The recent Texas law that banned abortions after six weeks gestation was written to be enforced by almost anyone, anywhere in the United States — creating a bounty hunter system. It could turn neighbors against neighbors, family members against family members, and incentivize strangers to spy on women.

The law’s bounty hunter quality is reminiscent of authoritarian governments’ secret police, says Nada Stotland, MD, MPH, professor of psychiatry at Rush Medical College in Chicago.

“What this new law sets up, in terms of psychiatry, I can only equate with what people in East Germany went through under the secret police,” Stotland says. “Everyone is incentivized to report and spy on the most intimate life of other people, for profit.”

The law gives people a big financial incentive to spy on women, see who is giving them a ride, and watch them closely.

Roe v. Wade was based on privacy, and a lot of smart people have complained that this wasn’t the best grounds for Roe v. Wade [to be decided],” Stotland explains. “Now, we have an action where we’re going to a place where there’s no privacy at all.”

Stotland predicts the law could result in people suing those of whom they are suspicious, even without proof that anyone obtained an abortion.

“Any kind of transaction or behavior could be interpreted as intended to cause an abortion to happen,” Stotland says. “If someone borrows $500 from somebody, and that’s how much an abortion costs, then [the loaner] has to prove it was for something else; it pervades everything you do and everywhere you go.”

Planned Parenthood centers have been flooded with calls from people trying to figure out what they can do and where they can turn for care, says Lauren Kokum, spokesperson and associate director of health media with Planned Parenthood Federation of America.

“All three Planned Parenthood affiliates in Texas are experiencing higher call volumes than normal,” Kokum says. “The No. 1 question on Planned Parenthood’s national Ask the Expert page is, ‘How far along can you be to get an abortion?’ It’s up 102% compared to last year.”

The Texas law also is affeceting reproductive health providers nationwide, but particularly in states near enough to Texas that people will drive there for safe and legal abortion care.

State laws that make legal abortion challenging already caused a migratory shift in which people crossed state lines to access abortion facilities. The Texas ban is expected to increase that trend.

“We provide abortions in Oklahoma, Louisiana, and New Mexico, through surrounding affiliates, and all of those states have seen Texas patients,” Kokum says. “We even had one health center outside of New York City that saw a patient who flew from Texas immediately after the law went into effect.”

Thousands of people go to California and other states to access abortions because they are unable to obtain a legal and safe abortion in their own state, says Julie Rabinovitz, MPH, president and chief executive officer of Essential Access Health in Berkeley, CA.

Since Texas SB 8 took effect, this number could increase significantly. “Now, we expect tens of thousands of people to come into California,” Rabinovitz says. “From a capacity standpoint, that could be really difficult for a lot of centers if they don’t have the ability to expand and serve these patients.”

Essential Access Health wants to be a supportive ally to providers in Texas, but its chief mission is to support California reproductive health clinics, she notes.

“We’re in active conversations with providers across the country to mobilize and do everything we can do in terms of abortion care,” Rabinovitz says. “We’re working with the California Alliance of Reproductive Freedom to see what we can do on our end to be supportive of both women and providers in Texas.”

The Texas law is particularly stressful for women and abortion providers because someone could be sued based on suspicions, and their legal costs could not be recouped from the accuser.

“We don’t know who is going to sue and how they’re going to sue, and it’s unclear how effective this law will be,” Rabinovitz says. “I think it’s terrifying.”

The Texas abortion ban has mobilized organizations across the country to do more to expand and protect access to abortion care. “We’re exploring ways to support partners across the country through telemedicine care,” Rabinovitz says. “We’re also exploring options to make California a haven for women from other states.”

About two dozen states, including California, have publicly opposed the Texas abortion ban. As of press time, the ban was suspended by U.S. District Judge Robert Pitman. Texas officials are appealing this decision to the 5th Circuit Court of Appeals.1

SB 8 gives very little legal room for defense. For example, if one plaintiff files lawsuits against different clinics in Texas and loses the first case, the other providers cannot rely on the first case to stop the litigation. Also, ignorance is not a defense. If someone gave money to a woman, who used it to have an abortion, the person cannot win against the plaintiff based on their not knowing that the money would be used for the abortion. Defendants cannot recoup their legal costs, although they have to pay the plaintiff’s attorney if they lose.2

“Had the Supreme Court just stayed the implementation of that law, then life could have gone on while people argued about this,” Stotland says. “What the Supreme Court has added to the horror of this law is a method by which clinics have to shut down.”

Meanwhile, pregnant women in Texas who are past six weeks of gestation are left with few safe options. One option is to travel to another state to obtain a safe and legal abortion. Another is to obtain abortion medications from overseas. This option is illegal nationally.

News reports suggest that some Texans have already engaged in self-administered abortions by ordering pills online from international entities.3

Undoubtedly, Texas women will face psychological repercussions from the law, Stotland notes.

“There are women who can’t get a legal abortion. We know that women will resort to almost anything, including life-threatening interventions, to keep from having babies that they feel they can’t be good mothers to,” she adds.

The public’s sentiment toward favoring legal and safe abortions and the actions of their elected officials who find creative ways to obstruct access to abortions is a cognitive dissonance that has made abortion a political wedge issue.

“The reason we have most people in the U.S. not wanting to outlaw abortion and yet they elect people who pass laws like this is because when you’re not in that circumstance, you like to believe you will never be,” Stotland says. “Women who belong to religions that condemn abortion get as many abortions as women who don’t.”

REFERENCES

  1. Marimow AE, Wax-Thibodeaux E. Federal judge blocks enforcement of Texas law banning abortion as early as six weeks. The Washington Post. Oct. 7, 2021.
  2. Douglas E, Astudillo C. We annotated Texas’ near-total abortion ban. Here’s what the law says about enforcement. The Texas Tribune. Sept. 10, 2021.
  3. Shabad R. How people are getting around the new Texas abortion law. NBC News. Sept. 25, 2021.