Ahead of Supreme Court decision on abortion, Texas is already a 'post-Roe world,' advocates say

Editor's note: With the Supreme Court's decision to overturn Roe v. Wade, nearly half of the nation's 50 states are prepared to ban all or nearly all abortions, according to the Guttmacher Institute. In Texas, a so-called “trigger law” will go into effect that makes performing an abortion at any time after conception a felony. Ahead of the ruling, “Good Morning America” went to Texas and heard from activists on the ground on both sides of the issue about the future of abortion access.

Down a dirt road, inside a church in Dallas, Texas, the cellphone of Zuleka Edwards buzzes constantly.

"I was just trying to seek termination of a pregnancy," one caller tells Edwards, abortion coordinator for The Afiya Center, the only Black-women-led abortion fund in North Texas. "I just need some assistance, OK, if that's possible."

Edwards gives the caller information about scheduling an appointment at an abortion clinic, explaining that even though she has already had an ultrasound, she'll be required to get another under Texas law.

"If you have any questions, just reach out and I'll be able to assist you," Edwards ends the call.

It's a conversation Edwards says she has multiple times a day with women throughout Texas who are trying to access abortion care in a state with one of the most extreme abortion laws in the country.

The phone calls, according to Edwards, have come with increasing frequency and urgency since September, when that law, Senate Bill 8, took effect in Texas, banning nearly all abortions after six weeks of pregnancy. Before the law, abortions up to 22 weeks of pregnancy were allowed in Texas, with restrictions.

"Sometimes there's just not enough time in the day," said Edwards, whom ABC News saw taking calls from women in need while doing laundry at home and caring for her three kids.

Edwards, 35, said she never turns down a woman's request for help because she knows personally what they are going through. The Texas native got her first abortion at the age of 17, a decision she said she felt "forced" into by her mom and one she said for years filled her with shame.

After going on to give birth to three children and get married, Edwards had a second abortion in Dallas.

At the time, Edwards said she was suffering from postpartum depression after the birth of her third child and knew she and her husband did not have the financial resources to raise a fourth.

"I knew for sure that whatever I was going to do, it was going to be what I needed to do," Edwards said. "It wasn't going to be from shame."

'Texas is already a post-Roe world'

Texas is known for doing everything bigger, and that has included the fight over abortion.

"We do the bad, the wrong stuff better. We do the great stuff better," said Marsha Jones, founder of The Afiya Center, which helps provide women with funding and logistics for abortion care. "So there's nothing bigger than here."

After years of chipping away at abortion rights, Texas in 2013 enacted strict requirements on abortion clinics, including that abortion providers have admitting privileges at a nearby hospital. By the time the measure was struck down by the Supreme Court in 2016, the number of abortion clinics in the state had shrunk from around 40 to 19.

Since last year, when SB8 went into effect, those remaining clinics have only been allowed to provide abortions before "cardiac activity or the steady and repetitive rhythmic contraction of the fetal heart" can be detected, which can be as early as six weeks into a pregnancy. The law includes an exception for medical emergencies but makes no exceptions for pregnancies due to rape or incest.

The result of SB8, according to abortion rights advocates on the ground, is that Texas for nearly the past year has been operating as a sort of test case for a post-Roe America, a version of the country if Roe v. Wade -- the landmark 1973 Supreme Court decision that declared abortion a protected right -- is overturned, as is expected to happen based on a draft court opinion leaked in early May.

If the Supreme Court rules, as expected, in favor of a Mississippi law that bans abortions after 15 weeks, abortion will go from being a federally protected right to one decided by each state.

"For those of us here in Texas, that's already been our reality," said Paige Alexandria, an Austin-based hotline intake counselor for the National Abortion Federation. "We're already living in a time where most people can't access the care they need in their own city, where they have to travel out of state."

Each month since SB8 went into effect, around 1,400 Texans have gone to another state for abortion care, according to Dr. Kari White, lead investigator of the Texas Policy Project at the University of Texas at Austin.

"Given what we've been seeing in Texas, I think it's safe to say we're already living in a post-Roe world," said Sarah Lopez, client coordinator for Jane's Due Process, an Austin-based abortion fund that helps kids under the age of 18 who need access to abortion care. "Not just with all the restrictions, but really the impact that those restrictions have on people, forcing them to flee their state to access abortion care."

'Feels like everything is on fire every single day'

With nearly all abortions banned after six weeks of pregnancy, the demand for abortions has not decreased in Texas, according to Alexandria, Lopez and nearly one dozen other abortion rights advocates ABC News spoke to in the state.

"Regardless of circumstance or zip code or income, people are always going to need abortions," said Lopez, who herself had an abortion in her home state of Texas after graduating college. "Whichever ban is in place, I think it just makes the process more risky, more arduous, you know, it makes it far more confusing, far more stigmatizing."

She said being an abortion rights advocate in Texas often feels "like everything is on fire every single day." In Austin, Alexandria said her day is consumed by an endless stream of calls from women in Texas seeking financial or logistical help for an abortion.

"Most of the people that I'm speaking to on the hotline are already parents, just like most people who have abortions," said Alexandria, who was a mom of two when she got an abortion. "They're struggling to find child care and the time to take off of work without making it more difficult financially to afford the procedure that they need."

In the U.S., nearly 60% of all women who obtain abortions are already mothers, according to the Guttmacher Institute, a reproductive rights research organization.

Qiana Lewis-Arnold, a birth justice associate with The Afiya Center, described the center's workload as having "quadrupled" in the wake of SB8.

"The obstacles are just overwhelming, not just for the folks who are seeking abortions, but for the folks like us who are working with them," she said. "This has created more obstacles, more stigma surrounding abortion and a lot of unnecessary fear."

The anecdotal evidence of this is backed by data showing that with SB8 in place, the number of abortions has not dropped dramatically, according to White's research. Instead, many women have resorted to traveling hundreds of miles out of state -- as far as Maryland, Illinois and Washington state -- or to ordering abortion pills online, if they are able to do so.

With increasingly limited access, a network of abortion funds -- nonprofit organizations that provide funding and support to those seeking an abortion -- has stepped in to fill the void.

The funds often cover a portion or all of the cost of the abortion itself -- which can be hundreds of dollars in some cases -- as well as practical care, including things like translation services, gas, hotel stays and child care.

"Texas is huge and there are abortion funds in basically every region of Texas," said Lopez. "So there's just been a lot of really cross-regional support that's had to happen, and a lot of collaboration, a lot of creativity."

Across the country, there are 92 abortion funds -- as of October 2021 -- that are members of the National Network of Abortion Funds, which helps connect organizations nationwide.

In the 72 hours after the Supreme Court draft opinion leaked in May, the network reported receiving more than $1.5 million in donations.

"The collaboration and the interconnectedness of abortion funds, I think that is a future of reproductive justice," said Lopez. "It's where we all work together and make sure that people have what they need."

Who gets abortions with restricted access, and how

If Roe v. Wade is overturned by the Supreme Court, nearly half of the nation's 50 states are prepared to ban all or nearly all abortions, according to the Guttmacher Institute.

Texas is one of 13 states that put a so-called trigger law in place to immediately ban abortion if the Supreme Court allows it. So if the court overturns Roe in its upcoming ruling, performing an abortion at any time after conception in Texas would be a felony.

With that ban in place, the distance women in Texas would have to travel to access abortion care would increase by 3,017%, according to the Guttmacher Institute. While New Mexico and Kansas would become the closest states that allow abortion, many Texans would likely have to travel even further because of the increased demand and wait times at abortion clinics in those states.

Already under SB8, abortion clinics in states surrounding Texas, including New Mexico, Kansas and Oklahoma -- which has since enacted its own abortion ban -- have reported being overwhelmed with patients.

In Kansas -- where the state capital is nearly 700 miles away from Texas' capital -- residents will vote in August on an amendment to change Kansas's constitution to remove abortion as a protected right.

Abortion restrictions' impact on maternal mortality

With increasing restrictions in states and the prospect of Roe being overturned, abortion is likely to be accessible only in certain regions of the country, meaning people seeking abortions will have to travel further for care, at a greater cost and very possibly at a later stage in pregnancy due to both travel and wait times at a limited number of abortion clinics, according to White, of the University of Texas at Austin.

With abortion funds' limited financial resources to help women as well as the inability of all women to travel, the impact, according to those on the ground in Texas who say they have already seen it happen, is that abortion becomes even more unequally accessible.

"The people who suffer the worst from abortion bans are the people who are always the most impacted," said Alexandria. "Black and brown folks, indigenous folks, trans and queer communities, immigrants, children, parents, students, all of these people are the first to feel the impact of these restrictions."

At The Afiya Center, which offers doula services in addition to abortion support, the residual impacts of abortion restrictions they see include high maternal mortality rates, high levels of childhood poverty and poor health rates, especially for Black women.

Texas has one of the worst maternal mortality rates in the country and Black women in the state are "disproportionately" affected, accounting for 11% of live births but 31% of maternal deaths, according to a 2020 report from the state's Maternal Mortality and Morbidity Review Committee.

"It's actually safer to have an abortion in Texas than to have a baby," said D'andra Willis, doula services coordinator for The Afiya Center.

In the U.S., two women were reported to have died following complications from legal-induced abortions in 2018, the latest year for which data is available. That same year, 658 women were reported to have died due to complications from pregnancy or childbirth, according to the Centers for Disease Control and Prevention (CDC).

Willis said that for Black women like herself, the right to abortion means the right to make a life-saving decision for themselves.

"It's just more than 'my body, my choice,' when it's my life. My life is on the line," said Willis, adding, "To be faced with Roe v. Wade being overturned, it's just going to increase maternal mortality. It's going to further perpetuate generational poverty. Access to health care is going to get even worse than it already is."

'Our work here becomes even more important'

Around 200 miles away from The Afiya Center, in Pflugerville, a city outside of Austin, Brittany Green, executive director of the Pflugerville Pregnancy Resource Center, stands in the center's baby boutique, which provides clothes and baby supplies for moms who have decided to carry their pregnancies to term.

Across the country, pregnancy resource centers -- nonprofit organizations that aim to support women on the path to parenthood -- outnumber abortion clinics three to one, data shows.

In Texas, which has more pregnancy resource centers than any other state, the Pflugerville center is one of around 200 such centers.

"The vast majority of the activity in the pro-life movement is really these hundreds of pro-life pregnancy centers and maternity homes who are designed to help women, and help them long after the baby is born," said Joe Pojman, executive director of Texas Alliance for Life, an Austin-based organization that opposes abortion, adding that he hopes Texas serves as an "example for the rest of the country."

"For those women who seek abortion out of state in border states or beyond, it breaks my heart," said Pojman. "It breaks all our hearts in the pro-life movement because Texas has such vast resources for women with unplanned pregnancies."

Last year, the Texas Legislature directed $100 million in state funding over two years to Alternative to Abortions, a state-run program that was launched nearly 20 years ago with the purpose of "promoting childbirth" and providing support to pregnant women, according to the state's health department.

The program, which provides funding to local pregnancy resource centers and subcontractors, served over 126,000 clients in 2021, according to Texas Health and Human Services.

Pflugerville's pregnancy resource center, based in a small house down a side street, is privately funded, relying primarily on donations from individuals and local churches, according to Green.

The mostly volunteer-run center hums with a sense of urgency as they await the Supreme Court's ruling.

"Power will come back to Texas and we'll be able to eliminate abortion here," Green said of what she believes will happen if Roe is overturned. "But women are still going to feel ashamed. They're still going to need help and they're still going to need resources, so our work here becomes even more important."

Green said the center has experienced an increase of what she calls "abortion-minded" women since SB8 went into effect in Texas.

"The good thing with the bill is it actually slows down their decision-making time," said Green. "So now that women are having to go outside of Texas to seek an abortion, it actually opens up the doors for us to talk about how desperate are you to terminate this pregnancy. And is it worth going the extra miles, is it worth paying additional money to have an abortion?"

According to Tere Grace, the center's sonographer, women are coming in earlier and earlier in their pregnancies.

"Before SB8, we were seeing people that were coming in at 12 weeks, 14 weeks, 18 weeks, pretty much when women had the window for legal abortion and still hadn't processed how they wanted to do it," said Grace. "Now we're seeing babies much much younger than that, sometimes 4 or 5, 6 weeks old because they want to beat that 'deadline' of the heartbeat."

She continued, "Finding the heartbeat is really important to us because we want to speak truth, 'There's a heartbeat here.'"

Supporters of SB8, including Texas Gov. Greg Abbott, call SB8 the "heartbeat bill." Medical doctors say using the word heartbeat is "clinically inaccurate."

According to the American College of Obstetricians and Gynecologists (ACOG), there cannot be a heartbeat at an early stage of pregnancy because the chambers of the heart are not developed. Instead, the sound is what ACOG describes as the "ultrasound machine translating electronic impulses that signify fetal cardiac activity."

Like most pregnancy resource centers across the country, Green says the one in Pflugerville does not "ever encourage a woman to seek abortion."

"Our goal is to help them choose life," she said of the center, which offers free sonogram services and pregnancy tests as well as education classes expectant women can take to earn points that they can then spend as money in the center's baby boutique.

Tiffany Turner, a single mom of two from Round Rock, Texas, came to the Pflugerville Pregnancy Resource Center last year when she became pregnant while finishing graduate school to become a physician assistant.

"I didn't have much support at all," Turner said while holding her infant daughter, River, adding that she found the support she needed as soon as she walked into the center, which she said she found by searching for help online.

"They started giving me diapers from the week that I came," said Turner. "And every week I would come and do Bible studies and classes, and they helped me through delivering her, and then three weeks postpartum, they started again."

Turner said she continues to come to the resource center for clothes for River and supplies like diapers. According to Green, the center helps women through a child's second birthday.

"We want our parents to leave feeling successful and that they can parent without support after us," said Green. "If it is a situation where they still need continuing support, we're actually going to refer them to another pregnancy center that can meet the need up until the child is 5."

If Roe v. Wade is overturned and abortion becomes even harder to access across the country, abortion rights advocates say they fear there will not be enough support for women and children in the long-term.

Advocates like Edwards, of The Afiya Center, said they see their work post-Roe being even more focused on what they see as the root causes of the need for abortion, addressing issues like poverty, domestic violence and lack of access to health care and contraception.

"If you really want to help people, then find out what the underlying issues are," said Edwards. "Help people get out of that predicament, and it'll prevent people from being in this predicament."

ABC News Alexandra Svokos, Devin Dwyer and Mary Kekatos contributed to this report.