After Texas' Senate Bill 8, which banned any abortions after the detection of embryonic cardiac activity, was allowed to go into effect last year, Dr. Bhavik Kumar, a physician at Planned Parenthood Center for Choice in Houston, said interstate travel was often the only recourse he could suggest for patients seeking to terminate their pregnancy.
But for one patient, that wasn't possible.
Due to her pending immigration case, the patient could not travel more than 70 miles or would risk jeopardizing both her ability to remain in the country and the security of her two children, he said.
"I didn't know what to say. I was speechless because I had nothing else left," Kumar, who himself is an immigrant and was undocumented for 11 years, told ABC News. "At that point, it felt like medicine was no longer the issue."
He never learned what happened to this patient. Kumar, who tried helping her navigate a law he called "so heavy and looming and intense and insurmountable," said he thinks about her often, fearing she was ultimately forced to carry her pregnancy to term.
Now, with a near-total abortion ban in Texas and trigger bans going into effect across the country following the Supreme Court's overturning of Roe v. Wade, many more pregnant individuals could find themselves in situations like Kumar's patient.
Colorado Organization for Latina Opportunity and Reproductive Rights (COLOR) has seen a recent uptick in the volume of frantic out-of-state calls they've received, especially from Spanish speaking immigrants, according to Aurea Bolaños Perea, COLOR's strategic communications director. Some callers have sought clarity from COLOR on how their immigration status would impact their ability to access abortions.
Residents of states with abortion bans have resorted to interstate travel to obtain care, increasingly discussed as a go-to solution. States like Colorado, where abortion is still legal, have become havens for people seeking abortions, particularly across the restrictive regions of the South and Midwest.
But this option provides little comfort to immigrants navigating the complex maze of reproductive health care. Organizers and physicians say barriers to accessing abortions -- an already convoluted process in a post-Roe world -- are exacerbated by limited English proficiency and immigration status, which may hinder or completely bar immigrants from traveling across state lines, leaving them to slip through the cracks.
"Our immigrant community, our monolingual communities are disproportionately impacted in ways that I don't think any of us are prepared to fully manage just three weeks into this decision being made," Bolaños Perea told ABC News.
A maze of care
With the power to decide abortion's legality in states' hands, people seeking abortions must now confront a rapidly evolving landscape of care made more confusing by state-specific technicalities, including limits on gestational age and mandatory ultrasounds.
Difficult enough to comprehend for native English speakers, this esoteric legal and medical terminology is often unintelligible for those with limited English proficiency, assuming they are aware these laws exist in the first place, according to Nancy Cárdenas Peña, Texas director for policy and advocacy at the National Latina Institute for Reproductive Justice.
Information coming out of the Texas Legislature, for example, is rarely if ever offered in Spanish, Cárdenas Peña said.
Without access to accurate information in their own language, immigrants can become misled by dubious sources on the safety of medication abortion or controversial pregnancy crisis centers that aim to steer people away from abortions, for example, according to Seri Lee, national campaign and membership director at the National Asian Pacific American Women's Forum (NAPAWF).
"That's something that is prevalent in every community, but particularly in the [Asian American and Pacific Islander] community with misinformation and false news that gets really easily disseminated through social media channels like WhatsApp or WeChat," Lee told ABC News.
Understanding the legality and availability of resources is only the first of many steps in the labyrinthine process of getting to an appointment, according to Dr. Kristyn Brandi, an abortion provider in New Jersey who serves as board chair of Physicians for Reproductive Health.
"Information that people are seeking in order to make an appointment may all be in English, and so they may not be able to make an appointment or have difficulty finding the place that they're going to access care," she told ABC News. "They may not know what kind of care is available to them."
Then there is travel, which can be financially prohibitive for immigrants, who are disproportionately low-income, and which presents further logistical hurdles.
With abortion now illegal in Texas, Kumar said he often directs patients to travel elsewhere to seek care -- only to learn they had never previously left the state, let alone been on a plane.
"If you think about somebody who has low English proficiency -- or zero English proficiency -- and having to navigate traveling and the airport, and finding childcare, if they don't already have it, and taking time off of work, if they're working, getting to another state where they're checking into a hotel and they don't speak English," he said. "They need to have somebody with them that can help them navigate that."
"That's not always an option," he added.
Assuming an individual successfully makes it to their appointment, they run up against the final obstacle of communicating with a physician and staff regarding their needs and treatment plan.
Kumar and Cárdenas Peña said it was standard for abortion clinics in Texas to have translation services and a bilingual staff, given the state's ethnic and linguistic diversity.
"People from the Rio Grande Valley are used to this cultural component of their health care that they probably wouldn't be able to find elsewhere," Cárdenas Peña said.
When they travel across state lines to access care, there is no guarantee patients will receive the same accommodations after leaving their familiar communities.
Bolaños Perea said in Colorado, there is not always a Spanish-speaking physician or translator at every clinic in the state, despite recently seeing an influx of Hispanic patients from Texas. Clinics also do not always have available resources to capture the diversity of languages represented in their patient base, including Vietnamese, Arabic, Somali and Amharic speakers in Colorado.
Lee noted that language access is especially complicated for Asian Americans and Pacific Islanders, who speak more than 100 distinct languages or dialects. As the only English speaker in her family growing up, she said she often shouldered the burden of translating complicated medical jargon to her parents.
While interpreters and translator phone lines are becoming more commonplace in clinics, Brandi said it's still extremely rare to find abortion providers fluent in the languages spoken in their communities, which can be critical to developing trust with patients who can be in vulnerable situations.
"Unfortunately, there are a lot of barriers to people that may have backgrounds that are representative of the communities that we serve. There are barriers to those people becoming doctors and becoming health care providers," Brandi, who is Puerto Rican and Panamanian, said.
"I'm really fortunate to be able to talk to my patients in Spanish," she added. "It's hard to have that conversation if you don't speak the same language."
Problems with travel
Before the June Supreme Court decision, reproductive health care could be difficult to access for immigrants, who are more likely to be uninsured given residency and immigration status restrictions on Medicaid eligibility.
Now, given increasing reliance on crossing state lines to obtain abortions, undocumented immigrants are left with few to no options.
Some people cannot travel to receive abortions as they are stuck in immigration detention or immigration proceedings. Undocumented immigrants confront further daily obstacles hampering their ability to travel.
For example, only 16 states and the District of Columbia currently permit undocumented immigrants to obtain driver's licenses, excluding many of the states where abortion is banned and interstate travel is necessary.
Furthermore, border regions with large immigrant populations like the Rio Grande Valley, where Cárdenas Peña lives, are peppered with internal Border Control checkpoints 100 miles in, meant to identify people in the U.S. unlawfully.
"In order to leave these communities, they must pass through the checkpoints and answer questions about their immigration status," Lee said. "If they lie about their immigration status, they can put themselves in danger and at risk of detainment and deportation."
With the legality of abortion in flux across the country, the risk of encountering law enforcement authorities may also frighten undocumented immigrants into avoiding seeking care, Lee said.
These fears are made worse by rumors about the presence of Immigration and Customs Enforcement agents at abortion clinics, according to Brandi.
Lee noted that states where law enforcement has "considerable discretion" to target immigrants are often the same states that are "hostile to abortion access," with Texas as a prime example. The state has recently come under fire for its Operation Lone Star initiative, which has authorized the detainment of thousands of migrants on misdemeanor trespassing charges.
"Every single time there is an immigration law that gets passed in Texas or at the federal level, we receive so many calls from the community members who are scared to go to simple health care appointments because of that fear that they would be placed in deportation proceedings," Cárdenas Peña, who grew up in a mixed-status family, said.
"We would definitely be naïve to believe that immigration enforcement -- DHS, Border Patrol, ICE, the surveillance and the capacity of surveillance under all of these agencies -- would not affect access to reproductive health care," she added.
An ICE spokesperson said in a statement to ABC News in response to Wall Street Journal reporting last week that the agency will "continue to comply with federal law and abide by current detention standards which ensure that pregnant detainees in custody have access to pregnancy services, including routine and/or specialized prenatal care, pregnancy testing, comprehensive counseling and assistance, postpartum follow up, lactation services and abortion services."
Last week, President Joe Biden signed an executive order aimed at protecting access to abortion nationwide, including instructions to the Justice Department to ensure people can travel out-of-state for abortion care.
A patchwork of solutions
Kumar said he has stopped providing abortions in Texas. But given his deep roots in the state and longstanding ties to its communities, he currently has no plans to leave.
"These are folks that have a difficult time accessing this care because it's so marginalized, and me moving is not going to make it any easier for them," he said.
Kumar continues to provide other reproductive health services and offers support to local patients traveling out of state. He has traveled in the past to provide abortion care and is exploring continuing that work.
While continuing to endorse legal battles against state abortion bans, many organizers have also ramped up efforts to assist immigrants in obtaining care.
NAPAWF's Texas chapter created a guide on its website to explain new and existing abortion laws in Texas, offering the guide in six different Asian languages, including Korean, Tamil, Telugu, Tagalog, Vietnamese and Chinese.
COLOR hosts a Spanish radio show, Mujeres de COLOR, to provide essential information on reproductive health care and continues to field phone calls and questions from within and outside Colorado. The National Latina Institute for Reproductive Justice in Texas continues to translate all materials that come out of the Texas Legislature, as well as host public education meetings.
NAPAWF and the Latina Institute's members are also educating their communities on medication abortion, especially for individuals who may be undocumented and for whom out-of-state in-office procedures are not an option.
Brandi noted that abortion funds can also help overcome some of the barriers immigrants face by footing the hefty bill for procedures not covered by insurance as well as coordinating logistics on patients' behalf, like booking travel and scheduling appointments.
But there's no silver bullet that will promise broad access to abortions for all individuals in this new environment, short of a federal protection, according to Lee.
"We're not just talking about one angle of, 'Oh, it's a matter of immigration status, or it's a matter of limited English proficiency,'" Lee said. "Oftentimes, those are compounded."
"It's a really layered issue," she said.