One year after the overturn of Roe v. Wade, a health researcher and an obstetrician-gynecologist in El Paso reflect on what reproductive health care is like on the border.
Pregnant people in El Paso entered a world of curtailed rights months before the U.S. Supreme Court ruling triggered Texas’ near-total abortion ban. On June 24, 2022, the Dobbs v. Jackson Women’s Health Organization ruling overturned Roe v. Wade, the landmark 1973 decision that protected the right to abortion.
But by that time, El Paso health care providers were already adjusting to a prior policy, Texas Senate Bill 8 – a law that outlaws abortions as soon as cardiac activity can be detected in an embryo, when most people don’t yet know they’re pregnant. The law also empowers private citizens to sue anyone who helps someone terminate a pregnancy – a law that’s already being tested in Texas.
These restrictions have impacted areas of pregnancy and reproductive health care outside of elective abortions, doctors told El Paso Matters in 2022. The Texas abortion ban makes no exception in cases of rape, incest or fetal anomalies, but allows the procedure if it’s necessary to save the mother’s life. A group of women in Texas, who lost their wanted pregnancies, have since sued the state after they tried to get abortions following medical complications.
El Paso Matters spoke with a physician and researcher about what the abortion ban means in El Paso. Interviews have been edited for length and clarity.
Dr. Yolanda Lagunas is an OB-GYN in El Paso with a focus on vaginal delivery after cesarean section. She has more than 35 years of medical experience, including in the U.S. Army, and is a member of the Catholic Medical Association.
Carina Heckert is a medical anthropologist at the University of Texas at El Paso. Her research focuses on maternal health and how policy shapes pregnancy, birth and postpartum health care along the U.S.-Mexico border.
El Paso Matters: Dr. Lagunas, as someone who guides patients through pregnancy, how would you describe your approach to reproductive health care?
Lagunas: My job is to do no harm and to help others with their health decisions. Pregnancy is not without risks. Women are still dying during pregnancy, delivery and afterward. My approach is to keep my C-section rate low and provide education concerning both pregnancy and how they can avoid a cesarean section especially with diet and exercise. If they come to me for birth control, I will go into details to explain the pros and cons.
El Paso Matters: How has the abortion ban affected pregnant people in El Paso?
Lagunas: In El Paso, patients can still go to Santa Teresa (New Mexico) to the nearest abortion clinic. Many go across the border where they can easily obtain misoprostol both now and in the past. If a patient has a fetus that has any condition which is incompatible with life, especially over 14 weeks, they can and still do go to Albuquerque for these terminations. Women in other parts of Texas do not have this easier access to the procedure and will need to travel farther.
Heckert: Misoprostol, which is used as a part of medicated abortions, is accessible without a prescription in Mexican pharmacies. With that being said, there are still many challenges to accessing abortion care. For one, people who decide to travel out-of-state or self-manage a medicated abortion may fear that doing so could cause them legal problems. If a person needs follow-up care, or even just wants to be checked out following an abortion, they may feel like they cannot seek this care in Texas.
An overwhelming majority of abortions occur during the first trimester. However, one reason a person may decide to have an abortion at a later time is if there are fetal abnormalities detected during the 20-week anatomy scan. The closest clinic that could perform an abortion at that stage is in Albuquerque. The cost and time involved in traveling that far may be impossible for some people. Additionally, the travel would require passing through internal Border Patrol checkpoints, which may not be an option for a person with immigration-related concerns.
El Paso Matters: How do abortion laws affect what doctors and health care providers can do?
Lagunas: I have never performed an (elective) abortion. I have always referred patients elsewhere, but as a cradle Catholic, I and my staff have always discussed the reasons with patients and the pros and cons. There are pregnancies caught early, especially now due to the advances in genetic testing, that are not viable. These respond well to misoprostol. I am still allowed to perform a termination, dilation and curettage, or hysterotomy on patients whose babies have died. Intrauterine fetal demise does not qualify as an elective abortion. These are nonviable conditions that threaten the life of the mother. These are not elective abortions.
Heckert: People who support making abortion illegal typically say they still support abortion to save the life of the pregnant person. However, what they often fail to grasp is that there is not a clear line that dictates when that pregnant person’s life is at risk. Without a clear line, providers may be unable to intervene at earlier stages that would in fact better protect the health of the pregnant person.
El Paso Matters: Crisis pregnancy centers are facilities that provide limited services for pregnant people and try to dissuade them from seeking other services, such as abortion and contraception. These centers outnumber licensed health clinics that offer abortion, but the religious groups that run these centers in El Paso and Las Cruces argue that supporting pregnant people would prevent abortions. What is their impact?
Heckert: One challenge with crisis pregnancy centers is that they often provide limited support in ways that undermine other aspects of reproductive justice. Many of these centers have a moral agenda that leads people to feel judged, which can exacerbate challenges that a pregnant person may already be experiencing. Further, there is little regulation and oversight over how crisis pregnancy centers operate.
As a taxpayer, rather than seeing public funding go to crisis pregnancy centers, I would prefer to see that money go into health care services and other evidence-based programs that we know contribute to a decrease in abortions. There is substantial scientific research showing that comprehensive and evidence-based sex education alongside improved access to contraception and other reproductive health services lead to significant decreases in abortion.
El Paso Matters: One year after the decision to overturn Roe v. Wade, what do you hope people will reflect on and where can we go from here?
Lagunas: As a woman, I am frustrated by men or anyone else making decisions for us. As a Catholic, I feel that what a woman does is between her and her God.
I hate the commercial that starts with a woman saying “I am at risk for an unplanned pregnancy…” If you know you are at risk, do something about it, just as we would for any other unwanted situation. I have always been frustrated by the rhythm method. Many Catholics are sexually active out of wedlock, conceive more than once, have abortions, multiple partners, etc. I am not judging, I am just saying that we should do a better job of teaching and making birth control available. We should also make it easier for men to obtain vasectomies.
Heckert: I am hopeful that there will be increased engagement in the political process. Public opinion polling suggests that a majority of the U.S. population believes people should be able to access an abortion, so the Supreme Court decision clearly does not reflect the public will. Also, abortion does not have to be as politicized as it currently is today. A lot of people have mixed feelings about abortion, and that is ok. People’s perspectives are often much more nuanced than what is reflected in the political realm. This division at times inhibits an investment in finding common ground on other issues of reproductive justice, such as expanding access to health services and supporting new parents.
