Finalist: Stephania Taladrid, contributing writer, The New Yorker

To end pregnancies, women are enduring clandestine medical procedures, gruelling travel, and fear of arrest.

Shortly after nine o’clock on the morning of June 24th, a woman in her forties, whom I’ll call Luisa, arrived for her appointment at an abortion clinic in Texas. Inside the waiting room, a space bedecked with posters of women rendered in white, red, and blue, she filled out a series of mandated forms, and was escorted to the back of the facility, where dozens of other patients waited. A single mother of three who moved to the U.S. several years ago, Luisa had visited the clinic the previous day to get a sonogram, which revealed that she was less than six weeks pregnant, the legal limit to have an abortion in Texas at the time. Per state law, however, she needed to wait at least twenty-four hours before the procedure could take place.

Minutes after Luisa’s arrival, the Supreme Court issued its ruling overturning Roe v. Wade. Few of the patients knew that the Justices had the authority to take away women’s right to abortion. But when the clinic’s staff broke into tears, it became clear that the morning would not unfold as planned. Sitting alongside other patients, in a row of chairs set against a wall, Luisa looked around nervously. She spoke English haltingly and had never heard of Roe v. Wade. When one of the nurses kneeled by her side to offer an explanation, Luisa froze, in disbelief. Despondent, she left the clinic. As she waited for a ride outside, Luisa recalled that a friend of hers had told her, “If things don’t work out at the clinic, you can always call this man.” Luisa’s friend gave her his number and said that she had gotten an abortion at home with pills that he had provided. Already struggling to support her children, she felt that she was running out of options.

Since the fall of Roe, six months ago, at least sixty-six clinics in fifteen states have closed, limiting the choices of nearly twenty-two million women of reproductive age who reside in them. People from Texas who have the financial means have flown to states like New York or California, where abortion remains legal, to receive the procedure. Others, with fewer resources, have driven to New Mexico, Kansas, or Colorado, nearby states where abortion is also legal. But, for undocumented women, who do not have the resources to travel long distances, the fear of being criminalized, and potentially deported, has become far greater—and so has the need to use underground abortion networks, where the risk of exposure is less.

Several days after Roe was overturned, Luisa picked up her phone and called the man with the pills. She said that he initially asked for a hundred and fifty dollars, then raised the price to a hundred and eighty and eventually to two hundred. All Luisa knew about him was that he was from Mexico, but she agreed to pay the full price and gave him her address. At Luisa’s home, the man handed her seven pills, instructed her to take five of them orally and place two more in her vagina. She said that he offered to do so himself, but Luisa declined. She didn’t know if the man was a doctor or if he had any kind of medical training. After handing him the cash, she inserted some of the pills vaginally, then took the rest that same day. (The man, who declined to be interviewed, denied selling Luisa the pills.)

At first, Luisa felt nothing and went to sleep, but by the next morning she could barely walk. Her vision was cloudy, and she felt weak and dizzy. At home with two of her three children, she lost consciousness. Luisa didn’t know it at the time, but the man’s instructions deviated from those of the Food and Drug Administration. A medication abortion typically involves taking two hundred milligrams of mifepristone, which blocks progesterone, on the first day. On the second or third day, the patient follows up with eight hundred micrograms of misoprostol, which causes uterine contractions. The F.D.A. recommends that the pills be taken until ten weeks of gestation and under the supervision of a health-care provider. Luisa had no idea what medicine, nor what amount, she had taken.

Sitting at home on a recent Tuesday, Luisa recalled how it took her two days to fully recover, and the heavy bleeding continued for two more weeks—far longer than it should have. After a medication abortion, many women experience heavy cramps and bleeding for a few days. If the bleeding persists, or if they experience prolonged nausea, fever, or diarrhea, it is recommended that they visit a doctor to rule out any serious complications. But, with the overturning of Roe, people in Luisa’s situation fear that calling a doctor or visiting an emergency room could result in their arrest.

Luisa also lacked the money to pay a doctor. Beyond rent, her salary primarily went to paying someone to watch her children during the holidays: a woman who charged twenty-five dollars a day per child and, in addition to caring for Luisa’s sons, looked after three others. With her child tax credit, she had bought a used midsize car, and, to make ends meet, she and her children had recently moved to a small apartment in a complex where residents had complained of flooding and busted pipes, moldy surfaces, termites, bedbugs, and rats.

When I visited Luisa and her children in their new apartment, there were some boxes left to unpack, but she had just finished assembling the furniture that she had brought from her previous home—faux-leather sofas, a button-tufted headboard, two king-size mattresses and a glass dining set—which she had paid for in monthly installments over several years. The walls were decorated with large, glittery canvases inscribed with phrases printed in cursive: “Be Daring My Darling” and “She Lived a Life She Loved.” When I asked Luisa if she understood their meaning, she responded with an amused smile: “No.”

Her limited command of English made it hard for her to help her eight-year-old son with homework. This year, his school had nearly expelled him; he constantly disobeyed his teacher’s orders and seemed to be learning next to nothing in class. At home, she spent most of her evenings trying to get him to obey her. As we spoke, the boy, with brown eyes and a curly undercut, repeatedly stormed out of the apartment after she ordered him to stay home.

Halfway into our conversation, Luisa’s phone rang, and she rushed to answer the call. “What are you up to? Aren’t you coming?” she asked, in a hushed voice. When Luisa hung up, she explained that her boyfriend was the one on the other line. They had been dating for almost two years. At times, their relationship felt unsteady, she said. Having the child was never an option for her, but her boyfriend was of a different opinion. “He wanted it, as long as it was a girl,” she said. “But how could I have another child?” She let the question hang before adding, “Not in these conditions.”

A woman whom I’ll call Rosa has the benefits of citizenship, as well as family support. At twenty-seven, she still lives with her parents in the home where she grew up, in Texas. Her sisters, Rosa told me, were her confidantes. Every time she went on a date, they waved her goodbye with a “Cuídate”—“Take care of yourself.” So, when Rosa began to feel ill in mid-July, and nearly fainted at work, she asked her older sister for a pregnancy test. Sitting on the toilet of her home, her eyes fixed on the test’s results window, she watched two red lines emerge. It cannot be, she thought. She hoped that the test might have been too old to use, even though its expiration date had not passed. Rosa asked her sister, who was waiting outside the bathroom, to bring another test. The results were the same. Ya me chingué, she told herself—I’m fucked.

Rosa initially considered raising the child by herself, but she and her siblings had been on welfare as children, and those years weighed heavily on her. “I did not want to rely on the state’s help,” Rosa told me. “I’ve already lived through that.”

Rosa and her sisters huddled around her laptop, typing searches for abortion providers outside of Texas. They had considered trying to buy pills, but they were convinced that their sister could end up in jail, or be considered a murderer, for having an abortion in her home state—so convinced that they closed the laptop after a few minutes, out of fear that their searches would be tracked. Even typing the word “abortion” online seemed like a risk. What better way, the sisters thought, to go after women in Rosa’s situation than to follow their digital footprint.

An arrest in Texas terrified Rosa and her sisters. Lizelle Herrera, a woman roughly their age, had been briefly jailed in April, two months before the overturning of Roe, and charged with murder for causing “the death of an individual by self-induced abortion.” The hospital where Herrera had checked in after taking abortion pills had reported her to the sheriff’s office. In a county where the median household income was roughly thirty-three thousand dollars a year, Herrera’s bond had been set at half a million dollars.

The local district attorney eventually concluded that Herrera could not be prosecuted under Texas law for obtaining an abortion. After a few days, the charges against her were dropped, but fear and confusion surrounding the law remained. “It’s a feeling of helplessness,” Rosa told me. “A feeling of knowing that you have no place to go, so you begin to panic and ask yourself, Who do you trust? Where do you turn to? Who do you seek help from?”

Together with her sisters, Rosa agreed that crossing the border into Mexico and trying to obtain an abortion there was the best option. But the youngest of them had heard rumors that Texas law-enforcement officials were now planning to perform pregnancy tests at border crossings. The rumor, which turned out to be false, caused Rosa to panic. “I’m going to get caught,” she told her sisters, her voice breaking. “What happens if they find out?”

The following day, after a full night’s sleep, Rosa decided that being subjected to a pregnancy test at the border wasn’t as threatening as she feared. That afternoon, she and her older sister crossed the border and visited a Mexican doctor who confirmed that she was five weeks pregnant. When Rosa asked him if he could perform the abortion, the doctor shook his head and declined to name anyone who would, but offered some advice: “If you’re thinking about doing it, do it now.”

Rosa returned home, ultrasound results in hand, feeling ready to share the news with her parents. There was only one problem: she could not confidently say whose child it was. Rosa had recently broken up with a longtime boyfriend and started seeing someone else. To her knowledge, neither man was thinking about fatherhood, so she was at a loss for words when the first question her parents asked was “Y el papá?” For days, her parents refused to speak to her.

Rosa briefly considered going back to Mexico, where she could walk into what her friends called “narco-pharmacies,” which sold abortion pills without a prescription. The thought of travelling to another state, like New Mexico or Colorado, also crossed Rosa’s mind, but the costs of gas, food, and a place to stay seemed prohibitive. Plus, she wondered, what if she got pulled over in Texas and detained along the way? “Money was always the problem,” Rosa recalled. The only money that she had managed to save this year was her tax refund—eight hundred dollars—which she had set aside to straighten her teeth.

Now Rosa planned to spend all of it on her abortion. The problem was that most clinics she found charged six hundred dollars or more for a medical abortion—and that did not include travel costs. Rosa didn’t want to put a strain on her parents’ budget, and borrowing from a friend didn’t feel right either. Everyone she knew in the area lived paycheck to paycheck, and she worried that someone “who happens to be strapped for cash” could file a lawsuit against her, even though the laws in place did not target pregnant women. A Texas statute known as S.B. 8 encourages private citizens to sue individuals who provide, aid, or abet an abortion, and, if successful in court, rewards them with a bounty of at least ten thousand dollars.

Rosa’s oldest sister had heard of a clinic in Mexico City where surgical abortions were performed for less than three hundred dollars. She and Rosa figured that they needed a thousand dollars in total to cover their round trips and accommodations, plus a few hundred more for unforeseen expenses. With her savings, Rosa could only afford part of the trip. So she reached out to the man she was seeing at the time, who agreed that she should get the procedure and covered the rest. The two sisters quickly planned their journey: it was a night-long bus ride to Mexico City, so Rosa decided that they should leave a day early.

After crossing the border by foot, Rosa and her older sister boarded the bus, which made multiple stops along a route that spanned hundreds of miles. Upon their arrival, the sisters headed straight to a small Airbnb, where they spent the night. The following day, they went to a clinic downtown, where nurses prepped Rosa for the procedure and gave her an I.V. She donned a hospital gown and was asked to count to sixty before the anesthesia kicked in. When Rosa woke up, she was on her way to a recovery room where dozens of other patients rested. No one at the clinic questioned or judged her decision. After about an hour, as is typically the case after a surgical abortion, Rosa was discharged from the clinic and went straight back to the Airbnb with her sister to get some rest.

A day later, they boarded a bus back to the U.S. Around three in the morning, heavy abdominal cramps awakened Rosa. The painkillers that she had been given in Mexico City seemed to have worn off. “I kept turning and turning, but it made no difference,” she recalled. “I felt like using the bathroom, but I could barely stand up.” The bumps along the road made it hard to rest or move. And so did her mother’s warning that thieves, who often pose as passengers, could rob the bus at night and strip her of her belongings. Rosa tucked the little cash that she had left inside her bra and eventually fell asleep. By the time she and her sister arrived at the border, it was noon the following day. It took them two hours to cross through a U.S. checkpoint by foot—a wait that only intensified Rosa’s fear. She was carrying the clinic’s paperwork with her, but American immigration officials only asked her cursory questions; no pregnancy tests were ever performed.

At home, Rosa found her bed exactly as she had left it: with a line of pillows meant to ease her discomfort at night. She lay there alone for an hour, as tears streamed down her face. Rosa’s emotions were mixed. Part of her felt like grieving, but she also resented that the state had had a say in one of her most intimate decisions. “How are you feeling? Do you want to take a shower? Will you come eat with us?” her older sister asked, via text, from her own bedroom.

Rosa knew that she was lucky compared to friends who had lived through an abortion alone. Some looked online for instructions on how to take the pills and did so safely on their own. Others ran into complications, because they had used the wrong dosage or didn’t know what to expect. Rosa remembered one call, in particular, from a friend who had reached out to her in a panic, after purchasing pills across the border, before the overturning of Roe. Her friend had taken a set of abortion pills, started bleeding profusely, and worried that she could be hemorrhaging. But she didn’t dare tell anyone else. She, too, had heard of the arrest of Lizelle Herrera and was terrified of going to jail. Instead, she sat in her bathtub alone for several hours to relieve her pain. “Imagine,” Rosa said, “if women refused to seek care during those times, when the clinic was still open, what will become of them now?”

nside Texas hospitals, doctors and medical personnel are also weighing the legal risks they now face. Shortly after the overturn of Roe, a nursing student who I’ll call Sandra enrolled in an obstetric-care class. Her professors explained how to perform a dilation and curettage, or D. & C., after a miscarriage, but rarely did they mention the word abortion. When state lawmakers visited the school grounds, students were told to not get into politics. “There were things we were not allowed to talk about, things we were not allowed to ask,” Sandra said.

In October, Sandra realized her period was two days late. Immediately, she feared that she was pregnant. Sandra had six months left before she would graduate from nursing school. For years, she had planned to attend law school and specialize in medical cases. After spending the better part of her twenties in an abusive relationship, she became a mom, went through a divorce, and managed to get her career back on track. She had also just started dating a man who was good-natured and shared her passion for health care. When Sandra told him that she had missed her period, he didn’t hesitate to go to the pharmacy and buy her a pregnancy test.

An hour later, in her boyfriend’s bathroom, the couple debated what to do about the test’s positive results. Neither of them felt capable of going through with the pregnancy. Combined, their student debt amounted to half a million dollars, and they had been in a relationship for only three months. Sandra’s boyfriend offered to order abortion pills online, so she didn’t have to leave her home for the procedure. But Sandra was keenly aware that anti-abortion laws in Texas targeted those who assisted pregnant women, and her boyfriend risked facing felony charges and life in prison for providing pills. “We can lose everything,” she warned him.

This was also not the first time that Sandra had faced an unexpected pregnancy: as a teen-ager, she had had an abortion without her parents’ knowledge. As a senior in high school, she felt woefully unprepared to have a child. She also feared her parents’ reaction. At the time, Texas law required minors to have the consent of their parents before undergoing an abortion, so Sandra decided to keep it a secret and wait a few weeks until she turned eighteen. By then, Sandra was past her tenth week—the recommended limit for medication abortions—and she had to find a clinic that would provide a surgical abortion. After a cursory Google search, she found one: a crowded, rickety building, where Sandra waited for half a day to get treatment.

Afterward, the doctor who performed the abortion sent Sandra home with a prescription for antibiotics. But she feared that, if she went to the pharmacy and handed over her insurance card, her parents might be notified. So Sandra decided to forgo the medication. Within a week, she came down with a high fever, and her parents rushed her to the emergency room. There, doctors diagnosed Sandra with a kidney infection. It took two weeks for her to recover from it and be discharged from the hospital. “It was traumatic,” Sandra told me of the experience.

Her understanding of reproductive care had since evolved, but her options were more limited now. Any doctor or person who performed a surgical abortion or provided abortion pills in Texas now faced the possibility of years in jail. Fearing prosecution, she and her boyfriend decided that they were better off travelling to a neighboring state where abortions were still legal. Including the procedure, driving or flying would cost them about a thousand dollars. “It’s a drop in the bucket compared to what we could lose,” Sandra recalled thinking at the time. When she called Planned Parenthood, she learned that the earliest appointment at a clinic in Kansas or New Mexico was weeks away. They suggested a smaller provider in southern New Mexico who offered better news: a doctor could see her within days.

Sandra made plans to fly to El Paso. From there, the couple would rent a car and drive to the clinic just across the border, in New Mexico. Before leaving, Sandra decided to get an ultrasound to confirm how far along her pregnancy was. She chose a clinic that someone she trusted recommended for its free services. After walking in, Sandra was reminded of the home she had grown up in. Abstract paintings hung on the walls, and the waiting room was neatly decorated with velvet sofas and cottage table lamps. A warm-looking woman greeted Sandra, holding her patient file in her arm.

As the woman took notes in a consultation room, Sandra explained to her why this was not the right time for her to have a child. “We’re bleeding money,” she recalled saying, referring to her and her boyfriend’s vast student debt. What would Sandra’s parent think of the abortion, the woman asked. What about her six-year-old son—did he know? Sandra was surprised by the questions, and she felt unsettled when the woman described an abortion that she had had at age twenty as the worst decision of her life. “It haunted me,” Sandra remembered her saying. Sandra was then instructed to lay supine on a table for an abdominal ultrasound. In an instant, the machine started emitting what the woman described as the embryo’s heartbeat.

Confused, Sandra wondered how this could be, since it appeared that she was five and a half weeks pregnant and she had learned in nursing school that health-care workers don’t usually try to detect an audible heartbeat until after the tenth week. And, to add to the confusion, a vaginal ultrasound would typically be used to obtain optimal images at that stage, not an abdominal scan. Sandra wondered, Is it my heartbeat that they’re hearing? She discreetly took her own pulse. “I felt like it was the same as what they were reading,” she said. It was only after Sandra left the office, and the staffer handed her a Bible and a collection of anti-abortion leaflets, that she learned the clinic was run by a Christian group. It was one of dozens of clinics in Texas that lure in unsuspecting women with offers of free medical care but are, in fact, operated by anti-abortion organizations.

Days later, Sandra and her boyfriend boarded a morning flight to El Paso. They drove to the clinic in New Mexico and arrived early for their eleven-o’clock appointment. After half an hour, they left the clinic carrying a set of abortion pills. Sandra took the first pill in New Mexico, before entering Texas. By the time their return flight landed that evening, Sandra had just started to feel the symptoms. “It feels like bad period cramps,” she recalled. Contrary to the predictions of the woman in the anti-abortion clinic, Sandra didn’t hate herself for the decision. It wasn’t a cause for celebration, either, but it felt like the right choice—her own choice. Within three days, she had fully recovered.

Until this year, Sandra had never registered to vote, and never felt that her ballot would make a difference. The Supreme Court’s decision to overturn Roe changed that. “It just represents women losing their right to make decisions on their own,” Sandra told me. “It feels like we’re going backwards in time.” She and her friends in nursing school had often wondered how much farther abortion restrictions in Texas would go and what other rights women might lose. After the Supreme Court’s ruling, the hands of medical providers in Texas were tied. They could no longer assist patients seeking abortions; it wasn’t even clear whether they could prevent the loss of a mother’s life due to pregnancy complications. For the first time in her life, Sandra voted, casting a party-line ballot of her own creation: all candidates that support a woman’s right to choose.

A multigenerational network of activists is getting abortion pills across the Mexican border to Americans.

The handoff was planned for late afternoon on a weekday, at an underused trailhead in a Texas park. The young woman carrying the pills, whom I’ll call Anna, arrived in advance of the designated time, as was her habit, to throw off anyone who might try to use her license plates to trace her identity. She felt slightly absurd in her disguise—sun hat, oversized sunglasses, plain black mask. But the pills in her pocket were used to induce abortions, and in Texas, her home state, their distribution now required such subterfuge, along with burner phones and the encrypted messaging app Signal. Since late June, when the Supreme Court overturned Roe v. Wade, Texas and thirteen other states had effectively banned abortion, and more were sure to follow. In some of the states, laws that originated as far back as the nineteenth century had been restored. Providing the tools for an abortion in Texas had become a felony that could lead to years in prison, and a fellow-citizen could sue Anna and collect upward of ten thousand dollars for every abortion she was found to abet.

Anna wasn’t a fainthearted woman—someone who had recently approached her for pills noted her “cottage-core vibes” and steely calm—but she wasn’t reckless, either. She and other women defying abortion bans had turned to a model developed by Verónica Cruz, a prominent Mexican activist. Until last year, abortion was considered a crime in most of Mexico, the second-biggest Catholic country in the world, and women there had become adept at providing safe abortions in secrecy. (Given the legal exposure, pseudonyms have been used for Anna and other American women who let me into their underground networks.)

By the time the pregnant woman for whom Anna was waiting walked up, the trailhead was quiet enough to make the chirping of birds seem jarring. As Anna pulled a plastic bag of pills from her pocket and settled across from the pregnant woman at a picnic table, she registered the fear on the woman’s face. Her distress, as Anna understood it, was less about a breach of Texas law than about the possibility that her husband, who was violent, might find out what she was doing. Hands shaking, the woman told Anna that she was already raising three children and had been trying to save enough money to remove them from a dangerous home. The prospect of having another child, she said, was like “getting a death sentence.” She couldn’t vanish from her household for a day without explanation, travel to a state where abortion is legal, and pay seven hundred dollars to a doctor for a prescription. Anna’s pills, which were free, were her best option. Taking the baggie and some instructions on how to take the medication, the woman thanked Anna and fled the park, hoping that her husband would never realize she’d been gone.

The town of San Miguel de Allende, in central Mexico, is known as the birthplace of legendary independence leaders. It is just as famous for its charm: cobblestone streets, Baroque churches, bright houses, and lively cantinas once frequented by Mexican muralists and Beat poets. Some Americans visit for a week and decide to stay. Among those expats is Liz, a retired Southern woman in her seventies. On the morning of June 24th, as she was making coffee in a kitchen where photographs of her great-grandchildren covered the fridge, she heard on the radio that the constitutional right to abortion in the United States had ended. She maneuvered her walker to a nearby chair and sank down. She felt as she had as a child, in a house by the sea where she’d once lived, when a hurricane she’d been dreading made landfall. It was awful, yes, but knowing what was coming had given her a chance to gather her courage and make a plan.

Five years earlier, Liz had met Verónica Cruz, who runs a nonprofit called Las Libres—the Free Ones—out of the city of Guanajuato, some fifty miles west of San Miguel. At the time, Cruz was defying Mexican law by helping women—mostly poor women—abort at home. In part because activists like Cruz successfully reduced the stigma of abortion, the Supreme Court of Mexico decriminalized it in September, 2021. That same month, Texas moved in the opposite direction: a state law known as S.B. 8 banned nearly all abortions past the sixth week. Since then, Cruz had widened her remit, supplying free abortion pills to undocumented women in Texas.

Liz figured that, with Roe overturned and states from Arkansas to South Dakota implementing abortion restrictions, the demand for Mexican abortion pills would soar. If she lacked Cruz’s decades of experience working on the cusp between the lawful and the criminal, she was neither too old nor too diminished to take a risk. She picked up the phone to call Cruz and then some friends, to find out which of them would be game to join an underground network.

Locals called expats like Liz “the Old Hippies,” in English. In early July, weeks after the U.S. Supreme Court’s Dobbs decision negated Roe, six of them joined Liz on her terrace for hibiscus tea and a talk with Cruz. Most of the Americans were over sixty and recalled what life was like before the 1973 Roe ruling. One tactic Liz remembered for ending an unwanted pregnancy was to alternate between a tub of ice-cold water and a tub as scalding as you could bear it. Those who tried this method suffered, then usually had a baby anyway. Liz had a baby, too, as a teen-ager. Although she had cheered when the Roe decision was announced, knowing how many lives it would change, it had come too late to change hers.

Cruz, the fifty-one-year-old daughter of farmers, has appraising dark eyes and a booming voice, and is direct by nature. She asked the Old Hippies if they would raise money and buy pills in Mexico that would be distributed across the border. Cruz paused to let an Old Hippie translate for those whose Spanish was weak.

Medication abortion in the United States is typically a two-day process that involves taking mifepristone, which blocks progesterone, and misoprostol, which causes uterine contractions. The Food and Drug Administration approves the use of this two-pill regimen under a doctor’s supervision up until the tenth week of pregnancy. A prescription, which can be obtained in states where abortion is legal, is required. In Mexico, Cruz explained, misoprostol is sold over the counter. Mifepristone still requires a prescription, but Cruz had found suppliers, and when she ran short she relied solely on misoprostol, which can cause an abortion on its own.

Immediately after Dobbs, Cruz said, her existing crew of volunteers had slipped enough medication across the border to help two thousand American women have abortions. If the Old Hippies agreed to aid distributors in abortion-ban states, Cruz told them, Las Libres could help many more women. Each cell in the supply chain would know little about the other cells—safer for everyone that way.

Several Old Hippies wondered aloud about consequences, as the legal terrain was decidedly unsettled. In Louisiana, anyone who “knowingly performs” a medication abortion is subject to a five-year prison sentence and a fifty-­thousand-dollar fine. In Oklahoma, it’s a ten-year sentence and a hundred thousand dollar fine. More such laws were likely to come, although no criminal convictions had yet been reported. If charged, an Old Hippie told Cruz, they might end up at the mercy of a district attorney in, say, Mississippi, facing years of jail time. But Liz was an optimist—“You have to be,” she always said—and by meeting’s end everyone in the room had signed on to her plan.

To avoid what Liz called the “gringo price,” she recruited her housekeeper to call more than two dozen pharmacies in San Miguel and find out what they had in stock, at what cost. Then the Old Hippies tried to buy all the pills they could. One pharmacist agreed to sell more than a hundred boxes but cancelled the order at the last minute without explanation. A second pharmacist demanded a prescription for misoprostol, something not required by Mexican law; an Old Hippie had to persuade her doctor to prescribe it for an ulcer, a condition that she didn’t really have but for which the drug was also used. It was a relief when a third pharmacist agreed to sell more than a hundred and fifty boxes with no questions asked.

Many of the pickups were handled by Diana, another Old Hippie, who at pharmacies gravitated to younger female clerks—less judgmental about her purchases, perhaps, than older men. On the day that she unpacked the last of the hundred and fifty boxes on her kitchen counter, she burst into tears. Every box contained more than enough pills for two abortions, and she saw in the stockpile before her hundreds of younger women who would be helped. “All of a sudden,” Diana said, “I realized what we’re all doing.” Those boxes just needed to get to the States, but that part of the relay would be left to others, as Diana, Liz, and other Old Hippies planned their next buy.

Six weeks later, sitting at a long table in a house on a hill in Guanajuato, Cruz counselled a woman in Georgia by phone while responding to a text from Arkansas: “I would like help with a medication.” A window behind Cruz overlooked a lemon grove, and around the table were colleagues—some social workers, some lawyers, most of them young—fielding questions from pregnant women on both sides of the border. The atmosphere was convivial, and taped on one wall was a phonetic cheat sheet for those with limited English: “Jai, dis is Las Libres. Can ay jelp iu?”

Cruz’s work had long been funded by American nonprofits, and after Dobbs the phone number of her organization was passed around by informal networks of activists. Cruz said that she was now getting fifty requests a day from the U.S. for abortion pills. Some women created fake profiles on Instagram to get in touch with her, or sent messages on WhatsApp or Signal, or called her in the middle of the night.

The evasiveness and fear that she sensed when communicating with Americans reminded her of how Mexican women spoke of abortion when she was growing up. Her mother worked on a farm, harvesting corn, and the only way she and her girlfriends alluded to abortion and miscarriage was with the expression malas camas—“bad beds.” Such euphemisms were necessary in part because women in the state of Guanajuato could face up to three years in prison for ending a pregnancy, and so could the medical personnel who assisted them. Before last year’s Mexican Supreme Court decision, abortion, in all cases except for rape, was deemed a criminal act in Guanajuato, where state law presumed that life began at the moment of conception. There is no reliable estimate of how many women died annually from secret abortions; authorities and family members often blamed the deaths on infection or hemorrhage.

In 1995, Cruz had completed training as a social worker and was helping Indigenous farmers improve their crop yields and distribution when, in a coffee shop, she heard an older woman discussing abortion in a way she hadn’t heard in school. The woman, who had attended a United Nations conference on reproductive rights, was speaking about abortion unapologetically, as a matter of public health that disproportionately affected poor women and curtailed their rights. Cruz was surprised, and energized.

Word had been getting out, first in Brazil and then across Latin America, about an expensive American drug that allowed a person to end a pregnancy at home. Manufactured by Pfizer under the name Cytotec and otherwise known as misoprostol, it was available over the counter in Mexico to treat gastric ulcers—to this day, the only use of the drug that Pfizer supports. (“The industry has never been an ally of women’s struggles,” said Raffaela Schiavon, a respected obstetrician-gynecologist in Mexico City.) Cytotec came in boxes of twenty-eight pills. Pregnant women who could afford it consulted other women who had had abortions and calibrated the dosage that would suit their bodies and stages of pregnancy. Some women took four or eight pills orally, and others inserted pills vaginally. When the abortions were done, Cruz had noticed, they’d typically toss out the remainder of the pills—a small fact that would later change the course of her work.

Mexican supporters of abortion rights were, and remain, up against a coalition of conservative politicians and leaders of the Catholic Church. When, in 2000, Guanajuato state legislators voted to make abortion illegal even for rape victims, subjecting them to years in prison, Cruz joined other activists to protest. But she wanted to do more than march on a statehouse­—she wanted to make sure that rape victims could still get abortions. She started Las Libres and began asking those who bought boxes of misoprostol for an abortion to set aside the remainder of the pills for women who had been raped. Cruz recalled, “We said, ‘Keep them, and next time someone comes to us you’ll give them the pills and talk about your experience.’ ” The idea was to make abortion not just more accessible but less frightening. A pregnant woman could meet someone who had survived an abortion and gone on with her life. Cruz called the woman who shared her pills and her experience an acompañante—a person who accompanies another.

Eventually, opposition to the new state law became so great that the governor vetoed it, at which point Cruz decided to take her activism a step further and help women in Guanajuato who wanted an abortion for any reason at all. The acompañantes she recruited would bring pills and tips about how to use them, providing comfort and answering questions during the abortion process. Because the acompañante figure did not explicitly appear in Mexican criminal codes, Cruz argued that such a person would be immune to prosecution.

According to Georgina Sánchez, an academic at El Colegio de la Frontera Sur who has researched medication abortion in Mexico, some feminists were skeptical about the acompañamiento model. Ordinary citizens would have to shoulder the state’s responsibility to provide health care to women, and acompañantes would become vulnerable to the whims of authorities. They, and Cruz, might end up in jail. “Me being me,” Cruz recalled, “I told them, ‘Well, you’ll have to get me out!’ ” The way Cruz saw it, women had a moral duty to stand up for one another when the state failed to guarantee their rights.

“At first, women would come to us and say, under their breath, ‘I need an abortion,’ ” Cruz told me. But she began convening meetings in bars and cafés, where she spoke emphatically about abortion as a right to be asserted, not a clandestine affair. “It was our way of saying, ‘Don’t be afraid. You have nothing to be ashamed of,’ ” Cruz said, adding, “There were times when the waitresses would come by afterward and say, ‘How did you say one takes the pills?’ ”

The acompañante movement grew, and so did Cruz’s influence. Working with a team of lawyers, she visited ten jails in the state of Guanajuato, in search of women being held for abortion-­related crimes. They found nine wo­men charged with infanticide when circumstances suggested miscarriage or other birth complications. Most of the wo­m­en had been given sentences ranging from twenty-five to thirty years and had already spent more than four years behind bars. Javier Cruz Angulo, a criminal lawyer who worked with Cruz, said that not all of them could read or write, and that “none of them fully understood why they had been prosecuted.” In 2010, Las Libres finally helped secure the release of all nine women, and Cruz went on to investigate similar convictions in other states.

In those states and elsewhere in Mexico, grassroots organizations were also campaigning for the liberalization of abortion laws. The capital, Mexico City, had already decriminalized abortion, in 2007. After sustained campaigns, the state of Oaxaca followed, in 2019, and in 2021 so did Hidalgo and Veracruz—just before the Supreme Court declared the criminalizing of abortion unconstitutional. “We are all pro-life,” the chief justice, Arturo Zaldívar, said, “only some of us are in favor of allowing women to live a life in which their dignity is respected, and they can exercise their rights fully.” The evening of the decision, which was unanimous, a 7.1-magnitude earthquake shook the capital—to some anti-abortionists, a sign of divine wrath.

In the following months, after S.B. 8 took effect in Texas and Cruz began sharing pills with activists there, she came to understand that she and some of her U.S. colleagues differed in their idea of what being an acompañante entailed. The Americans had been driving people to clinics and helping pay for the procedure for years; now they were planning to travel farther, to states with fewer restrictions. The Mexicans’ experience of aiding women had little to do with clinics. Rather, their model was one that Cruz believed her American contacts would need in the years ahead: a process of aborting that, in addition to being medically safe and effective (as a study of the acompañamiento practice in Argentina and Nigeria, published in The Lancet Global Health, had recently found it to be), also minimized the risk of criminal prosecution. If women avoided doctors and medical establishments and followed the blueprint of Las Libres, Cruz said, “there wouldn’t be a single trace. If the woman getting the abortion kept it to herself, no one would ever find out.”

In the Americas, one of the privileges of advanced age is getting the benefit of the doubt at security checkpoints. The first person to run the Old Hippies’ pills over the border was a gray-maned, soft-spoken Social Security recipient named Rosie. She would pave the way for the second border crosser, an octogenarian.

When Rosie first met Cruz, she was too intimidated to speak; the activist, she said, seemed “like a rock star to me.” But she returned home from the meeting brimming with purpose. Pouring her husband a glass of red wine, she said, “Honey, I’m going to be sneaking some pills across the border.” Her husband did not take this news calmly. What if the Texas governor, Greg Abbott, decided to make an example out of some grandma? What if all their savings went toward hiring lawyers and bailing Rosie out of jail? “Our retirement money is limited,” he told her. “What the heck are you doing?” Her kids, mercifully, were indifferent. “They don’t take their parents very seriously,” Rosie explained. No matter. Because she happened to reside in Mexico, she had an opportunity to change the lives, and maybe even save the lives, of younger women. “I have never felt so important,” she said.

Rosie’s specific assignment was to pick up a cache of pills, travel across the border, and mail them to a volunteer in Texas, who, in turn, would deliver the pills to women who had asked for them. Rosie had been told that crossing the border was necessary because packages sent from within the United States receive less scrutiny than those sent from abroad. Of course, U.S. Customs and Border Protection has its own rules and levels of scrutiny for goods entering the country. It requires that any medication brought into the U.S. have a doctor’s note or prescription and tells travellers not to carry more than a ninety-­day supply.

Rosie had been crossing the border for twenty years, and, as she planned her first journey with abortion pills, she realized that although Border Patrol agents had sometimes searched her luggage and X-rayed her car, they had never opened her toiletry kit. It was there that she tucked two plastic bottles containing three hundred and thirty-six pills of misoprostol. She placed the kit in an overnight bag, said goodbye to her husband, got in her pickup truck, and headed to Texas.

Not long afterward, she walked into a post office, the sound of rattling accompanying each step—hundreds of pills in plastic bottles, seeming to announce themselves from her bag. Unnerved by the noise, she packed the pill bottles into a box, approached a clerk at the counter, and reflexively pulled out a credit card to pay the postage. As the printer spat out her receipt, it dawned on her that she’d created the sort of paper trail illicit suppliers like herself were supposed to avoid.

The recipient of the box was a Las Libres associate elsewhere in Texas, and Rosie had left the return address blank. Back home, searching the Internet, she learned that the lack of a return address was a red flag to postal inspectors—“like the kind of thing a drug dealer would send,” she said. Mailing pills within Texas to facilitate a self-induced abortion there is a felony punishable by up to two years in prison. If the pills eventually wound up in Mississippi, she could face up to five years in prison and additional charges for racketeering.

Two days later, the package arrived safely at its destination, and only then was Rosie able to sleep. Waking up the following morning, she wanted to do it again. Before long, her husband would be raising money for misoprostol buys, and associates in the syndicate would be referring to her by the nickname Pills on Wheels.

Three months in, the Old Hippies of San Miguel de Allende had raised ten thousand dollars to buy abortion pills—a decent haul, in the estimation of Liz, the great-­grandmother, given that they had to persuade people to part with their money while sharing little about what would be done with it. Keeping donors ignorant was crucial because, post-Roe, giving money to a network like theirs could be construed as a crime.

The end of Roe had emboldened conservative activists and politicians in the U.S. After the court ruling, the Department of Health and Human Services assured doctors from states where bans had taken effect that they would not face prosecution under federal law for performing an abortion when the mother’s life was on the line—a decision that prompted Ken Paxton, the attorney general of Texas, to sue the federal government.

Now that clinics in abortion-ban states had closed, conservative activists were targeting nonprofits that gave women money to travel for the procedure. These funds were now “criminal organizations,” in the words of Briscoe Cain, a Texas state congressman. As Mary Ziegler, a professor of law at the University of California at Davis, points out, one lesson of S.B. 8 is that a threat of legal consequences is enough to empty a state of abortion providers, regardless of whether there are prosecutions. This summer, many abortion funds in Texas ceased operation.

Conservative lawmakers were also threatening private companies, among them Lyft, that promised to reimburse employees for out-of-state travel to get abortions. Writing to an international law firm, Sidley Austin, which has offices in Houston and Dal­las, eleven legislators warned it not to help employees “murder their unborn children.” Texas criminal prohibitions, the legislators said, extended to medication abortions, “even if the drugs were dispensed by an out-of-state abortionist.”

One of the best-known attempts to prosecute a ring of abortion providers in the United States occurred in 1972, when seven women belonging to a group known as the Jane Collective were arrested in Chicago. Members of the collective, which evolved from the efforts of a Uni­versity of Chicago student to help a friend’s sister secure an underground abortion, lacked medical training; however, they had taught themselves to do the procedure ac­cording to clinical safety standards. Their hope was to improve the odds of pregnant wom­en sur­viving what the historian Alicia Gutierrez-­Romine calls “abortion roulette.” For most of the last century, women of means who sought to end a pregnancy turned to obste­tricians and gyne­cologists who, for a steep price, performed illegal abortions on the side, while women with fewer resources risked having a vital organ punctured or bleeding to death. The Janes had done thousands of abortions in the years before the seven women were arrested. Charged with performing and conspiring to perform abortions, each of them faced a sentence of more than a hundred years in prison if convicted. However, when Roe was announced, in January, 1973, the charges against them were dropped.

It’s not yet clear whether, after Dobbs, authorities will choose to prosecute people for involvement in networks like Cruz’s. Amy O’Donnell, a spokesperson for the Texas Alliance for Life, argues that state law already allows for the extradition on felony charges of those who bring abortion drugs into Texas from other states. How­ever, extradition of people who reside outside the country is a federal matter and, she speculates, would likely not happen without the election of a President with anti-­abortion views.

Even within Texas and other states with strong laws against abortion facilitators, the politics of enforcing penalties is complex, in part because the belief that abortion equals murder doesn’t appear to be widespread. A survey released last month found that, among Texas voters, sixty per cent ­favored abortion being “available in all or most cases,” while only ten per cent supported banning abortion completely. In this political context, David Donatti, a civil-rights attorney at the A.C.L.U. of Texas, says, “conservative legislators would benefit just as much from pretending no abortions are happening as they would from prosecuting abortions.”

Early on in her American mission, trying to assess the sorts of risks volunteers might encounter crossing the border with pills, Verónica Cruz arranged a trial run. Five hundred pills arrived in Texas unhindered. Her methods for determining whether the people she chose to make the runs were sincere and not setting her up for trouble were somewhat less concrete. She made those decisions, she said, “by feeling.” When Claire, a California woman who spent part of the year in Mexico, heard about the network and contacted Cruz about becoming a pill runner, she didn’t get an assignment immediately. Instead, Cruz came to her house in San Miguel and spent hours “sniffing me out,” Claire said. Claire didn’t know about the Old Hippies and didn’t need to. As Cruz said once she came to trust Claire, one person could be a network of her own.

Claire slipped her first batch of pills into the States in May, and mailed packages to women all over the country. Three months later, shortly before her second run, she dashed through an artisan market, past a woman charring corn over an open flame, to a stall that sold flower-shaped earrings crafted by Huichol people in the Sierra Madre mountains. Each piece was made of colorful glass beads.

“Hola, ¿cuánto cuesta? ”

“Cincuenta pesos.”

Two dollars and fifty cents. Paying in cash, she bought twenty pairs of ear­rings—sunflowers, camellias, roses—to camouflage the abortion pills she’d be bringing back to the U.S. She would put the earrings in cardboard jewelry boxes that had a layer of ­cotton padding. The earrings would go on top of the cotton, and the pills would be embedded inside, the better to keep a husband or parent from finding them. But Claire, who had had two abortions herself, liked the idea of placing earrings in every package for reasons other than discretion. “It’s so stressful to be pregnant when you don’t want to be,” she said. “You have all these hormones going, you don’t like the way your body feels, you just want it to be over, and so I thought, It’d be nice to get a pair of earrings when you’re in that kind of mood. You know, an abortion and a present!”

She made her way out of the market, past portable shrines for the Virgin of Guadalupe and hearts of blown glass, and ran home, where Cruz was waiting at her door, navy-blue backpack in hand. “Little earrings,” Claire called out, “para las chicas! ”

At the kitchen counter, Cruz unzipped the backpack and pulled out blister packs of mifepristone and misoprostol, and Claire took a pair of scissors from a drawer. They cut open each of the packs, combining six pills of misoprostol with one of mifepristone—usually sufficient for one abortion. Each envelope would also contain instructions on the abortion process which Cruz and Claire had written together. The notes ended, “Hugs, the pill fairy.”

The pills that Claire and other fairies would be sending remained cheaper to obtain from a Mexican pharmacy than from a doctor in the U.S. But, after Dobbs, the price of a box of Pfizer pills in several establishments in San Miguel de Allende had markedly increased. In one pharmacy, the price rose from about two thousand pesos per box to more than three thousand, or from roughly a hundred dollars to a hundred and sixty. The cost of generic misoprostol fluctuated wildly—forty-five dollars in one pharmacy, seventeen in another—and at the nearby Costco you could encounter two different prices for the drug in a single day. If the inflation seen in San Miguel pharmacies suggested private-sector opportunism, it might also have reflected well-meaning expats dominating the market, clearing the shelves on behalf of Americans and, in the process, jacking up the price of abortion for Mexican wom­en—an ethical dilemma that some of Cruz’s associates had yet to think deeply about.

As they divvied up pills, Claire mentioned to Cruz that crossing the border with pharmaceuticals was not, for her, a big deal. “I have Global Entry,” she said. “I’ve never been stopped by customs in my life.” But, when she’d asked a friend if she would consider joining her as a pill runner, the friend had responded, “I’m Black. I can’t do that. Isn’t that obvious to you?”

On Claire’s first mission, she’d sent pills to women in seven states where, if her actions were discovered, they could be seen as a crime. But she was given less to paranoia than to curiosity. Preparing to send her first lot of pills, she had Googled the addresses where they would land: trailer parks, run-down apartments, a house valued at thirty-four thousand dollars. She’d envisioned women with other children and tapped-out bank accounts who couldn’t travel out of state for an abortion. She had to force herself not to Google any further, should authorities uncover the digital footprint she now regretted having created. This time, she had resolved simply to cross the border, mail the earrings and pills in an envelope with a fake return address, pay the post office in cash, take a photo of the tracking number, and destroy all receipts. She would later delete the photo of the tracking number, too.

Finishing up, as salsa music drifted in from another room, Claire asked Cruz about the varieties of civil disobedience that led the Mexican Supreme Court to decriminalize abortion. Cruz told her that she thought of herself as part of an ant colony: one of countless workers toiling beneath an unbroken surface, carving intricate paths toward their goal. “Was all of this hidden from the public eye?” Claire wondered. Cruz shook her head. From the start, Las Libres members defied the system openly. In the United States, as in Mexico, Cruz predicted, the more people who got involved in the movement, the harder it would be for anyone to stop it.

A few days later, as Cruz trained future acompañantes in Yucatán, Claire packed abortion pills and earrings in a carry-on alongside her perfume, oregano-­oil capsules, and shea butter and caught an early-morning bus to the airport in Mexico City.

“Bringing anything back, Ma’am?” the customs agent asked when she arrived in San Francisco.

“Just some souvenirs.”

Handing her passport back, the agent said, “Welcome home.”

When you risk years in prison to distribute abortion pills to wom­en who wouldn’t otherwise be able to access them in Texas, you tend to appreciate more straightforward aspects of existence. So Anna delighted in an okra plant in her small garden that, by September, had sprung up to twice her height. Her tomatoes were thriving, as were the rosemary and parsley, and one day, as she picked up some jalapeño seeds left over from a seasonal planting, it occurred to her to hide pills in a packet of seeds. You never knew which recipient might have a patch of dirt in which to plant them.

It had taken some time for Las Libres to find collaborators like Anna. After S.B. 8 went into effect, Cruz and her colleagues identified thirty abortion-rights groups in Texas that they thought might be interested in receiving pills from Mexico. The first meeting of the Mexican and American activists had been awkward, though. The Mexicans had gathered in a conference room; the Texans joined the meeting individually, via Zoom. Most of their cameras were off, and the sound was bad. At the end of the meeting, when Cruz asked who was interested in collaborating, only one person raised her hand. There followed a long silence, until one of the Texans unmuted her sound. “The law has won,” she said. “They accomplished what they wanted: scare us to the point where we feel there is nothing to be done.” Only later did messages from some of the participants begin to trickle in, on Signal. They had been reluctant to assert their intention on a video call, but they were ready to work with Cruz.

Anna’s first move had been to post on social media that she could be of help to women in need—a post that never mentioned abortion directly. She said the same to strangers and friends in bars and cafés, just as Cruz used to do in Mexico, even as the penalties she might face increased.

Many of Anna’s pills almost certainly came from the Old Hippies of San Miguel de Allende, but she eschewed such precise information, for her own protection and that of others. She found mailing the pills especially nerve-racking; for reasons she couldn’t quite explain, she chose as a fake return address a shopping mall where, in third grade, she’d made a joyful trip with her mom to get her ears pierced. It was better to hand off the pills in person, she thought, because those exchanges were harder for authorities to track and safer for women who lived in homes where an envelope with a dubious return address might be opened by the wrong hands.

She’d set a hard rule for herself, early on: to meet pregnant women only in parks or other public spaces that could not easily be linked back to her neighborhood or her job. Some days, self-conscious about her disguise, she thought she’d be the last person in Texas still wear­ing a mask outside. Other days, sympathetic, she decided hard rules could be broken, as when she capitulated to the grandmother of an eighth grader who insisted that the only place she’d feel safe collecting pills was in Anna’s own home.

The pregnant eighth grader seemed almost in shock when she arrived with her grandmother and an aunt, who were furious at the girl. “It was, like, ‘You fucking idiot! You have a child in you! How did we get here?!’ ” Anna said. In the living room, lights dim and blinds closed, Anna tried to ignore the tension and focus on practical details: what to expect as the abortion progressed, and what to do if complications ensued. “If you have two regular menstrual pads and you’re soaking them front to back, side to side, completely full of blood, for two hours in a row—that would be too much blood,” she said. Across the room, Anna recalled, three sets of eyes widened. She quickly added, “Medication abortion is very safe.”

The eighth grader’s procedure went smoothly, but the grandmother told Anna some weeks later that the girl was still depressed: “She’s just walking around in a big hoodie all the time, even though she’s not pregnant anymore.” Anna felt haunted by all she hadn’t been able to do for the girl. “In other states, or under another law system, her grandmother could have taken her to a sexual- and reproductive-health clinic, where they could have had a conversation with her, taught her about condoms, given her birth control, and sent her home feeling empowered with more information,” she said. “Instead, she had to go to some random person’s house. I’m sure they did not feel safe or comfortable here.”

If Anna was sometimes frustrated and uncertain, she appreciated that sensible counsel was coming from Mexico at a moment that flipped “the narrative that America is this beacon of democracy and hope and progress.” She had begun to see herself as part of an age-old global tradition: women helping other women with their reproductive-­health concerns because they knew they couldn’t count on institutions for protection. As Gutierrez-Romine, the historian, notes, physicians began functioning as “­gatekeepers” for women seeking to end their pregnancies only in the nineteenth century.

In this new era of criminalized underground abortions, doctors were still occasionally required, though. One morning, Anna delivered pills to a slight woman in her thirties, a friend of a friend, who was eight weeks pregnant. When they were going over the instructions, the woman mentioned that her health had been precarious. Anna reassured her that the risk of developing an infection or hemorrhaging was low—less than one per cent in each case, studies showed. But, within an hour of taking the medication, the wom­an texted Anna that she was feeling dizzy. She’d thrown up, and her palms were itchy. She was at her parents’ house, the woman told Anna, and no one there was aware that she was having an abortion. She texted Anna again shortly afterward to say that she had lost consciousness twice.

Panicking, Anna advised her to rush to the nearest emergency room. Eventually, the woman confided to her mother, “I took some pills. We’re going to the hospital. And you cannot tell them that I took some pills.” For the next four hours, Anna heard nothing. None of the tricks she used to calm herself—Wordle, Spelling Bee, mindless scrolling through her friends’ feeds on Instagram—worked. She was sick with fear that the woman had died.

Midafternoon, a text arrived: “I’m stable.” The woman explained, “I was hooked up to all these I.V.s, so I couldn’t text you. Let’s go out for drinks in a couple of weeks.”

That night, in tears, Anna told a friend, “I don’t know if I can do this anymore. I thought I had killed somebody.” Her friend reminded her that the people who had failed this woman, and others, were the officials who had stripped them of their right to reproductive care under medical supervision.

In June, the day before Roe’s overturning, the Journal of the American Medi­cal Association published an editorial warning of an imminent crisis of abortion ac­­cess, citing research indi­cating that maternal mor­tality would rise by at least twenty per cent. The authors estimated a rise of ma­­ternal mortality among Black people of upward of thirty per cent. The biennial maternal-­mortality report in Texas, due to be released last month, has been delayed until after the midterm elections.

Not long ago, on a Thursday morning, a Texas woman named Sarah sat on her toilet, watching a pregnancy test develop a second red line. She was pregnant—a big problem given the complex circumstances of her life at that moment, among them the needs of the toddler daughter just outside the bathroom door. Still inside, she texted a friend for advice. The friend suggested contacting Plan C, a project that links U.S. women and abortion-pill providers around the world. Within minutes, Sarah had chosen a provider in Austria, paid a hundred and seven dollars by credit card, had a “telehealth appointment” with a doctor she never actually spoke to, and ordered a set of abortion pills that would be mailed to her from India. The problem was that the pills could take almost a month to get to Texas. She couldn’t bear to wait that long.

Her friend, concerned, was also text­ing other people. “I might have a local contact,” she wrote a few minutes later. By eleven-thirty that same morning, in a quiet working-class neighborhood, Anna was handing Sarah a plastic bag of pills.

Afterward, Sarah’s abortion complete, the toddler laid claim to the party hats a few of her mother’s friends had brought over to keep her cheerful during a ­process they’d taken to calling a “Texas miscarriage.” (Just in case “Zuckerberg is tracking our texts,” Sarah said, half in jest.) Empty cans of White Claw the friends had also brought were in the recycling bin. Sometimes, Sarah grieved. She could imagine wanting a second child at a different time in her life, but she also knew that she was fortunate. Many other wo­men in states where abor­tions had been banned didn’t have the support of friends like hers.

Weeks later, when the package she’d ordered from India arrived and she was stowing the abortion pills in a drawer, it suddenly occurred to her that nothing but stray fear stood in the way of her doing what Anna did. She didn’t know Verónica Cruz or the Old Hippies or Claire or anyone besides Anna who worked with them, but she imagined an expanding constellation of women, operating in secret and in concert, to help other women. “Try to arrest all of us!” Sarah said to herself. She grabbed her phone and texted Anna: “Hey! How do I start doing what you do?”

The Heartbeat Act is forcing families to journey to oversubscribed clinics in other states—offering a preview of life in post-Roe America.

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 straightforward 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, mid-term, 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.

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?”