Letter from Texas: An Abortion Odyssey
In the dilemma of one girl and her family, a preview of a post-Roe America.
A new law has forced women to make arduous, expensive journeys to oversubscribed clinics in other states. (ILLUSTRATION BY ANNA PARINI)

Last summer, shortly after a date to Six Flags Over Texas, a thirteen-year-old girl in Dallas was falling in love for the first time. Her father could see it in the pencil drawings she made before bed. Instead of the usual, precise studies of koi fish and wildflowers, she’d sketched herself holding the hand of a boy in a Yankees cap, and enclosed the image in a pink-and-red heart. In the fall, the girl’s father permitted her to meet the boy, a tenth grader, after school one day a week. This spring, when he learned that his daughter was pregnant, he concluded that one day a week had been too many.

Within a day, his daughter, whom I’ll call Laura, came around to the idea that getting an abortion, soon, might be the best option. This required scheduling an appointment with a doctor who could prescribe her one pill to block progesterone and stop the growth of the fetus, and four other pills to prompt contractions. Her father, who worked in a factory painting locomotives on a 4 A.M.-to-2:30 P.M. shift, decided to use his next day off to take her to a doctor to get the medication. The question was: where? Last September, Senate Bill 8—also known as S.B. 8, or the Texas Heartbeat Act—went into effect across the state and sped up the timeline for enacting such a choice. The new law makes it illegal for women to obtain an abortion past the sixth week of gestation, or even before the sixth week, should electrical activity in fetal cells be detected by ultrasound. No exceptions are made for pregnancies that result from rape or incest, or for those of very young teen-agers.

The father’s girlfriend, who is close to Laura and controlled the household supply of sanitary pads, deduced that the girl had missed only one period. That meant Laura might just beat the six-week cutoff, so the girlfriend hastened to call local clinics. A few hours later, though, she and the father were confronting a fact faced by many other Texas families since the passage of S.B. 8. “Everything is booked out for a month’s time, if you can even get someone on the phone,” the girlfriend said. In the nine months since the law was implemented, the number of abortions performed in Texas has fallen by half, according to the Texas Policy Evaluation Project, at the University of Texas. Meanwhile, thousands of women and girls who want to end their pregnancies have been compelled to seek care in other states.

For Laura’s family, the nearest option was Oklahoma, but none of the clinics that the girlfriend called had appointments available. In Arkansas, the wait to see a doctor would be weeks—a delay that the father thought would be hard on Laura, an eighth grader who sometimes spoke of feeling isolated and depressed. “I’m not putting her through that,” the father told his girlfriend. Finally, seven calls later, the girlfriend reached a clinic in Santa Teresa, New Mexico, whose doctor could see Laura that weekend. It was a decent place, the girlfriend could report with confidence; she’d taken a pregnant relative there the month before. There were two catches, though. The clinic was seven hundred miles away, and the cost was, for the family, exorbitant.

Under Texas law, insurers are forbidden to cover abortions unless the woman’s life is at risk. At the New Mexico clinic, the appointment to get a sonogram and obtain the five abortion pills would cost the family seven hundred dollars. And, because the trip was so long—ten or eleven hours by car—they would also have to leave a day early and pay for somewhere to spend the night. The previous month, the father had ransacked his savings to make a five-thousand-dollar down payment on a three-bedroom house—a step up from the decrepit rental where the family had lived for five years. After renting a U-Haul truck for the move, paying utility deposits, and buying pots, pans, and a toaster, all he had left was fifteen hundred dollars—his emergency stash, “something to fall back on,” he said. He felt sick at the thought that he’d now be using that stash to secure a legal abortion for Laura in New Mexico.

The father understood intimately what teen-age parenthood entailed. Laura was born when he was a high-school sophomore. She was, as he always told her, a wanted child. But, after his relationship with Laura’s mother imploded and he found himself raising their daughter and, later, two younger girls, it had taken him a decade, and at times three jobs, to get his family off public assistance. If Laura had a baby, they might find themselves slipping back into the food-stamp life they’d left behind. More than that, though, the pregnancy threatened a particular dream he had for Laura: that she would press through this hard phase of her adolescence childless, and enjoy some of the fun, silliness, and high-school dance parties that he had missed.

One in four girls and women in the United States will, at some point in her life, seek an abortion. Yet, if the Supreme Court overturns Roe v. Wade, which, in 1973, established a woman’s constitutional right to the procedure, the long journeys to oversubscribed clinics that have become a fact of life in Texas will almost certainly become the norm throughout much of the country. Post-Roe, legal authority will devolve to the states, thirteen of which have in place “trigger laws” that would ban all, or nearly all, abortions. Ultimately, according to the Guttmacher Institute, twenty-six states are likely to outlaw the procedure. Some pregnant people in the U.S. who will be stripped of the right to legal abortion will go on to have illegal procedures. Others will be forced into motherhood. And millions of families will find themselves grappling with the same calculations that Laura’s family was encountering this spring: How far are we able to go, financially and emotionally, to terminate a pregnancy? And, when it’s all done and paid for, how much farther down the socioeconomic ladder will we be?

By necessity, the trip to get Laura an abortion would be a family affair. The father’s girlfriend would come along to be with Laura when she saw the doctor, and Laura’s sisters would also be joining them, the family budget being too tight to cover two days of babysitting. The father told the younger girls, in lieu of an explanation, “This is a top-secret mission.” He hoped they might never learn that Laura had been pregnant. But, in a time of regrets about his parenting judgments, taking his eldest girl out of state to have the abortion would not be one of them. “There’s always a crowd of people outside protesting,” he said, of Texas clinics. “They’ve got baby-fetus signs and are yelling, ‘In the name of the Father!’ They’re coming to your car window as you’re driving in.” Even if Laura had been able to get an appointment for an abortion within the time frame demanded by S.B. 8, he couldn’t stand the thought of subjecting her to the shame and stigma associated with the procedure in his home state.

Instead, one gusty Friday afternoon in April, he, his girlfriend, and the three girls climbed into a blue Chevrolet van and headed west. The middle sister, who was eight, brought along persistent questions—Is Laura sick? And, if she is sick, why does she have to go so far away to see a doctor? The four-year-old brought along her stuffed unicorn, Chelsea. For the journey, she had put on bright-pink sneakers, and they lit up every time she tapped her feet.

The small, unincorporated community of Santa Teresa sits on the southern edge of New Mexico, a short drive from downtown El Paso. A developer established the town in the nineteen-seventies, envisioning a binational planned community of industrial parks, country clubs, and luxurious homes—a dream that, by the nineties, had failed. Today, as its golf courses turn to rubble and the tennis courts grow hairy with weeds, the new draw in town is a clinic tucked away in a drab strip mall near the Rio Grande, where girls and women can end their pregnancies legally.

Women’s Reproductive Clinic, which is poised, post-Roe, to be among the last remaining abortion providers in the Southwest, is situated alongside insurance businesses, fast-food joints, and a cannabis store. Last year, it averaged a hundred and fifty-four abortion patients a month. This spring, thanks to Texas’s new restrictions, the number of monthly patients is nearing three hundred. Occasionally, picketers in front of the clinic try to intercept arriving patients and usher them into a large turquoise van, where free sonograms are performed and anti-abortion literature is shared. But on most days a sense of stillness pervades the outside of the clinic, in part because of Juan Carlos, a spry, silver-haired security guard whose gaze alone is said to dissuade those who may be primed for a fight. The greater tension, since the passage of S.B. 8, lies on the other side of the tinted-glass doors, in the waiting room.

In late April, when I visited the clinic, a receptionist named Elizabeth Hernández sat at a desk heaped with patient records and bills, greeting women and answering calls. Lately, she said, some of the callers are panicked as they schedule appointments, asking, “Am I going to get arrested? Are they going to follow me from the clinic afterwards?” A provision in S.B. 8 allows any private citizen to sue those who “aid or abet” a woman seeking an abortion in Texas past the six-week mark, whether the abettors are Lyft drivers or relatives who lend money for the procedure. Hernández, who is thirty-five, feels the ambient anxiety surrounding S.B. 8 even when she goes home, where her children have started worrying that she’ll be attacked on the job.

Her friend and fellow-receptionist Rocío Negrete has been working at the clinic for seven years. Until S.B. 8, she never saw patients from East Texas or Central Texas. But a stack of folders she was examining one afternoon showed how far women would be travelling to receive the abortion pills, mifepristone and misoprostol, the following day. They were coming for these “medication abortions” from Lubbock, Houston, Odessa, Oklahoma City. Lots of women were coming from Oklahoma and Louisiana this year, because Texan women had taken so many open slots at abortion clinics in their own states. In the coming months, the influx from Oklahoma will likely surge, given that its governor, Kevin Stitt, just signed a bill prohibiting abortion from the moment of fertilization, the most extreme restriction in the country.

If both running a clinic and getting an appointment at one feel fraught these days, early abortion remains, medically speaking, a simple procedure. A woman who comes to the clinic in Santa Teresa will, like women who visit many other clinics in the U.S., receive a counselling session, a sonogram to confirm how far along she is in the pregnancy, and the five pills, all but one to be ingested elsewhere, that will end it. But, as the conversation around abortion grows more punitive, and as states continue to roll back women’s rights, distressed patients sometimes take their feelings out on clinic workers. “They talk to us like we’re the ones that made them be in this situation,” Hernández said. And yet she is sympathetic, because she considers all the new obstacles to having a straight-forward procedure to be a form of psychological warfare. “People barely get the courage to actually go forth with it,” she said. “They’re just trying to break you down, further and further, until you’re finally, like, ‘You know what? Never mind.’”

One morning, a thirty-two-year-old bartender from Houston lay supine on a table in the clinic’s windowless sonogram room, ultrasound jelly smeared across her flat stomach. She was determined not to say “Never mind.” She was on birth control, which had, evidently, failed. And although she had discovered the pregnancy at five weeks—seemingly in time for a legal abortion in Texas—she discovered, as Laura’s family did, that all the clinics near her were booked for three or four weeks in advance. A woman would have to make an appointment before even missing a period to beat that unforgiving clock.

To her further shock, during a sonogram in that fifth week of pregnancy, she learned that, atypically, cellular electrical activity—what is often called the fetal heartbeat—could already be heard. So, even if she’d been able to unearth a slot at a clinic elsewhere in Texas, an abortion was already illegal. Motherhood was not an option. “I want to be able to choose a different path for myself,” she told Franz Theard, the gynecologist who owns the clinic, as he moved the probe over her belly.

Theard, who is seventy-three, has been performing abortions for nearly five decades. His usual demeanor, casual and sunny, is in stark contrast to the vehemence of the abortion debate. He’d like to spend more time in the years ahead on his backhand and net game, and during the pandemic, recovering from a bad bout of COVID-19, he considered retiring. He considered it again recently upon learning that the clinic’s landlord didn’t want to renew his lease and that he’d have to find another space to practice. But he doesn’t want to make the existing shortage of abortion providers in the American Southwest worse.

The bartender told Theard that she had contemplated travelling to Arkansas, where abortions are currently allowed up to the twentieth week, but getting one would require first meeting with a counsellor, as mandated by the state; undergoing an ultrasound; observing the fetus and listening to its heartbeat; getting a detailed description of its development; waiting seventy-two hours before the procedure took place; and, finally, driving four hundred miles back to Houston. How could she take that much time off work? She had briefly considered Louisiana, but the clinics that she found there, including one in a small, dark-brick house in Baton Rouge, inspired no trust. “It looked like somewhere where I would die,” she said.

Back home, people close to her had already suffered S.B. 8’s consequences. A member of her family had found out in her first trimester that her fetus had a possible birth defect, but it was too late for her to get an abortion under Texas law, so she had to continue the pregnancy until the fetus died, midterm, after which she had no option but to deliver the corpse. Around the same time, her boss’s wife had a similar experience and almost died. “I was about to give up,” she told the doctor. “Then my boyfriend suggested we try New Mexico, and we found you.”

Twenty states, New Mexico among them, have a firmly liberal stance on abortion, a position that a Roe reversal is unlikely to change. There is no waiting period in New Mexico, minors can undergo the procedure without consent from their parents, and the state offers funding for abortions necessitated by medical emergencies. Theard appreciates the privilege of treating patients in this unusually stable context. Even before S.B. 8, abortion providers had been fleeing Texas, and he had been one of them.

Until 2020, he had operated a second clinic, in El Paso. Although there, as in Santa Teresa, he treated many pregnant people whose babies he would go on to deliver, his practice became a political target because of the abortions he was willing to perform. For years, picketers had accosted his employees, shouting and waving placards that said “Burn in Hell!” Those picketers sometimes swarmed his home, forcing his family to live behind closed shutters. (His eldest daughter is now a photography editor at this magazine.) Still, he kept working until, mid-pandemic, a friend and business partner died. Theard realized that, on his own, he couldn’t face another year in a state whose legislators kept devising ever more onerous regulations. He had learned to live with the frequent inspections and fines for infractions. More troubling was the mandate that he provide each of his patients with a reading package containing information he knew to be false, such as the long-debunked connection between abortion and an elevated risk of breast cancer.

Research has established a far clearer link between carrying an unwanted pregnancy to term and living in poverty. One longitudinal project, the Turnaway Study, found that women who were denied an abortion they had hoped for were almost four times more likely to fall below the federal poverty line than women who had received one. Many women I met at Theard’s clinic—some of them in visible distress—had decided that they couldn’t bear the cost of another child.

The unbearable cost was typically economic (half of abortion recipients, nationally, have incomes below the federal poverty line), but in some cases it was time. A mother from North Texas, in her late twenties, worked the night shift as a supervisor in a lab. Every day, she returned home at 11 A.M.; slept until 3 P.M., when it was time to help her children with their homework; went back to bed at 7 P.M.; and forced herself to get up four hours later to go back to work. And this job was better by far than her previous one. “I barely have time for the children I have,” she said, resigned. Research by the Centers for Disease Control and Prevention indicates that sixty per cent of abortion recipients are mothers already. One Peruvian woman I met at the clinic had left three children, including an eleven-month-old, at home to travel seven hundred miles not to have a fourth—a decision that made her tired eyes well with tears.

The stigma surrounding abortion leaves some of its exploitative economic components underexamined. Between 2017 and 2022, according to researchers at the University of California, San Francisco, the average cost of a medication abortion escalated in lockstep with demand, from four hundred and ninety-five to five hundred and sixty-eight dollars. The trap—one perhaps not unintentionally set—is that, as states mandate that abortions be done earlier and earlier in the pregnancy, increasing costs extend the time it takes for many people to come up with the funds. Of participants in the Turnaway Study, fifty-four per cent of those who had abortions reported delaying the procedure because they had to raise the money for it.

An East African woman who had flown in from Fort Worth told me ruefully that the total cost of her trip would be thirteen hundred dollars: five hundred for the flight, seven hundred at the clinic, and a hundred in cab fares. “I have three kids—I can’t drive eight hours,” she said, adding that her husband had stayed home to look after the children, the youngest of whom was two. The woman, who said she had missed one birth-control pill, was six weeks into her pregnancy.

In the wake of S.B. 8, Theard had decided to treat first the patients who had travelled the farthest to reach his clinic—the sooner they got back on the road, the less likely they would be to fall asleep at the wheel on the drive back home. But the receptionists, Negrete and Hernández, sometimes had to tweak his rule when tensions arose in the waiting room, whose atmosphere they worked hard to keep welcoming and soothing. “What I try to do is have one out-of-towner, followed by one local,” Negrete said. “That way, they won’t feel forgotten. If not, they’re, like, ‘Well, we’re coming from Texas, too!’ Yeah? From where? ‘From El Paso.’ Mija, that’s not McAllen.”

The week I visited, the youngest patient Dr. Theard and his staff would be seeing was fourteen-year-old Laura, from Dallas. On the ride to Santa Teresa, Laura mainly sat in silence, staring at the Snapchat feed on her phone and feeling annoyed at her younger sisters for gulping their drinks and lengthening the trip with their constant need for bathroom stops. To Laura, the journey felt like eighth grade in general—an extended nightmare you just wanted to end.

It had been hard for her to make friends this school year, though she had really tried. “People were, like, ‘Yeah, we should make plans this weekend. I’ll let you know what we want to do.’ And I’m, like, ‘O.K., let me know,’ and nothing really ever happens,” she said. Having her first boyfriend was the bright spot. At fifteen, he seemed older—already working as a server at a local restaurant to help his mom pay the bills. He was one of those guys who, like her dad, was always hitting up the boss for extra hours. But, in the week before the drive to New Mexico, she hadn’t seen much of the perfect smile that had enticed her last summer. He “needed space” was how she explained it. He was finding her pregnancy “a lot to process.”

As Laura’s father drove, he occasionally glanced at her face in the rearview mirror. He tried not to burden his daughters with concerns about money, but Laura was clever enough to figure out for herself how a newborn in the family would affect their ability to cover the new $3,003 mortgage payments, which he and his girlfriend, an administrative assistant, shouldered together. The rental unit they’d recently left had holes in the roof, and the ceiling below was encrusted in mold. They’d had to clean up rat droppings everywhere, including the refrigerator. The new house was in a calm neighborhood with decent schools that made the father think of the background illustrations in Dr. Seuss books he’d read to his girls. Just before the pregnancy, he’d bought a dining table, and his brother had given him a secondhand fridge with an icemaker and, thus far, no rats. Laura had called the house “our fresh start.” But now, with inflation, soaring gas prices, and this unexpected abortion expense, the father had begun questioning a choice he’d finally made after ten years of planning.

The road from Dallas to New Mexico was monotonously flat, and, for those in the car who knew the real purpose of the trip, the stress and the secrecy were equally fatiguing. If Roe is overturned, the emotional intensity of trips like this one will only increase, should anti-abortion legislatures experiment, as is expected, with laws that impose penalties on those who cross state lines to get procedures that their home states have declared illegal. The father and his girlfriend took turns at the wheel, and at each stop he saved the receipts: forty-five dollars at Chick-fil-A; between forty and seventy dollars each of the three times they stopped for gas; a hundred and eighty dollars for a single room at a low-rise Holiday Inn in El Paso, which the family reached after midnight, all of them collapsing, exhausted, on arrival.

The Holiday Inn is twelve miles from the Paso del Norte International Bridge, which spans the border with Mexico. On the other side, in Ciudad Juárez, the streets are crowded with medical establishments: dentists, surgeons, opticians, imaging labs, hospitals, and a multitude of pharmacies. Some of the pharmacies, unbeknownst to Laura’s father, were selling misoprostol, which, taken alone, may induce abortion, though at increased risk to a woman than if taken with mifepristone. Demand in the United States for such “self-managed abortions” is already high.

One day, I visited a string of Juárez pharmacies with Negrete, who was born and raised in the city. At one of them, nestled among currency-exchange kiosks on a busy avenue, a pharmacist said he had seen an uptick in the number of American women coming in to ask about misoprostol. Depending on the brand, the retail cost of the pills that are needed to induce abortion ranged from five hundred and seventy-six to three thousand pesos—twenty-eight to a hundred and fifty dollars. A prescription was required, he said. No exceptions.

“I gotta go. I see an opening in the maelstrom.”

A few blocks into the city center, however, another pharmacy sold boxes of abortion pills over the counter for less than thirty dollars. Each box contained twenty-eight pills—enough to induce multiple abortions—and was affixed with a label stating that the doses should be administered by a doctor. When I asked the woman at the counter for advice about how to use the pills safely, she replied with a blank stare. “They are clueless,” Negrete said, once we’d left the pharmacy.

Women pretending to be Theard’s patients often called the clinic, hoping to get guidance about the abortions they are doing on their own. Self-managed abortion will inevitably increase after Roe, as will the accompanying problems. Negrete knew of women who had swallowed all twenty-eight pills at once. Others had shown up at the clinic having inserted the twenty-eight pills vaginally—a popular underground method that may result in a fatal bacterial infection. “Women,” Negrete said in a hushed voice, “are risking their lives.”

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.

The call went to voice mail when one of Dr. Theard’s employees tried to reach Laura. What was she going to tell a stranger, anyway? In the weeks after the abortion, her emotions were raw. She was angry about being barred from seeing her boyfriend for the foreseeable future, and sick of lectures about actions having repercussions. She’d been dragged to a doctor who prescribed birth control and tested her for S.T.D.s. “I’m tired of talking about consequences,” Laura said. “I just want it to be over.” It was a relief one day to hang out with her grandmother, who didn’t judge her and laughed when, in passing, someone called El Paso beautiful, because to her it was “just dirt and rocks.” But mainly, Laura said, “it’s kind of just been lonely—sitting in my room the whole time, watching TikTok.” She didn’t even feel like drawing. A sketch of her and her boyfriend, made right before she learned she was pregnant, was the last one she’d done.

In the middle of the night recently, Laura’s father woke to overhear his daughter, in the next room, finishing a call with her boyfriend and then weeping. “Dude, I gotta get up at 2 A.M. to get to work,” the father snapped, upon entering her bedroom. When he saw her face, he sat down on the bed.

“I guess I had been holding it in for a while,” Laura explained. She was embarrassed about having had an abortion, disgusted with herself. She wanted to go back to the person she was before. Sometimes it felt like a whole country was second-guessing her decision. “Think about it, either way you were going to have to battle with emotions,” her father said, embracing her. “If somebody else is saying anything, it’s none of their business. Remember why you did it. It was to better your future, wasn’t it?”