine outside the body to filter blood that the kidneys cannot, often causes severe fatigue.
“This is extremely difficult,” McGarry said. “It can be done, but it will require a lot of funding and a lot of coordination among a lot of different people.”
Because these concerns are common, McGarry has also created a guide for questions staff may receive from people with disabilities, chronic illnesses or other medical conditions.
In most cases, abortions are safe, but some conditions may require more personalized care. Some conditions, such as certain heart or seizure disorders, require a patient’s doctor to give permission for treatment. If a patient has uncontrolled diabetes or blood pressure issues, they may need an in-clinic abortion rather than medication, according to McCurry’s guide.
“Clinics and funders can only do so much, and what’s left for patients can still be too much, especially when there is limited or no support, which is unfortunately the case for many people with disabilities,” McGarry said.
“A lot of times they find themselves in a position where they think, ‘Oh no, I’m not going to get the abortion I need.’ And it’s heartbreaking and really infuriating that Texas law puts them in that position,” she added.
Since 2019, the Texas Equal Access Fund, a nonprofit that helps people pay for medical procedures, has included an optional question on its intake forms asking potential patients about their disability status.
Over the past five years, the fund has sent hundreds of people who identify as disabled out of state, though the numbers have declined since the U.S. Supreme Court’s decision in Dobbs v. Jackson Women’s Health Organization, which overturned Roe v. Wade in 2022.
“It was very difficult [disabled Texans] “When care was close by, people couldn’t get it,” said Charlie Hughes, receptionist at the foundation, “now it seems impossible.”
Hughes, who has a disability himself, advocates for the fund to track the population, but acknowledges that many people may choose not to self-identify, making it difficult to fully understand how legal changes have affected them.
Fund Texas Choice, a nonprofit that helps Texans pay for lodging, child care, gas and other incidental costs associated with getting an abortion, has a policy that allows people with disabilities to bring a chaperone, said Sarah Harvin, program manager.
Harvin said he has relationships with the same hotels that allow him to refer clients to accessible rooms and is also working with airlines to accommodate guests, but there’s always more planning involved, and for many of his clients, this is their first time traveling out of state.
“Most of our clients travel by air, and some of them have a variety of disabilities,” Harbin said. “Many of these disabilities are invisible, and just looking at them might not tell you how difficult it is for them to travel.”
Mia Ives Rubley, director of the Disability Justice Initiative at the Center for American Progress, said it’s also important to recognize that bodily autonomy — the right to make decisions about one’s own body — is a common pillar of the disability rights movement.
Ives-Ruby has conducted research on access to health care for people with disabilities across the country and has spoken out about how reproductive freedoms, like the right to have children and access to abortions, have historically been taken away. Numerous studies have shown that people with disabilities, especially those with intellectual disabilities, are at increased risk of sexual assault and violence.
Texas does not allow abortions in cases of rape or incest, but it had the highest estimated number of rape-related pregnancies among the 14 states included in the recent analysis.
For Texans with disabilities who belong to other marginalized communities, such as women of color, the barriers can be even more “extreme,” said D’Andra Willis, birth justice coordinator at the Afiya Center, which provides health care resources to Black Texans.
At the same time, not everyone among people with disabilities agrees that access to abortion counts as bodily autonomy, Ives-Rubry said.
“Like any part of America, there are a lot of nuances there and some people don’t believe the right to an abortion is a bodily autonomy choice,” she said.
John Seago, executive director of the anti-abortion group Texas Right to Life, said his organization is working with disability advocates on other issues, including trying to change Texas advance directive laws to allow hospitals to turn off life support if they determine the treatment is “futile.”
“Part of being pro-life is being considerate to vulnerable patients, to people with disabilities, so that’s really important to us. But when it comes to the issue of abortion, our opinions and views don’t change. Our ethical principles don’t change,” Seago said. “It doesn’t matter who the mother is.”
Robin Powell, an associate professor at the University of Oklahoma School of Law, said it was important to address the issue of disability, because she said the Dobbs decision exacerbated existing accessibility issues in reproductive health care.
“Abortion remains available to those who can get on a plane, get in a car, go to another state, and have the means,” Powell said, “but it has become much less accessible to people with disabilities and other marginalized communities.”
Neelam Vohra is a 2023-24 New York Times Disability Reporting Fellow based at The Texas Tribune through a partnership with The New York Times and the National Center on Disability and Journalism, based at Arizona State University’s Walter Cronkite School of Journalism and Mass Communication.
Disclosure: The Afiya Center and The New York Times are financial supporters of The Texas Tribune, a nonprofit, nonpartisan news organization that is supported in part by donations from members, foundations and corporate sponsors. Financial supporters have no role in Tribune journalism. A complete list of financial supporters can be found here.
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