Sign up for The Brief, The Texas Tribune’s daily newsletter that keeps readers up to speed on the most essential Texas news.
Since the U.S. Supreme Court overturned Roe v. Wade over a year ago, Texas remains the largest state in the country to prohibit almost all abortions. However, this has led to various concerns and alterations regarding the accessibility of abortion and birth control.
State lawmakers have recently reinforced safeguards for healthcare providers who make decisions based on “reasonable judgment” to provide necessary medical care for ectopic pregnancies and cases where a patient’s water breaks prematurely, resulting in no possibility of the fetus surviving outside the womb. This action comes in response to numerous accounts of patients encountering denials or delays in receiving the required medical attention for such emergencies that require an abortion.
In the midst of this, there has been a recent federal court decision that has imposed restrictions on birth control availability for minors visiting Title X clinics that receive federal funding. As a result, parental consent is now mandatory for minors seeking a prescription for birth control at these clinics.
This is the current status of reproductive health care in Texas. This information will be revised if any significant developments or modifications occur.
What does abortion access look like in Texas?
Performing an abortion in Texas remains illegal in the majority of cases, including the distribution or shipment of abortion-inducing drugs like mifepristone and misoprostol. The state’s laws provide limited exceptions solely to safeguard the life or prevent significant harm to the overall physical well-being of the pregnant individual.
State laws do not criminalize the person who has an abortion. Some Texans have found ways to get abortions by traveling to other states or Mexico, or self-managing abortions at home by getting medications through international nonprofits, such as Aid Access, or online stores.
What counts as a medical emergency in Texas?
State law says treatments for miscarriages, known as “spontaneous abortions” in medicine, and ectopic pregnancies, in which a fertilized egg grows outside of the uterus and becomes unviable, do not count as illegal abortions. However, there were several reports of medical providers delaying medical care for these conditions due to confusion or the threat of jail time and six-figure fines for medical professionals.
In response, state lawmakers passed a law that now gives a legal defense to health care providers who exercise “reasonable judgment in providing medical treatment” for an “ectopic pregnancy at any location” or a “previable premature rupture of membranes,” which is when a pregnant patient’s amniotic fluid breaks before a fetus is determined to be able to survive outside of the uterus.
Viability – or when a fetus can survive outside of the uterus – depends on each pregnancy and various factors, according to the American College of Obstetricians and Gynecologists. The group recommends that patients who experience a premature water break be counseled about the risks of continuing or terminating the pregnancy. This should also include information about the realistic potential outcomes for the fetus. Risks associated with a premature rupture of membranes include infection, placental abruption and umbilical cord accidents.
State law also says the Texas Medical Board cannot take disciplinary action against a physician for providing such treatment, and that pharmacies and pharmacists who provide medication ordered by a physician in these circumstances also have a defense.
Texas abortion laws, however, don’t make an exception for lethal fetal abnormalities, forcing some pregnant patients to carry pregnancies to term even if they are not expected to have viable outcomes.
What court cases could affect abortion access?
- Medical emergencies: A group of Texas women who said they were denied medically necessary abortions sued the state of Texas, seeking to block the law from applying to medically necessary abortions and clarify when a medical emergency justifies an abortion. Some of the women described the medical care delays in a July hearing. A state judge sided with the women, but the Attorney General appealed the ruling to the Texas Supreme Court, essentially putting the ruling on hold.
- Abortion medication: A federal judge in Amarillo revoked the Food and Drug Administration’s approval of mifepristone – an abortion-inducing medication – after a lawsuit by a group of anti-abortion doctors. But the U.S. Supreme Court has allowed the drug to remain on the market until the case is resolved. Mifepristone, used along with misoprostol, is the most common way Americans terminate their pregnancies. Numerous studies have shown mifepristone to be safe and effective, and it’s recommended by the American College of Obstetricians and Gynecologists and the World Health Organization. It was approved by the FDA in 2000.
- Abortion funds: Abortion funds in Texas – nonprofit groups that help people pay for abortions and out-of-state travel – have resumed their efforts after a federal judge indicated that they likely cannot be criminally charged for helping people travel out of state to terminate their pregnancies.
- Aiding in abortions: A man in Galveston is suing his ex-wife’s friends for helping her obtain abortion-inducing medication. The women have countersued, arguing he knew his ex-wife had the pills and did nothing to stop her. Both cases are still pending.
- A federal judge in Texas struck down Biden administration guidance requiring hospitals to provide medically necessary abortions under the Emergency Medical Treatment and Active Labor Act, after a lawsuit filed by Attorney General Ken Paxton. Paxton also sued over guidance to pharmacies that reminded them of their obligation to fill prescriptions for abortion-inducing drugs. The case is before an appeals court.
What does contraception access look like in Texas?
In Texas, adults can still access a variety of birth control and reproductive healthcare services through both health insurance plans and government-funded programs. Contraception options and family planning counseling are typically covered by most health insurance plans without any additional cost to the individual. Additionally, contraception is available through state programs and federally-funded Title X clinics for those without insurance or who are undocumented.
However, most minors need parental permission to be prescribed birth control in Texas. Federal Title X clinics used to provide confidential contraception to minors, but after a recent court ruling in an ongoing lawsuit, those clinics now require parental consent as well. Minors can still access testing and treatment for sexually transmitted infections, pregnancy tests, condoms and counseling without parental consent at these clinics. Minors on Medicaid, or who are emancipated, can consent for themselves to get prescribed birth control.
The emergency contraception known as Plan B is still available over-the-counter in stores and, in some cases, through federally-funded clinics and public health departments. Ella, another emergency contraception pill that works up to five days after sex, requires a prescription, but it can also be prescribed and ordered online through an online pharmacy.
The Food and Drug Administration also recently approved the daily contraceptive pill Opill for sale without a prescription. It is expected to become available in stores and online in early 2024, according to its manufacturers.
You can read more about birth control access in Texas in our guide.
