Disabled Texans face more barriers to accessing abortion

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When disabled Texans used to visit abortion clinics, staffers would remember them. They may have needed in-clinic accommodations or American Sign Language Interpreters, and they appeared infrequently. Still, they came.

But more than a year since performing abortions became illegal in the state of Texas, disabled people have become a “missing population” at the clinics still providing abortions out of state, said Amy Hagstrom Miller, CEO of Whole Woman’s Health, an abortion provider.

“We're not seeing them traveling over the border,” Miller said. “They just represent a group of people that are falling through the cracks.”

Other than the internal statistics of some abortion providers, abortion fund groups that help pay for the procedure or its transportation costs, and advocacy groups, there’s no central data tracking how many disabled Texans have sought abortions.

These groups agree, though, that the barriers to access the procedure have increased for disabled Texans. Organizations say it’s more difficult for those with disabilities to navigate the current system, which toggles between out-of-state appointments and procedures, or self-managed abortions at home conducted with by-mail medication.

The demand for access still exists — Whole Woman’s Health’s help hotline gets calls from a similar number of people with disabilities, said Grace McGarry, who manages the line. But those questions and conversations aren’t translating to visits at the same rates.

McGarry said the nature of someone’s disability might change what they specifically need, but the biggest barrier, by far, is transportation. Between the potential need for an accessible vehicle or a driver, and the fears around flying as a disabled person, the last-minute travel needed to access an abortion in time can be “borderline impossible.”

“Disabled people are, broadly speaking, really accustomed to the system screwing them over at every turn,” McGarry said. “A lot of them are seeing this as just another way that's happening. They come into our conversation frequently expecting that it is going to go poorly for them, and it's that sense of resignation and perfectly justifiable anger at the situation.”

On-the-ground access

Beyond travel barriers, people may simply not have the income to get out of state, or their conditions limit how long they can go without regular treatment.

In one example, a Texas dialysis patient needed an in-clinic abortion but couldn’t go out of town for longer than two days because her body couldn’t afford missing dialysis, McGarry said.

As a result, Whole Woman’s Health spent time arranging things so the patient would fly out of state right after her dialysis treatment ended, receive an abortion first thing in the morning, and fly back home right after the procedure so she could make her dialysis appointment the next day, McGarry said. Dialysis, which uses a machine to filter blood outside of someone’s body when their kidneys cannot, often causes intense fatigue.

“That is extremely, extremely challenging to do,” McGarry said. “It can be done, but it takes a tremendous amount of money, and a tremendous amount of coordination of various individuals.”

Because of concerns being common, McGarry has even created a guide to questions her staff might encounter from people with disabilities, chronic illnesses or different medical conditions.

In almost all cases, abortion is safe, but some conditions might mean care needs to be more individualized. Conditions like certain heart diseases or a seizure disorder might mean a patient’s doctor needs to clear them for care. If a patient has uncontrolled diabetes or blood pressure issues, they might need an in-clinic abortion over medication, according to McGarry’s guide.

“There is only so much that any clinic or any funder can do, and what is left with the patient may still be too much, especially if they have limited support, or no support, which unfortunately is the case for a lot of disabled people,” McGarry said.

“A lot of times they just reach a point of: ‘Well, I guess I can't get the abortion that I need,’ which is both heartbreaking and also really infuriating that Texas law has put them in such a position,” she added.

The Texas Equal Access Fund, one nonprofit that helps people pay for the medical procedure, has included an optional question in its intake forms asking potential patients about their disability status since 2019.

In the past five years, the fund has sent hundreds of those identifying as disabled out of state — although the number decreased in the years after the U.S. Supreme Court’s ruling in Dobbs v. Jackson Women’s Health Organization, the case that overturned Roe v. Wade in 2022.

“It was very difficult for [disabled Texans] to access care when it was close by,” Charlie Hughes, intake director for the fund. “Now, it just seems impossible.”

Hughes, who has a disability herself, has advocated for the fund to track the population. But she also acknowledges that many people might choose to not self-identify and that makes it harder to fully understand how legal changes have impacted them.

Fund Texas Choice, a nonprofit that helps Texans pay for the ancillary costs associated with getting an abortion like lodging, child care, or gas money, has a policy that allows those with disabilities to bring a companion with them, said Sahra Harvin, a program manager.

Harvin said they work with the same hotels and have accessible rooms they’re able to refer clients to, as well as working with airlines to accommodate people, but more planning is always involved. For many of their clients, it’s their first time traveling out of state.

“A majority of our clients end up flying and we do have clients who are disabled in many ways,” Harvin said. “Many disabilities are invisible, and people might not realize how difficult it is for somebody with a disability to travel based on just looking at them.”

It’s also important to acknowledge that bodily autonomy, or the right to make decisions about one’s own body, is a general pillar of the disability rights movement, said Mia Ives-Rublee, the director for the Disability Justice Initiative at the Center for American Progress.

Ives-Rublee has researched disabled people’s access to health care across the country and spoken about how reproductive freedoms — between the right to have children, or the right to access abortion — have been historically taken away. People with disabilities are also at higher risk for sexual assault and violence, according to countless studies, especially those with intellectual disabilities.

Texas, which does not allow abortions in cases of rape or incest, had the largest estimate of rape-related pregnancies of the 14 states included in a recent analysis.

For disabled Texans who belong to other marginalized communities, like women of color, barriers can be even more “extreme,” said D’Andra Willis, birth justice coordinator at The Afiya Center, which helps provide health resources to Black Texans.

At the same time, people with disabilities are not all in agreement over whether abortion access counts as bodily autonomy, Ives-Rublee said.

“As in any cross section of America, there's a lot of nuance in that, and some people don't think that access to abortion is a bodily autonomy choice,” she said.

John Seago, president anti-abortion group Texas Right to Life, said his group has worked with some disability advocacy groups on other issues, including to try and change the Texas Advance Directives Act, which allows life support to be removed when a hospital decides care has become “futile.”

“Part of being pro-life is being sensitive towards vulnerable patients and those with disabilities, so that's really important to us. When it comes to the issue of abortion, though, our opinions and our views don't change. The ethical principles are still the same,” Seago said. “It doesn't matter who the mother is.”

Robyn Powell, an associate law professor at the University of Oklahoma College of Law, said bringing disability into the abortion conversation is critical. She said the Dobbs decision exacerbated existing accessibility issues in reproductive health care.

“Abortion will still be available for those who can get on a plane, get in a car, go to another state, who have the resources,” Powell said. “But for people with disabilities and other marginalized communities, abortion has now just become even less accessible.”

Neelam Bohra 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, which is based at the Walter Cronkite School of Journalism and Mass Communication at Arizona State University.

Disclosure: Afiya Center and New York Times have been financial supporters of The Texas Tribune, a nonprofit, nonpartisan news organization that is funded in part by donations from members, foundations and corporate sponsors. Financial supporters play no role in the Tribune's journalism. Find a complete list of them here.

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