Abortion in Texas

According to the Center’s “What if Roe Fell?” interactive tool, Texas is categorized as a “hostile” state for abortion. See more about Texas’s abortion laws here.

Even before Texas’s S.B. 8 abortion ban took effect, abortion access in the state was already extremely limited.   

• Prior to the implementation of S.B.8, Texas had the largest number of U.S. cities classified as “abortion deserts”—where residents need to travel 100 miles or more to reach a provider—of any state. Ten of the 27 cities classified as “abortion deserts” are in Texas.ⁱ
• 96% of Texas counties are without a single abortion providerⁱⁱ, which is even higher than the already dire national average of nearly 90 percent of counties in the U.S. without a provider.ⁱⁱⁱ

Texas imposes more restrictions on abortion care than almost any other state,^iv including

• Trigger ban – In 2021, Texas enacted a trigger ban. These are abortion bans passed since Roe that are currently not enforced but could become effective if the Supreme Court limited or overturned Roe.  
• Pre-viability gestational ban – In 2021, Texas enacted a six-week ban on abortion with a private right of action, which allows private individuals to sue abortion providers or helpers in Texas courts. Prior to the enactment of the six-week ban, Texas law already prohibited abortion at twenty weeks.  
• Pre-Roe ban – There is an unenforced pre-Roe abortion ban still on the books in Texas. 
• COVID abortion ban – In 2020, Texas Governor Greg Abbott exploited the COVID-19 pandemic in an attempt to ban abortion care, issuing an executive order that purported to suspend procedures deemed “not immediately medically necessary” by the state. This measure is no longer in effect. 
• Method ban – Texas prohibits dilation and evacuation (D&E) and dilation and extraction (D&X) procedures, two common methods of second trimester abortion care.  
• Telemedicine ban – Texas restricts providers from using telemedicine for the provision of abortion care. 
• Additional Restrictions – People in Texas who seek abortion care must undergo a mandatory 24-hour waiting period, biased and often inaccurate counseling, and an ultrasound prior to receiving care. These laws serve no medical purpose and are intended to dissuade pregnant people from having an abortion. 
• Access to funding – Texas restricts public funding for, and private insurance coverage of, abortion. 
• Parental consent requirement – Texas requires that a parent or legal guardian be notified prior to a minor’s abortion and consent to it. Alternatively, a judge can approve a minor’s petition.
• Targeted regulation of abortion providers (TRAP) laws – Texas singles out abortion facilities and physicians who provide abortion care with medically unnecessary restrictions that are more burdensome than laws imposed on physicians who provide comparable types of care. Texas’s TRAP laws include facility requirements and reporting requirements for physicians. Texas also restricts provision of abortion care to licensed physicians. Providers who violate Texas’s abortion restrictions may face civil and criminal penalties. 

Every day that S.B. 8 is in effect, it causes devastating impacts on Texans seeking abortions and on abortion clinics in surrounding states. 

• The average one-way driving distance for a Texan seeking an abortion is estimated to have increased by as many as nearly 240 miles, a 14-fold increase.^v 
• An abortion clinic in Denver, CO saw a 520% increase in patients traveling from Texas following the enforcement of S.B. 8 in September 2021.^vi 
• Just nine days after the implementation of S.B. 8, the Trust Women clinic in Oklahoma City, OK had already seen more than a tenfold increase in appointments from Texas patients.^vii 
• The number of abortions in Texas fell by nearly 50% in the first 30 days following implementation of S.B. 8. (The decrease in access could have been greater were it not for the efforts of abortion providers working longer hours to accommodate as many patients as possible and an increase in donations to abortion funds following implementation of S.B. 8. These extraordinary factors helped people overcome otherwise insurmountable financial and logistical barriers to accessing abortion care.)^viii ix

Texas is the nation’s second-most populous state–so abortion bans affect millions of people.

• More than 29 million people live in Texas^x, including nearly 7 million women of reproductive age.^xi
• Prior to the implementation of S.B.8, approximately 55,000 abortions were obtained in Texas each year.^xii xiii

Like all abortion laws, the burdens imposed by S.B. 8 fall hardest on those who already face structural barriers to health care, especially Black, Indigenous and other people of color, immigrants, and those working to make ends meet. 

• Most abortion patients in Texas are people of color. In 2018, nearly 75% of abortions in the state were obtained by a person of color, categorized as Black, Hispanic, and Other in this study.^xiv 
• Black and Indigenous birthing people experience far higher rates of pregnancy-related death and complications than their white counterparts. The maternal mortality rate for Black women in Texas is 2.5 times more than that of the overall maternal mortality rate in Texas.^xv
• Many pregnant people in Texas cannot travel out of state to access abortion care due to a variety of financial and logistical barriers—including lack of transportation, childcare, sick leave, or insufficient income. These burdens fall hardest on people working to make ends meet, who may be forced to continue their pregnancies to term as a result of the hardships imposed by S.B. 8.  

Texas has focused on passing laws like S.B. 8 that make it harder for people to access needed reproductive health care—even though the state has among the worst health outcomes for women and children in the U.S.  

• Texas ranks 44^th among states when it comes to indicators measuring the health of women and children, such as access to publicly funded women’s health services, clinical care during pregnancy, and infant and maternal mortality.^xvi 
• Texas ranks 43^rd among states for maternal mortality¹, over 65% higher than the national average.^xvii
• The infant mortality rate² of Texas is slightly higher than the overall infant mortality rate in the US.^xviii 

Footnotes:

1. ⁱ Cartwright AF, Karunaratne M, Barr-Walker J, Johns NE, Upadhyay UD. Identifying national availability of abortion care and distance from major US cities: Systematic online search. J Med Internet Res. 2018;20(5). doi:10.2196/jmir.9717

2. ⁱⁱ  Jones RK, Witwer E and Jerman J. Abortion Incidence and Service Availability in the United States, 2017. Guttmacher Institute. 2019. DOI: doi.org/10.1363/2019.30760

3. ⁱⁱⁱ  Guttmacher Institute. Data Center. 2021. data.guttmacher.org/states/table?dataset=data&state=US&topics=72. Accessed September 10, 2021.

4. ^iv  Center for Reproductive Rights. What If Roe Fell? | Texas. Accessed October 27, 2021. maps.reproductiverights.org/what-if-roe-fell.

5. ^v  Nash E, Bearak J, Li N, Cross L. Impact of Texas’ Abortion Ban: A 14-Fold Increase in Driving Distance to Get an Abortion. Guttmacher Institute. Published August 2021. Accessed October 26, 2021. www.guttmacher.org/article/2021/08/impact-texas-abortion-ban-14-fold-increase-driving-distance-get-abortion#.

6. ^vi  Schmidt M. Denver Abortion Clinic Sees Over 500% Increase in Texas Patients. Colorado Times Recorder. Published October 7, 2021. Accessed October 26, 2021. coloradotimesrecorder.com/2021/10/denver-abortion-clinic-sees-over-500-increase-in-texas-patients/40081/.

7. ^vii  Tong R. Texas’ new anti-family abortion law is already hurting women’s health care in Kansas. The Kansas City Star. Published September 9, 2021. Accessed October 26, 2021. www.kansascity.com/opinion/readers-opinion/guest-commentary/article254076098.html.

8. ^viii  White K, Vizcarra E, Palomares L, et al. Initial Impacts of Texas’ Senate Bill 8 on Abortions in Texas and at Out-of-State Facilities. Texas Policy Evaluation Project. 2021. Accessed November 1, 2021. sites.utexas.edu/txpep/files/2021/10/initial-impacts-SB8-TxPEP-brief.pdf.

9. ^ix  Miller CC, Bui Q and Sanger-Katz M. Abortions Fell by Half in Month After New Texas Law. The New York Times. Published October 29, 2021. Accessed November 16, 2021. www.nytimes.com/interactive/2021/10/29/upshot/texas-abortion-data.html.

10. ^x  United States Census Bureau. QuickFacts Texas. 2021. Accessed November 1, 2021. www.census.gov/quickfacts/fact/table/TX/POP010210#POP010210.

11. ^xi  Texas Policy Evaluation Project. Abortion in Texas fact sheet. 2021. Accessed November 1, 2021. sites.utexas.edu/txpep/ files/2021/10/Abortion-in-Texas-Fact-Sheet-Sept.-2021.pdf.

12. ^xii Kortsmit K, Jatlaoui TC, Mandel MG, et al. Abortion Surveillance — United States, 2018. Centers for Disease Control and Prevention Morbidity and Mortality Weekly Report. Surveillance Summaries. 2020. 69(No. SS-7):1–29. DOI: dx.doi.org/10.15585/mmwr.ss6907a1.

13. ^xiii  Jones RK, Witwer E and Jerman J. Abortion Incidence and Service Availability in the United States, 2017. Guttmacher Institute. 2019. DOI: doi.org/10.1363/2019.30760.

14. ^xiv  Kortsmit K, Jatlaoui TC, Mandel MG, et al. Abortion Surveillance — United States, 2018. Centers for Disease Control and Prevention Morbidity and Mortality Weekly Report. Surveillance Summaries. 2020. 69(No. SS-7):1–29. DOI: dx.doi.org/10.15585/mmwr.ss6907a1.

15. ^xv  United Health Foundation. State Summaries Texas | 2018 Health Of Women And Children Report. America’s Health Rankings. Accessed October 27, 2021. www.americashealthrankings.org/learn/reports/2018-health-of-women-and-children-report/state-summaries-texas.

16. ^xvi  United Health Foundation. State Summaries Texas | 2018 Health Of Women And Children Report. America’s Health Rankings. Accessed October 27, 2021. www.americashealthrankings.org/learn/reports/2018-health-of-women-and-children-report/state-summaries-texas.

17. ^xvii  United Health Foundation. State Summaries Texas | 2018 Health Of Women And Children Report. America’s Health Rankings. Accessed October 27, 2021. www.americashealthrankings.org/learn/reports/2018-health-of-women-and-children-report/state-summaries-texas.

18. ^xviii  United Health Foundation. State Summaries Texas | 2018 Health Of Women And Children Report. America’s Health Rankings. Accessed October 27, 2021. www.americashealthrankings.org/learn/reports/2018-health-of-women-and-children-report/state-summaries-texas.