In such a context, it’s easy to forget that women with access to the pills are the lucky ones. Today and in the future, regardless of what happens with Roe, the choice to have an abortion is effectively eliminated already for two overlapping sets of Texans: those who lack the money to travel out of state and those who are unable to risk the journey, as is the case for many women who are undocumented. There are more than a dozen checkpoints manned by U.S. Border Patrol officers across Texas, which means that nearly all undocumented women in need of an abortion are essentially confined to the areas where they live, and thus cannot escape the six-week rule. The rare exceptions are those who are awaiting immigration court hearings, which determine whether or not they can legally stay in the country.
At the clinic, I met one of the exceptions: a Cuban immigrant newly arrived in Texas without documents. She’d travelled to the U.S. with her brother, ahead of her husband and daughter, hoping she could eventually earn enough as a hair stylist to pay for their passage. “Either you have a relative abroad,” the woman said, “o te mueres pa’l carajo”—or you die in Hell. She’d gone first to Nicaragua, then hopped a bus to Honduras, where she was detained until, for two hundred dollars, local immigration authorities offered safe passage into Guatemala. Five days later, alongside fifty others, she crossed the border into the U.S. from the northern Mexican city of Piedras Negras, swimming through the Rio Grande’s forceful currents after dawn. “Throughout the entire journey, I never got my period,” she told me. “I thought it was because of stress.” Rumor in a stash house where the woman spent the night had it that her chances of being allowed into the country would improve if she turned herself in, so she did. After six days in a U.S. Customs and Border Protection facility, she was released and reunited in Texas with her father, who had settled eight years ago in Odessa. That same day, she learned she was pregnant.
Her father had spent twenty thousand dollars to get her and her brother out of Cuba. There was no more money for a baby, so the woman had to request permission from immigration authorities to cross state lines to get to Theard’s clinic. They gave her a phone that had a tracking app called SmartLINK, which routinely asked her to submit a photograph of herself. She worried less about the immigration surveillance than about her husband, who had threatened to divorce her if she got an abortion. “I still don’t know what I’m going to say to him,” she told me.
“Would you be upset if I talked you out of it?” Dr. Theard asked a patient gently while performing her sonogram. The thirty-five-year-old woman, who had been raised in foster care, replied with a cautious smile that she was sure. She refused to risk having a child go through what she had experienced. For years, she had taken antidepressants, sedatives, and other drugs to help her cope with the effects of that childhood trauma, and hadn’t had a period in four years. Her body was gradually ceasing ovulation, as if ratifying a choice she’d made long ago.
Later, Theard told me that he often asks women if he can talk them out of their decision—a question at which patients and staff have been known to bridle. On one level, he is trying to discern whether women are being coerced into the procedure. On another, he told me, he’s thinking about how, pregnant with him in Haiti, in the late nineteen-forties, his own mother considered not having a child. Evenings, her husband would put on an elegant suit, mist himself with cologne, and be off to what he called a meeting. “He would come back home at two in the morning and all hell would break loose,” the doctor recalled. In the end, she had Franz and later left Haiti, resettling with him in Washington, D.C.
In the years after the Second World War, the United States and small islands in the Caribbean weren’t terribly alike, but in both places an illegal abortion could usually be obtained if you had money and lived in a city and knew the right people. Through the fifties and sixties, in this country, hundreds of thousands of women managed to get one, according to a Guttmacher Institute estimate. Theard’s own mastery of the practice came the following decade, after abortion was legalized. Having completed medical school at George Washington University, he was deployed with the Army in Frankfurt, Germany, where, he recalled, “there was a lot of screwing going on.” Every week or so, military planes carrying men and women from bases elsewhere landed in Frankfurt, where ten gynecologists, including Theard, were on call. After watching other doctors perform abortions over and over, it was soon second nature to him, too.
When the U.S. became, with Roe, one of the first countries in the world to liberalize its abortion laws, dozens of other countries followed—an expansion of legal abortion rights worldwide that continued into this century. In recent years, though, a handful of countries have retracted those rights, among them Poland, Nicaragua, and the U.S. Theard believes that the politics of abortion in Texas today, and across the U.S. tomorrow, will bring back the secrecy, the criminality, and the unrest that buffeted women’s lives when he was growing up. “I cannot believe that people who were born after ’73 are going back to the Middle Ages,” he said. “Sometimes I think it is more of a taboo now than it was then.”
If Roe is overturned, federal agencies are bracing for a rise in anti-abortion violence, but Theard has decided it’s useless to anticipate public antagonisms that he is helpless to control. “I never learned to shoot while I was in the Army,” he said. “It’s not like I’m going to get a gun now.” A more pressing concern is how to sell his practice to a younger doctor. Like many other aging abortion providers, he’s tried for years. There are no buyers.
Laura’s boyfriend had been slow to text back on the morning she would start her abortion. He had some story about having to take his little brother to get a haircut. Distressed, Laura put on a black hoodie and sweatpants, pulled her long, straight hair back into a ponytail, and rode to the clinic, where she welcomed the minor mercy of being able to hide her face behind a medical mask. In accordance with typical clinic practice, her father and sisters would wait outside, as would other partners, husbands, brothers, and children. Dr. Theard believed that discouraging men from entering the clinic lowered the risk of women being pressured to have the procedure against their will. Children—at least, those not having abortions—were usually kept out because many women had told him that their presence made them sad and uncomfortable. As Laura crossed the parking lot with her father’s girlfriend, two people were offering free pregnancy tests to women exiting their cars, and she couldn’t make out their agendas. That confusion was one of the many elements of the day that left her feeling “just scared.” She was morning-sick, maybe. Heartsick, definitely. Inside a waiting room crowded with other patients from out of town—some of them staring at every new person who walked through the door—she was all too aware that she was the youngest.
No patient at the clinic is called by name, for privacy reasons, so Laura was Patient No. 10. For three hours, Patient No. 10 used every bit of self-discipline in her possession not to turn for comfort to TikTok, knowing that its spangly music and trippy voices might bother the women around her, or provoke more age-appraising stares. Finally, her number rang out in the room.
A few minutes later, Theard was wiping down the probe he’d applied to her belly and informing her that she was in her sixth week: early enough for a legal abortion in Texas, had the state had any slots. She put her hoodie back on and accepted a thimble-size cup containing one mifepristone pill, which prevents the pregnancy from growing. “Nothing is going to happen,” Theard said. “Just swallow it like a Tylenol.” Laura lowered her mask, did as instructed, and left the clinic carrying several items that, together, felt like a lot: instructions to visit the emergency room the next day for a shot to reduce the likelihood of complications connected to her blood type, O negative; an envelope containing four misoprostol pills, to be taken to start the contractions the next day; and a note to middle-school administrators to excuse her absence the day after that.
Laura’s father couldn’t pack up the family and flee the parking lot fast enough, and on impulse he decided to make some quick detours in El Paso, where his mother had grown up. One stop, made in part to cheer up his artistically gifted daughter, was the Segundo Barrio, where graffiti artists from around the country had come together in February to tag walls of industrial warehouses as part of a celebration known as the Borderland Jam. There were renderings of Indigenous goddesses and gods and Mexican icons and the Virgin of Guadalupe. The youngest girl was ecstatic—“Come on, come on, come on!” she said, running toward the murals. Laura gravitated to the paintings farthest from her family. The next stop was a cheese shop that her grandmother had loved, in the sleepy border town of San Elizario. She’d urged her son not to leave West Texas without picking up her favorite asadero cheese, a specialty of northern Mexico. She’d reimburse him, she had solemnly promised.
A third stop, nondiscretionary, was at a Border Patrol checkpoint, where a long line of cars and trailers also waited, and dogs were circling vehicles, sniffing for drugs and hidden migrants. When the family’s turn came to be eyeballed, Laura’s father answered flatly and truthfully a single question—“U.S. citizen?”—and was free to go. A hundred miles later, at an Exxon, his debit card giving him trouble, the U.S. citizen turned to his eldest daughter and said, sighing, “It’s your turn to take care of me.”
He wondered how, or if, his family would recover from the financial blow, now that they had “nothing to fall back on.” He couldn’t feign interest in Season 4 of “The Vampire Diaries,” which his girlfriend was watching on her phone to stay awake as she drove the trip’s final leg. He slept instead. By the time he woke up in the driveway of his house in a Dr. Seuss neighborhood, it was one in the morning, the next mortgage payment was due in seven days, and the absurdity of the top-secret mission hit him all over again. He said, as if summoning a distant memory, “We did feel like we were moving up.”
“Place the pills between upper lip and gum for 30 minutes then swallow with water,” read the instructions on the envelope in Laura’s hand. If Roe is overturned, what Laura did that Sunday after a few hours’ sleep will likely be criminalized in many states, including her own. In some places, terminating a pregnancy from the time of the egg’s fertilization—or fetal personhood, as anti-abortion activists call it—may be tantamount to murder.
Before long, Laura was beset by agonizing cramps. She threw up the macaroni and cheese that she’d eaten for lunch. At one point, she felt like she was dying. And although her boyfriend was texting back that morning, sharing thoughts on the new Batman movie and the relative cuteness of a range of husky dogs on YouTube, the only real comfort came from a hot shower. She was in such pain that her father had to carry her to the bathroom. By day’s end, Laura was no longer pregnant.
Negrete and other employees at the Santa Teresa clinic routinely follow up with patients, three days after they take the pills, to make sure their abortions have gone smoothly. Many will experience severe cramping and feel nauseated and dizzy, as Laura did. A few will face more serious complications, such as critical blood loss or septic shock. Sometimes medication abortions simply fail and women remain pregnant. But a lot of what patients experience Negrete and her colleagues will never know, because they don’t reach half the women on their lists. Women often share fake contact details, and, when they do provide genuine phone numbers, some of them hang up when they hear that the person on the other end is from the clinic.