Caroline Kitchener of The Washington Post

Brooke Alexander found out she was pregnant 48 hours before the Texas abortion ban took effect.

CORPUS CHRISTI, Tex. — Brooke Alexander turned off her breast pump at 6:04 p.m. and brought two fresh bottles of milk over to the bed, where her 3-month-old twins lay flat on their backs, red-faced and crying.

Running on four hours of sleep, the 18-year-old tried to feed both babies at once, holding Kendall in her arms while she tried to get Olivia to feed herself, her bottle propped up by a pillow. But the bottle kept slipping and the baby kept wailing. And Brooke’s boyfriend, Billy High, wouldn’t be home for another five hours.

“Please, fussy girl,” Brooke whispered.

She peeked outside the room, just big enough for a full-size mattress, and realized she had barely seen the sun all day. The windows were covered by blankets, pinned up with thumbtacks to keep the room cool. Brooke rarely ventured into the rest of the house. Billy’s dad had taken them in when her mom kicked them out, and she didn’t want to get in his way.

The hours without Billy were always the hardest. She knew he had to go, as they relied entirely on the $9.75 an hour he made working the line at Freebirds World Burrito, but she tortured herself imagining all the girls he might be meeting. And she wished she had somewhere to go, too.

Brooke found out she was pregnant late on the night of Aug. 29, two days before the Texas Heartbeat Act banned abortions once an ultrasound can detect cardiac activity, around six weeks of pregnancy. It was the most restrictive abortion law to take effect in the United States in nearly 50 years.

For many Texans who have needed abortions since September, the law has been a major inconvenience, forcing them to drive hundreds of miles, and pay hundreds of dollars, for a legal procedure they once could have had at home. But not everyone has been able to leave the state. Some people couldn’t take time away from work or afford gas, while others, faced with a long journey, decided to stay pregnant. Nearly 10 months into the Texas law, they have started having the babies they never planned to carry to term.

Texas offers a glimpse of what much of the country would face if the Supreme Court overturns Roe v. Wade this summer, as has been widely expected since a leaked draft opinion circulated last month. If the landmark precedent falls, roughly half the states in the country are expected to dramatically restrict abortion or ban it altogether, creating vast abortion deserts that will push many into parenthood.

Sometimes Brooke imagined her life if she hadn’t gotten pregnant, and if Texas hadn’t banned abortion just days after she decided that she wanted one. She would have been in school, rushing from class to her shift at Texas Roadhouse, eyes on a real estate license that would finally get her out of Corpus Christi. She pictured an apartment in Austin and enough money for a trip to Hawaii, where she would swim with dolphins in water so clear she could see her toes.

When both babies finally started eating, Brooke took out her phone and restarted the timer that had been running almost continuously since the day they were born.

She had two and a half hours until they’d have to eat again.

Brooke and Billy first met at the downtown skatepark with a big group of friends, one clear night in May of last year. They didn’t talk that first day, but Brooke noticed how effortlessly Billy dropped into the quarter-pipe, the way his blond hair flipped out from underneath his red beanie. She followed him on Instagram, and her stomach did a little dance when she saw that he followed her back.

Soon, they were spending almost every day together, throwing themselves into the Gulf of Mexico waves on Padre Island and watching the sun set over the pier. At the skatepark, he’d help her do the tricks she’d been scared to try alone.

“Pinkie promise me you’ll do it,” he’d say, all blue eyes and dimples, as she peeked over the edge of the ramp.

Once he hooked her little finger, there was no backing down.

Billy was different from the other guys Brooke knew. He held her hand in public and introduced her to his dad. When she took him to the mall, he grinned each time she stepped out of the dressing room, telling her how good she looked in each new crop top she tried on. He made her feel pretty.

“I wasn’t used to feeling like that,” Brooke said.

Brooke took the pregnancy test at 11 o’clock on a hot night at the tail end of the summer. When the two pink lines appeared, she looked over at Billy, then slid onto the bathroom floor, finally connecting the signs she’d ignored for weeks.

The nausea she’d chalked up to food poisoning. The two missed periods. That moment a few weeks back, when Billy put a hand on her stomach and asked if she was sure she wasn’t pregnant.

Leaving Billy in her bedroom with the pregnancy test, Brooke grabbed her keys and drove to her best friend’s house, where they sat on his bed and examined her options.

She could always get an abortion, she told him. Then he reminded her of something she vaguely remembered seeing on Twitter: A new law was scheduled to take effect Sept. 1.

Brooke had 48 hours.

The abortion clinic in South Texas, two and a half hours from Corpus Christi, had no open slots in the next two days, with patients across the state racing to get into clinics before the law came down. When Brooke called, the woman on the end of the line offered the names and addresses of clinics in New Mexico, a 13-hour drive from Corpus Christi.

In the meantime, the woman said, Brooke could get an ultrasound somewhere nearby: If she was under six weeks, they could still see her.

“We’re gonna see how far along it is,” Brooke texted her dad, Jeremy Alexander, later that night. “See if abortion is an option.”

“What’s the cut off date,” he asked.

“They just passed a law today!!” she responded in the early hours of Sept. 1, referring to the ban that had just taken effect. “What are the f---ing odds I believe it’s 6 weeks.”

“Fingers crossed????” her dad said.

Brooke found a place that would perform an ultrasound on short notice and scheduled an appointment for 9 a.m.

Whenever a new client walks into the Pregnancy Center of the Coastal Bend, they are asked to fill out a form. After all the usual questions of name, date of birth and marital status comes the one that most interests the staff: “If you are pregnant, what are your intentions?”

From there, the team sorts each client into one of three groups:

If they’re planning to have the baby: “LTC,” likely to carry.

If they’re on the fence: “AV,” abortion vulnerable.

If they’re planning to get an abortion: “AM,” abortion minded.

The Pregnancy Center of the Coastal Bend, which advertises itself as the “#1 Source of Abortion Information” in the region, is one of thousands of crisis pregnancy centers across the United States, antiabortion organizations that are often religiously affiliated.

When Brooke showed up with her mom for her appointment, she had no idea she’d walked into a facility designed to dissuade people from getting abortions. She also didn’t know how much significance her form held for the staff: By signaling that she wanted an abortion, she became their first “AM” of the Texas Heartbeat Act.

Brooke heard about the center from her mom’s friend, who knew she needed an ultrasound. This place offered them free. Brooke felt a sense of calm, sitting in the waiting room, lulled by its decorative throw pillows and soft watercolors of ocean scenes.

The advocate assigned to her case, Angie Arnholt, had been counseling abortion-minded clients at the pregnancy center for a year. While many of the center volunteers signed up only to talk to “LTCs” to have happy conversations about babies their clients couldn’t wait to have, Arnholt, a 61-year-old who wears a gold cross around her neck, felt called to do what she could to help women “make a good decision,” she later told The Washington Post.

Back in a consultation room, Brooke told Arnholt all the reasons she wanted to get an abortion. She had just enrolled in real estate classes at community college, which would be her first time back in a classroom since she dropped out of high school three years earlier at 15. She and Billy had been dating only three months.

Sitting across from Brooke and her mom, Arnholt opened “A Woman’s Right to Know,” an antiabortion booklet distributed by the state of Texas, flipping to a page titled “Abortion risks.” The first risk listed was “death.”

As Brooke listened to Arnholt’s warnings of depression, nausea, cramping, breast cancer and infertility, she tried to stay calm, reminding herself that women get abortions all the time. Still, Brooke couldn’t help fixating on some of the words Arnholt used: Vacuum suction. Heavy bleeding. Punctured uterus.

(Serious complications from abortion are rare. Abortion does not increase the risk of mental illness, breast cancer or infertility, according to leading medical organizations.)

Starting to panic, Brooke looked over at her mom. When she found out Brooke was pregnant, Terri Thomas told her daughter to get an abortion. While she was a devout Christian, going to church a few times a week and twice on Sundays, she had her own views on this particular issue.

Thomas had her first kid at 20, she said, just as she was transferring out of community college with hopes of starting law school. If the timing had been different, she said, she might have been a prosecutor. Instead, she hopped from one retail job to another: Bath & Body Works to Walgreens to Home Depot.

Growing up, Brooke said, she bounced back and forth between her mom’s house and her dad’s, depending on who was the more stable parent at the time. Her happiest years as a kid were spent with her dad, she said, on a tree-lined street with a ping-pong table in the garage and a trampoline in the backyard. But then Brooke’s dad started using cocaine.

While Alexander has been sober for a few years now, he said, back then he couldn’t kick the habit. Around the time he stopped paying all the rent, and sewage started backing up in their toilets, Brooke moved back in with her mom.

With her mom, Brooke always felt like she was tiptoeing. If Brooke forgot to turn off the lights or do the dishes, Thomas would start yelling. Thomas felt she had every right to respond that way, she said, because she was the “hen” in her henhouse.

Arnholt ushered Brooke into the ultrasound room, where Brooke undressed from the waist down and lay back onto an examination table, looking up at a large flat-screen TV.

As the ultrasound technician pressed the probe into her stomach, slathered with gel, Brooke willed the screen to show a fetus without a heartbeat.

The technician gasped.

It was twins. And they were 12 weeks along.

“Are you sure?” Brooke said.

“Oh, my God, oh, my God,” Thomas recalled saying as she jumped up and down. “This is a miracle from the Lord. We are having these babies.”

Brooke felt like she was floating above herself, watching the scene below. Her mom was calling the twins “my babies,” promising Brooke she would take care of everything, as the ultrasound technician told her how much she loved being a twin.

If she really tried, Brooke thought she could make it to New Mexico. Her older brother would probably lend her the money to get there. But she couldn’t stop staring at the pulsing yellow line on the ultrasound screen.

She wondered: If her babies had heartbeats, as these women said they did, was aborting them murder? Eventually, Arnholt turned to Brooke and asked whether she’d be keeping them.

Brooke heard herself saying “yes.”

Brooke walked out of the pregnancy center that day with an ultrasound photo and a handful of lollipops that Arnholt promised would help with her morning sickness.

Arnholt and the ultrasound technician each followed up with Brooke a few times over text. Brooke scheduled what the pregnancy center called a “prenatal appointment,” where she sat through another ultrasound, then dropped by for a parenting class, earning “points” she redeemed for a package of diapers.

After that, Brooke didn’t go back to the pregnancy center. She said the class felt like a waste of time.

Instead, she turned to Billy.

Within a few weeks, Brooke and Billy had a plan. He would join the Air Force as soon as he graduated from high school. Brooke would wait for him to finish basic training, then follow him wherever he got assigned.

Soon they were debating baby names. Surrounded by their friends and families one afternoon in October, Brooke and Billy fired gender-reveal cannons into Thomas’s backyard, unleashing two giant puffs of pink smoke.

“I’m so happy I met you billy,” Brooke wrote in an Instagram post announcing her pregnancy. “Starting a family with you is gonna be one of the hardest things I’m ever gonna experience, but I’m glad I get to do it with you.”

Brooke started her real estate classes in early November, and she loved everything about going to school. When she showed up the first day in her favorite crop top and jeans, the cinder-block building “felt like an opportunity,” she said. Most days, she’d buy a Frappuccino from the vending machine and sit down in the chair she’d claimed as her own, opening her textbook to a page she’d already covered in yellow highlighter.

Brooke got an 83 on the final exam, the highest grade in the class.

She texted everyone she could think of who might want to hear the news: Billy, her brother, her mom, her dad, her grandpa. After three years out of school, she couldn’t believe she’d done so well.

“I felt like, man, I must be really smart,” she said.

Throughout the fall, Billy was her biggest worry. He’d stayed pretty quiet back when she was deciding what to do about the babies. Just once, he told her he’d prefer to get an abortion, but would support her completely in whatever she chose. He’d thought about adoption, but Brooke wouldn’t even consider it.

“I don’t think I’m ready for this,” he’d told her.

Billy was scared to lose what he described as “the freedom of being a teenager.” After he graduated, he’d planned to keep working at Freebirds, just enough hours to get by, so he could maximize his skate time and “just chill.” People respected Billy at the skate park. Whenever he geared up to film some tricks, everyone else cleared out of the bowl.

By November, Billy was paying all of Brooke’s bills. She’d stopped working at Texas Roadhouse after the smell of the meat and grease had been making her sick to her stomach. To swing Brooke’s $330 car payment, they applied for a WIC card and ate ramen or pancakes for dinner. When they overdrafted Brooke’s credit card, Billy worked double shifts until he could pay it off.

Brooke wanted to work, but she couldn’t hack a waitressing job. At seven months pregnant, she struggled to stay on her feet for too long and felt utterly exhausted by even the simplest tasks. She started falling asleep while doing her homework. Then she missed a class. Then another.

When she decided to drop out of real estate school, she couldn’t bring herself to tell her teacher. She convinced herself it wasn’t that big of a deal. They’d be moving away soon anyway, and the Air Force would pay Billy enough to support them both.

Brooke wedged her real estate textbook in a line of books on her dresser, between “What to Expect When You’re Expecting” and the fourth Harry Potter. Maybe she’d come back to it one day.

Anytime Brooke went out with the babies in public, she knew that people were staring. She was 18 and she looked 18, with rosy cheeks and curly blond ringlets tied together with a ribbon. As she struggled to maneuver her double stroller through the doors at Freebirds, she imagined everyone was judging her, writing her off as a clueless kid and a bad mom.

She was determined to prove them wrong.

Somehow, mothering came naturally to Brooke. Whenever one of the babies started crying, Brooke would tick through her mental checklist: Was her daughter hungry? Tired? Did she need to be changed?

If it was none of those things, Brooke would pick up her daughter and hold her close, swaying from side to side, kissing the silky brown strands on the top of her head. Almost always, her baby would stop crying.

“I think they can smell me,” she said. “And that makes me feel so special.”

Brooke knew the little things about her daughters that no one else would notice. Olivia had a higher-pitched cry. Kendall was harder to soothe. You could always tell when they were about to wake up, because they’d start to smile.

Looking at her daughters, Brooke struggled to articulate her feelings on abortion. On one hand, she said, she absolutely believed that women should have the right to choose what’s best for their own lives. On the other, she knew that, without the Texas law, her babies might not be here.

“Who’s to say what I would have done if the law wasn’t in effect?” she said. “I don’t want to think about it.”

Brooke considered all that she’d lost: long nights at the skate park, trips to the mall, dropping $30 on a crab dinner just because she felt like it.

“I can’t just really be free,” she said. “I guess that really sums it up. That’s a big thing that I really miss.” She sat silently for a while, Olivia’s hand wrapped around her finger. “It’s really scary thinking that I wouldn’t have them,” she said.

There was only one way she could make sense of it, she said. Losing them now, as fully formed human beings, would be different from losing them back then.

All through the pregnancy, Brooke had planned to bring the babies home to her mom’s house, where they’d all live together until Billy made enough money to pay for a home. Brooke’s mom had promised to be there for them, back in the ultrasound room, and Brooke had believed her. But after a couple of weeks, Brooke started to feel like her mom could turn on her at any moment.

Thomas would remind Brooke that she was staying in her house rent-free, running the TV and AC all night without paying for electric. After Brooke left dirty dishes in the sink one night in May, she woke up to her mom yelling at her from the kitchen.

“You don’t get a prize for getting yourself knocked up and pregnant,” Thomas remembered saying. “I don’t know what you think I owe you, but you don’t get a prize for that.”

Brooke told her, “You treat me like some random chick off the street. I’m your daughter.”

Thomas said she told her to find another place to live.

Brooke packed up a few things and drove the babies to Billy’s dad’s house. Billy’s room wasn’t exactly where she’d imagined raising her daughters, with its stash of skateboard magazines and a giant Freebirds billboard behind the bed, advertising fountain drinks for 95 cents. But it was a place she was welcome.

The next morning, Brooke woke up to a text from her mother. “I am by no means a perfect human or a perfect mom, but I love you no matter what,” she wrote. “You don’t have to stay over there.”

Brooke would rather rely on Billy than her mom, she decided, though in her most anxious moments, she worried he might kick her out, too.

She often relived an argument they’d had one Saturday night in April, when they got a little too drunk and Billy finally talked about all the things he’d been avoiding. He didn’t really like the way his life was turning out, he told her. He didn’t want to join the Air Force. He just wanted to skate.

“That’s not my fault,” she’d told him. “I didn’t get myself pregnant.”

At one point, she recalled, he suggested they try living apart.

They were over that now, Brooke reminded herself as she hung up her clothes in Billy’s closet. She placed a bouquet of flowers on his desk and lit a candle, filling the room with a scent called “Forever Love.” Bit by bit, she would make Billy’s room a home.

Across town, a woman Brooke had never met would soon be sharing her story, holding up the twins as an antiabortion triumph, just two weeks after the leaked draft decision revealed a Supreme Court on the brink of overturning Roe.

The Coastal Bend Republican Coalition gathered on May 19 for its weekly meeting at a local barbecue joint. Over brisket and coleslaw, members listened to the speaker they’d invited for the evening: Jana Pinson, the executive director of the Pregnancy Center of the Coastal Bend.

To explain the center’s work, Pinson told a story about a girl who showed up with her mom on the morning the Heartbeat Act took effect, asking for an abortion. The mother and daughter “were so furious with us,” Pinson said, “so angry.” But as soon as they saw the ultrasound, she said, everything changed.

“The moment we put that wand on her sweet belly and two babies popped up … it absolutely melted them.”

Last year, Pinson said, 583 abortion-minded and abortion-vulnerable women chose to continue their pregnancies after visiting their facility. At their banquet in March, with over 2,800 attendees from across the region, Pinson and her staff lit 583 candles.

One of those was for Brooke.

Three weeks later, the babies stayed home while Brooke and Billy drove to the courthouse. Billy was about to leave for a five-month stint in basic training and technical school. For Brooke to qualify for military benefits, they had to get married.

At 11 o’clock on a Monday morning, they walked into a courtroom with an American flag behind the bench, Brooke in a flowery sundress, Billy in jeans. She’d looked around for white dresses on Amazon but couldn’t justify the $30: She was terrified she’d run out of money while Billy was away.

The loneliness scared her, too. She kept imagining the long nights alone in Billy’s house, trying to calm two crying babies without him. He wouldn’t have his phone at basic training, and she would hear from him mostly through letters. She knew she’d have to manage that little voice in the back of her head: What if he changed his mind about their life together?

Standing with Billy in front of the justice of the peace, Brooke told herself that, one day, they would have their “love story moment.” She would walk down the aisle in a wedding gown. Their friends and family would cry and cheer as she and Billy publicly declared how much they meant to each other.

“I, Brooke Alexander, take thee, Billy High, to be my wedded husband,” she repeated.

If it wasn’t for the Texas law, Brooke knew she might not be standing here. She’d probably be studying for her next exam, while Billy mastered some new trick on the quarter-pipe. She liked to think they’d still be together, spending their money on movie tickets and Whataburger, instead of diapers and baby wipes.

She told herself that alternate life didn’t matter anymore. She had two babies she loved more than anything else in the world.

“I do,” she said, tears in her eyes.

Brooke pulled out her phone once they finished the ceremony: 1 hour, 15 minutes.

Time to grab some lunch and head home. The babies would be hungry.

Story editing by Peter Wallsten. Photos by Marvi Lacar. Photo editing by Thomas Simonetti. Copy editing by Mike Cirelli. Design by Stephanie Hays.

Amid legal and medical risks, a growing army of activists is funneling pills from Mexico into states that have banned abortion

Monica had never used Reddit before. But sitting at her desk one afternoon in July — at least 10 weeks into an unwanted pregnancy in a state that had banned abortion — she didn’t know where else to turn.

“I need advice I am not prepared to have a child,” the 25-year-old wrote from her office, once everyone else had left for the day. She titled her post, “PLEASE HELP!!!!!!!!”

Within hours, she got a private message from an anonymous Reddit user. If Monica sent her address, the person promised, they would mail abortion pills “asap for free.”

Monica didn’t know it at the time, but her Reddit post connected her to a new facet of the battle for abortion access: the rise of a covert, international network delivering tens of thousands of abortion pills in the wake of the Supreme Court ruling in June that struck down Roe v. Wade.

The emerging network — fueled by the widespread availability of medication abortion — has made the illegal abortions of today simpler and safer than those of the pre-Roe era, remembered for its back alleys and coat hangers. Distinct from services that sell pills to patients on the internet, a growing army of community-based distributors is reaching pregnant women through word of mouth or social media to supply pills for free — though typically without the safeguards of medical oversight.

“You’re truly [an] angel,” Monica wrote in a string of messages reviewed by The Washington Post. “I think tonight will be the first night i will actually be able to sleep.”

This account of the illegal abortion movement that has grown quickly since the Supreme Court ruling is based on interviews with 16 people with firsthand knowledge of the operation, and includes on-the-ground reporting in four U.S. cities and Mexico. Many who spoke to The Post did so on the condition of anonymity to discuss activity that potentially breaks multiple laws, such as practicing medicine without a license and providing abortions in states where the procedure is banned. The Post was permitted to observe distributors handling pills in antiabortion states on the added condition that their locations not be identified.

Those interviewed described a pipeline that typically begins in Mexico, where activist suppliers funded largely by private donors secure pills for free as in-kind donations or from international pharmacies for as little as $1.50 a dose. U.S. volunteers then receive the pills through the mail — often relying on legal experts to help minimize their risk — before distributing them to pregnant women in need.

The system could upend Republican plans for a post-Roe America. Despite the strict abortion bans that have taken effect in over a dozen states, some antiabortion leaders fear that the flow of abortion pills could help make abortion more accessible than it was before Roe fell. Las Libres, one of several Mexican groups at the center of the network, says its organization alone is on track to help terminate approximately 20,000 pregnancies this year in the United States. That amounts to about 20 percent of all legal abortions that took place in 2019 in the 13 states where abortion is now almost entirely banned.

“Soon there will come a moment when we won’t be able to count any of this,” said Verónica Cruz Sánchez, the director of Las Libres, adding that the group works with a U.S.-based volunteer network that numbers about 250 and is “growing, growing, growing.”

The leader of another Mexico-based group that supplies pills, Red Necesito Abortar, said the elaborate volunteer structure was “like a spiderweb.”

“Once we get the pills into the U.S., they can distribute them across the whole country,” said Sandra Cardona Alanís, the group’s co-founder.

Most people interviewed for this story acknowledged that the network they are building is far from ideal, with participants taking legal and medical risks they would not face if abortion was still permitted nationwide.

The medication — a two-step regimen of mifepristone and misoprostol — was approved by the U.S. Food and Drug Administration in 2000 with a prescription, for use during the first seven weeks of pregnancy, a limit that was then extended to 10 weeks in 2016. But people involved in the network described a process that goes beyond what the FDA has endorsed. Organizations like Las Libres offer abortion pills without a prescription and, typically, without access to a medical professional — occasionally providing medication to those who say they’re at or beyond the FDA’s 10-week limit. To avoid detection in antiabortion states, the group also mails pills unmarked and unsealed, often in old bottles used previously for other medicines.

Some experts worry that as demand soars and cross-border networks expand to include less credible suppliers, women could start to receive illegitimate pills that are ineffective or, worse, dangerous. Fake abortion pills have been circulating in other countries with strict antiabortion laws, said Guillermo Ortiz, an OB/GYN and senior medical adviser with Ipas, an international abortion rights nonprofit.

“It’s scary,” he said. If women don’t know how to recognize real abortion pills, “it could cause huge harm.”

Other experts are less skeptical. Kristyn Brandi, a doctor and spokesperson for the American College of Obstetricians and Gynecologists, the leading professional organization for OB/GYNs, said she feels confident that patients can carry out abortions safely without medical supervision — as long as the pills they receive are clearly labeled.

“Medication abortion is one of the safest processes that you can go through,” she said. “Regardless of where you get that medication, based on the science … what’s happening in your body shouldn’t be any different.”

Monica’s abortion pills arrived in the mail on a Friday afternoon, hidden inside a cat flea medication box. While the pills themselves were sealed and labeled, Monica’s boyfriend said he wasn’t sure if she should take them.

“What if they’re fake?” he recalled asking. He’d recently read news reports of other drugs that had been laced with fentanyl.

“What if they’re sending you something that isn’t even the abortion pill?”

By that point, Monica — who relayed her experience to The Post in real-time texts and calls, and then later in a lengthy interview at her home — had known about her pregnancy for over a month. She knew she wanted to have kids one day, but she and her boyfriend lived paycheck to paycheck, without health insurance. At the end of the month, they’d sometimes get down to their last $40 — and have to decide between groceries and gas.

Without the money or time to get an abortion out of state, Monica had tried to give herself a miscarriage — first with mugwort tea, an herbal remedy she read about online, then with a heavy night of drinking. When none of that worked, she turned to Reddit.

“I’m scared, too,” she said she told her boyfriend.

“But this is my only option.”

A nurse joins the network

Two weeks earlier, on the day Roe fell, a nurse in a different city rushed from room to room at the abortion clinic where she worked — frantically telling patients where they could order illegal pills now that their state had banned abortion.

“Do you have Insta?” she asked at least 20 patients that day, waiting as they pulled up their Instagram accounts.

She instructed each patient to follow an online resource called Plan C, which compiles a list of sources where patients can buy abortion pills on the internet. The nurse reviewed various options, including Aid Access, the prominent online service run by Dutch physician Rebecca Gomperts, as well as various online pharmacies that sell abortion pills illegally to people in antiabortion states.

The next day, one of those patients found the nurse in the grocery store.

“I have the money,” the woman said, her eyes desperate. “Will you buy the pills for me?”

The nurse couldn’t remember the patient’s name, but she remembered other details the woman had shared about her life — pleading in Spanish in the clinic hallway five hours after the Supreme Court overturned Roe. A mother of four, the woman was an undocumented immigrant from Mexico with a history of severe pregnancy complications and a Catholic husband who did not believe in abortion.

She couldn’t order the pills herself, she explained, because she didn’t speak English and had no reliable access to the internet. If the pills came to her home, she also worried her husband would find them.

Hyper-aware of the other grocery carts moving around her, the nurse considered all she might lose if she helped the woman and got caught. Where she lived — a Republican-led state in the South — she knew she could be stripped of her nursing license for distributing abortion pills. Maybe even go to jail.

The nurse promised herself she would do it just this once.

“I’ll tell you when I have them,” she said to the woman.

Securing the pills was easier than the nurse ever imagined: She called a friend, who sent her the number for Las Libres. The organization, she learned, had been working with many volunteers like her — helping patients who, for one reason or another, couldn’t buy pills on their own.

Many patients had never heard of Plan C or Aid Access. Some couldn’t afford the advertised price tag of $100 or more. Then there were patients like the woman in the grocery store, desperate for pills but without a safe place to receive them.

On the phone with Las Libres, the nurse had requested just one set of abortion pills — enough to help her former patient. But, she said, the package arrived three days later with the means to end five pregnancies.

Las Libres soon followed up with the address for a woman in a different city.

“Can you help her?” a Las Libres activist asked over text.

The nurse, in her late 20s, thought about the lawmakers who had ushered in these laws — and those who had implemented similar restrictions years ago in Mexico, where she’d had to secure her own illegal abortion at age 16. She still remembered her feet in the stirrups in an empty apartment building. The unsure medical student who performed the abortion. The speculum and dilator boiling in a pot of water on the stove.

“I want those politicians to feel powerless,” the nurse said of her decision to join the ranks of the illegal abortion movement. “I want them to feel the same way my patients feel.”

She mailed her second set of pills the next day.

A supplier secures the pills

Before the pills arrived in the nurse’s mailbox, they occupied a corner of Cruz Sánchez’s closet — tucked away in the central Mexico headquarters that has housed Las Libres for almost two decades.

The pill supplier and her team of seven employees work from a mountainside home in Guanajuato, hidden from the road by an eight-foot electric gate and a tangle of red trumpet vines. Inside, the Las Libres office hums with the rhythms of a family: Cruz Sánchez’s nephew brews a pot of coffee while her sister fries up leftover chilaquiles, chatting about everybody’s weekend plans before they all have to get to work.

When Cruz Sánchez, 51, started Las Libres in 2000, she envisioned a feminist activist organization that would help Mexican women in desperate situations. In its early years, the group provided legal counsel for victims of domestic violence and demanded freedom for women whose abortions had landed them in jail. They’ve long provided free abortion pills without facing any legal trouble, despite recent laws in Mexico that criminalized abortion.

It wasn’t until Texas banned most abortions in the fall of 2021 — one week before Mexico’s Supreme Court decriminalized the practice across that country — that Las Libres began to consider an international expansion. Suddenly, Cruz Sánchez was getting calls from women across the border, begging for pills.

“We wanted to help the women in Texas because we understood their situation,” Cruz Sánchez said. “We’d experienced it.”

Demand skyrocketed as soon as Roe was overturned in June, Cruz Sánchez said. Las Libres went from sending 10 sets of pills to the U.S. every day to sending over 100 — all at no cost to the patient.

The rapid expansion has only been possible, Cruz Sánchez said, with the help of U.S. volunteers who find some of the patients and shepherd the pills along to their final destinations. Since the Supreme Court decision, she said, she has been inundated with messages from Americans eager to take a stand against the ruling. In one state, she says, she is working with a group of registered nurses. Elsewhere, 50 pastors and priests.

Some of the volunteers work with U.S.-based abortion funds and other abortion rights groups, connecting with pregnant patients through established pipelines that existed long before Roe fell. Others are doing this work for the first time, Cruz Sánchez said.

“They just show up and say ‘I want to organize my community, my neighbors, my friends — and I’m going to make a network,’” she said.

These days, the women of Las Libres spend much of their time fielding calls and texts from Americans, hunched over laptops at a table strewn with sticky notes and boxes of mifepristone. Cruz Sánchez regularly logs five or six Zoom calls a day — fundraising with American donors, or teaching volunteers how to safely join her efforts.

Until recently, Cruz Sánchez said, Las Libres received all its pills as in-kind donations. International advocacy organizations mail large shipments of pills to their office, she said. Individuals come by with donations of misoprostol, widely available at Mexican pharmacies to treat stomach ulcers. Sometimes Mexican pill distribution companies send over a batch of pills that is about to expire, free of charge, Cruz Sánchez said.

When American demand started outpacing the stash in her closet, Cruz Sánchez said, she called her contacts around the world, searching for the cheapest supplier. Las Libres had roughly $15,000 to spend, she said, from mostly American donors — the product of fundraising efforts they’d stepped up since June. On one recent Zoom call, a leader of a U.S.-based abortion rights group pledged $4,000, adding that she hoped to make the same payment quarterly.

Cruz Sánchez declined to disclose her group’s donors and said she has not been keeping detailed records of the money she has received from donors in the United States. Between 2009 and 2018, Las Libres received at least $193,000 in public grants from the Mexican government, according to government records.

On its search for cheap pills, Las Libres determined that Mexico-based suppliers were too expensive. One set of mifepristone and misoprostol costs about 26 U.S. dollars in Mexico, Cruz Sánchez said. But in South Asia, pills are a fraction of that price, according to Chris Purdy, chairman of the board of DKT International, one of the largest organizations that registers, imports and distributes abortion pills around the world. In India, where many of the largest abortion-pill manufacturers are based, combo-packs of mifepristone and misoprostol are widely available at pharmacies for as little as $1.50, Purdy said.

In mid-September, Cruz Sánchez boarded an overseas flight from Guanajuato, returning four days later with thousands of abortion pills. From there, Cruz Sánchez began sending the pills to towns along the U.S.-Mexico border, where volunteers were waiting to carry them into the United States.

When selling directly to patients, suppliers typically offer pills at a significant markup. Europe-based Aid Access prescribes and sells pills for just over $100 per dose, sometimes offering discounts or free pills for low-income customers. Other online pharmacies charge hundreds of dollars. A medication abortion at a licensed U.S. clinic typically costs between $500 and $600, on top of the price of transportation and accommodations for those who have to travel out of state.

Cruz Sánchez says she will never charge patients for abortion pills, which she believes should be widely accessible to all. She is critical of organizations that sell pills to patients for more than they bought them for, accusing these groups of engaging in the “corporatization” of illegal abortions.

The Aid Access website invites people who can’t afford to pay for the pills to “tell us,” so the organization can help.

“Aid Access believes that a just and equal system means that women with the financial means can pay this way and also support the service for women who cannot afford to pay,” Gomperts said.

While Gomperts and other Aid Access-affiliated physicians write prescriptions for abortion pills — and provide medical consultations to anyone who asks for assistance up to 12 weeks of pregnancy — Cruz Sánchez and her network of volunteers offer their own, more informal support services to women who need guidance while taking the pills. Cruz Sánchez has been expanding these connections, connecting with U.S.-based hotline services and medical professionals.

As far as she knows, Cruz Sánchez said, no one in the U.S. has had severe medical complications after receiving pills from Las Libres.

For most Americans working with Las Libres, Cruz Sánchez said, the more pressing concern is a legal one. Many of her U.S.-based volunteers are terrified of the prison sentence they could face if they get caught, adopting aliases and avoiding police.

Cruz Sánchez tells them not to worry.

“If they stop you, just point at your stomach and try to look old,” she advised one 80-year-old who picked up 500 pills en route home from her Mexican vacation.

“What’s the government going to do? Open every package in the mail? Conduct an inspection inside every woman’s home?”

“They don’t have a way to do it,” she’ll say with a smile. “There’s no way.”

A lawyer defines the ‘legal lines’

One thousand miles north, in Dallas, Tex., nearly 100 abortion rights advocates squeezed into a hotel conference room in late August to learn about the illegal abortion movement — and the risks of signing up.

The lawyer at the front of the room did not explicitly mention the abortion pills flowing into the U.S. from Mexico. But she singled out a group she calls “the helpers”: people who are helping American women secure pills in antiabortion states.

This group was particularly vulnerable to legal risk, she said.

At a conference led by SisterSong, a national reproductive justice group, attendees flocked to this particular session, “Self-Managed Abortion in the US After Roe.” Many in the room worked for abortion funds and other abortion rights groups, eager to bring what they learned back to their communities.

“Let’s say this one together,” the lawyer told the audience, gesturing to the all-caps message on the projector: “Don’t talk to cops.”

“One more time for the people outside.”

The room reverberated with dozens of voices: “DON’T TALK TO COPS.”

The lawyer leading the chants that day was Jill Adams, the executive director of If/When/How, an abortion rights group that in 2015 started supporting people prosecuted for ending their own pregnancies, or assisting in that process.

Staffed by over two dozen lawyers and bolstered by a network of law students, the organization runs a legal help line for those charged — and those who fear they might be charged. The hotline now receives 14 times more calls than it did before the Supreme Court decision, Adams said.

To get a sense of what their clients are facing, the group has been tracking pregnancy-related prosecutions over time. Between 2000 and 2020, 61 people were criminally investigated or arrested for either ending their own pregnancy or helping someone else end theirs, according to a preliminary report the organization published in August.

That number is likely a significant undercount, Adams said — and almost certain to climb now that the Supreme Court has overturned Roe.

Adams and her team don’t know of anyone who has gone to jail for shepherding abortion pills since the June ruling, she said. But she warned that could start happening soon. While the new wave of abortion bans explicitly prohibit prosecutors from going after the people seeking abortions, volunteers caught securing or distributing abortion pills could be charged as abortion providers, Adams said — subject to the same punishment as a doctor who performed a surgical abortion at a shuttered clinic. Across much of the South and Midwest, that means at least several years in prison.

Adams, in an interview after the conference, said that If/When/How doesn’t promote breaking the law.

“We don’t encourage them,” she said of her clients. “We just provide the information so they can conduct their own risk analysis. Our job is to make sure that everybody understands where the legal lines are drawn.”

The abortion pill pipeline creates a challenge for conservative state lawmakers, who had hoped the Supreme Court’s ruling would be a major step toward eliminating abortion. With the push for self-managed abortions and increased funding available for out-of-state travel, Missouri state Rep. Mary Elizabeth Coleman (R) said in an interview that she expects the number of abortions to increase in the wake of Roe’s reversal.

“People don’t know that it’s happening,” said Coleman, who has championed aggressive antiabortion legislation.

Now that strict new bans have taken effect across much of the country, some lawmakers have turned their attention to local prosecutors, eager to make sure their laws are enforced.

Once prosecutors realize the extent of the illegal activity, Coleman said, “they are going to be interested in making sure that the law is followed.”

A distributor hosts a ‘packing party’

By the time Roe was overturned, some abortion rights activists had been mailing pills illegally, without prescriptions, for years.

In one Republican-led state in the south, a leader of a high-profile abortion rights group launched her organization’s “shadow side” in 2019, sending medication to women who couldn’t make it to a clinic: Minors with antiabortion parents. Domestic violence victims trapped with abusive partners. Anyone who couldn’t afford the high cost of clinic care.

When she first started out, the distributor mailed a few sets of pills a year.

Now, she mails 12 a day — more than the number of abortions performed at many clinics.

The distributor, in her sixties, messages Cruz Sánchez of Las Libres every few weeks to ask for more inventory. Once the pills arrive, she convenes what she calls “packing parties” at her suburban home, where she and her colleagues mete out the medication, dose by dose.

“It would be nice to be able to send them something more professional,” the distributor said as she readied a new batch in early September, pouring 150 misoprostol pills out of a calcium bottle.

The pills she poured into a bowl were slightly different shapes and sizes. Some scored, others smooth. The distributor plucked out a few that had broken in half.

When she used to buy pills from various online pharmacies, the distributor said, they would arrive in individual blister packs, with an expiration date. But those were $200 a set — and Cruz Sánchez sent hers for free.

“I want women to feel like it’s legitimate,” said another participant at the packing party, a younger activist. “Like they haven’t just gotten drugs in a nightclub, you know?”

“Like we’re not a back-street type of organization,” said a third helper, an 80-year-old who had smuggled the pills from Mexico.

They did what they could to create a dignified operation in the distributor’s living room. While the pills were out on the coffee table, the women would not eat. They would not drink wine. They would wear blue latex gloves.

“If I were taking pills that someone sent me, I’d hate to think that they’d been rumbling around in hands that might have just pet a dog,” said the distributor, her fingers swirling around in the misoprostol.

The 80-year-old raised her eyebrows.

“You just pet your dog with that glove on,” she said.

“I did?” said the distributor.

“Well, you know what?” said the younger activist, throwing up her hands. “We’re not f---ing doctors, we’re not health-care workers. Everyone is taking some risk in this somewhere along the line, and what can you do when it’s illegal?”

Since Roe fell, the distributor has become a teacher of sorts for newcomers joining her in the abortion pill movement. Among her students was the clinic nurse who had recently begun distributing Las Libres pills after reconnecting with a patient at a grocery store. By the end of the summer, the nurse was receiving bulk shipments of 150 abortion pills and consulting with women across eight states.

On a call in late August, the distributor offered the nurse a long list of tips: Look up houses for sale to use as return addresses. Set your messages with Las Libres to delete after 24 hours. Absolutely never meet a patient in person. If you have legal questions, reach out to If/When/How.

“It’s legally risky to do this,” the distributor told the nurse. “You need to take every precaution possible.”

As these networks expand, the distributor said, there will be even more to worry about. She said she recently saw a public service announcement issued by Ipas Partners for Reproductive Justice, the abortion rights nonprofit, warning about online abortion pill scammers — a message that echoed concerns frequently voiced by antiabortion advocates.

“We don’t know what’s coming in the mail,” said Ingrid Skop, an OB/GYN and a senior fellow at the Charlotte Lozier Institute, an antiabortion organization. “We’re inclined to think they’re getting misoprostol and mifepristone — but are there contaminants in the drugs? Does it contain the quantities that is advertised?”

Asked if she worries about the authenticity of her pills, the distributor is quick to shake her head.

“I get them from a verified source,” she says, her tone reverent: “Verónica,” the founder of Las Libres.

With Cruz Sánchez’s blessing, the distributor says, she has helped send pills to women as far as 15 weeks along in their pregnancies. Many in the medical community, including Brandi, the spokesperson for the American College of Obstetricians and Gynecologists, say it’s safe to take abortion pills beyond the 10-week limit imposed by the FDA.

The distributor refers the later-term cases to an abortion doula she’s known for years, who counsels them over text about exactly what they will see when they pass the pregnancy. A 12-week fetus is roughly the size of a plum; a 15-week fetus, the size of an apple.

These cases, in particular, present significant legal risk to the patient, who has to figure out how to surreptitiously dispose of the remains. The abortion doula said she often sends a small amount of acid so the client can dissolve some of the fetus, and bury whatever is left.

“I try to emotionally prepare them and say, ‘It’s going to look like a baby,’” the doula said.

The distributor has seen enough of these complex cases to know how to respond, she said. She worries about the new volunteers joining the movement: eager to help, but green.

“Someone is going to end up getting less than ideal treatment, and someone is probably going to get arrested,” the distributor said. “There are just so many things that could go wrong.”

Sitting in her living room, the distributor shook her head and sighed: Time to focus on the things she could control. She powered up her burner phone and logged into her Proton Mail account, an encrypted email service she uses to correspond with patients who need pills.

Some of the women get her contact information from Cruz Sánchez. A few hear through a friend, or a friend of a friend. One of the biggest spikes in demand came after the distributor met several volunteers who offer advice in a Reddit forum frequented by anonymous women searching for abortion care.

“I can handle more traffic,” the distributor had told the volunteers.

She immediately started mailing packages to Reddit users — answering their frantic calls for help.

A woman takes the pills

Monica’s cramps didn’t start until she took the second set of pills on a Sunday morning. She said she lay down in bed as soon as she felt the first one coming on, wearing her favorite oversized T-shirt and a diaper pad.

This was her first pregnancy, but Monica imagined this was what contractions might feel like: intense pain, a few minutes of relief, then more pain — each wave of cramping a little worse than the one before. Balled up in the fetal position, she said she called a friend who’d had a medication abortion a few years before at Planned Parenthood, with a doctor beside her.

“Dude, I don’t know if this is normal,” her friend said when Monica described the pain. “Maybe you should go to the hospital.”

But Monica couldn’t go to the hospital — surely, she thought, the doctors would know what she’d done and report her. Her boyfriend threw some clothes in a bag anyway.

“Turn on the bath,” Monica said she yelled out to him. “I need to get in there.”

She felt a flood of liquid in her underwear and stepped into the bath with her clothes still on. Lying back in the tub, she said, she felt some pressure release. Then she screamed.

The fetus was floating in the water. Slightly smaller than her palm, the fetus had a head, hands, and legs, she said. Defined fingers and toes.

She leapt from the bath and collapsed in her boyfriend’s arms. Desperate for some guidance, soaking wet and crying, she took out her phone.

“I just passed the fetus,” Monica wrote to whomever had sent her the pills. She learned later that her fetus matched descriptions of those roughly 13 weeks along, well beyond the 10-week cap set by the FDA for taking abortion pills.

“I’m just feeling a little scared,” she added.

The anonymous user, whose identity is not known by The Post, immediately started typing. Everything would be okay, they assured Monica: The worst was over. Whatever she was feeling — sadness, relief, grief, anger — it was all normal.

“Going through an abortion can bring up a lot of emotions,” they wrote. “Just take some time for yourself.”

Three hours later, Monica said, she and her boyfriend selected a tree in a quiet corner of their favorite park — far enough back in the forest, they hoped, that a dog wouldn’t catch the scent. While most people flushed the fetus down the toilet, the Reddit user had told her, others preferred to do some kind of ritual.

Monica knew she wanted to say goodbye.

When she was ready, she gathered a handful of wildflowers. Her boyfriend dug a small hole. As Monica lowered the cardboard box into the ground, she said, she knew she’d made the right choice. She couldn’t give that fetus a good life yet, she thought to herself. She wasn’t ready to be a mom.

“I hope in the future, when I am ready, your soul will find me again,” Monica remembers saying as she knelt in the dirt.

“It just wasn’t our time.”

Story editing by Peter Wallsten. Photo editing by Natalia Jiménez-Stuard. Copy editing by Sam-Omar Hall. Design by Madison Walls. Alice Crites, Mary Beth Sheridan, Nora D. Palma, Alejandra Ibarra Chaoul, Danielle Villasana, Antonio Campos Ayala and Gabriela Montejano Navarro contributed to this report.

With abortion banned, a crisis pregnancy center plots a $10 million waterfront expansion for the post-Roe era

By Caroline Kitchener and Beth Reinhard

CORPUS CHRISTI, Tex. — Jana Pinson leaned over the table at the architect’s office, craning for a better look at the textures and patterns that would bring her post-Roe dreams to life.

At a meeting in mid-July, three weeks after the Supreme Court retracted the constitutional right to abortion, Pinson was plotting a new-age makeover for her crisis pregnancy center, an organization designed to persuade people to carry their pregnancies to term. She ran her fingers across samples of porcelain tile and beechwood-stained cabinets. The walls of her new building would be varying shades of green and gray, splashed with abstract pictures of trees, each detail designed to evoke, as she’d requested, the feeling of a “coastal spa.”

The executive director of the Pregnancy Center of the Coastal Bend had recently overseen the purchase of what she sees as the most “strategic” plot of land in Corpus Christi, a city of 300,000 people on the South Texas coast. Right next to the local Texas A&M campus, looking out over the Oso Bay, Pinson’s $10 million crisis pregnancy center will be built to attract female undergraduates, with a coffee shop and a thrift store visible from the road, and a patio where students can sip their caffè lattes.

Chuck Anastos, the architect, gestured to the blueprint for the 20,000-square-foot facility. When it opens in February 2024, he said, the pregnancy center would be the “hip place for people to come.”

Over the past 50 years of legal abortion in America, crisis pregnancy centers have been one of the top tools of the antiabortion movement, and a target for intense criticism from abortion rights advocates. With more than 2,500 locations across the United States, these centers deploy what critics decry as overly aggressive — even deceptive — tactics to talk women out of abortions. Often religiously affiliated, they typically offer free pregnancy tests and ultrasounds, sometimes initially presenting themselves as abortion clinics or objective sources of “abortion information.”

Now that abortion is banned across much of the South and Midwest, including Texas, many crisis pregnancy centers in these regions are preparing to assume a larger role, stepping into a void left by shuttered abortion clinics as the go-to place for ultrasound exams and pregnancy resources, despite the fact that they are not licensed medical facilities. The goal is to intercept women before they can access abortion some other way — through an online pharmacy or across state lines — and convince them that they’ll have support.

With its new building in Corpus Christi, the Pregnancy Center of the Coastal Bend would become home to one of the largest such facilities in the country. The center’s plans, detailed in blueprints, artist renderings and other documents reviewed by The Washington Post, offer a rare glimpse inside the post-Roe strategy of a crisis pregnancy center in transition.

Pinson, 60, has emerged as a prominent champion of transforming these centers — often mom-and-pop shops that operate as small storefronts — into large-scale professional operations. In addition to directing the rise of her own organization, she has taken on the role of evangelist, training other center directors in the tools and tactics required for a new era.

In Texas, that means tapping into what has become a reliable stream of public money. The legislature approved $100 million for crisis pregnancy centers in 2021, to be doled out over two years, while simultaneously banning abortions after six weeks of pregnancy. Pinson says the new building will be financed largely by state money — funding that is distributed with little government oversight. Records show the center received $776,000 last year.

Pinson’s plans are not widely known in Corpus Christi, and are likely to draw controversy as construction begins, especially on campus.

“They want to camouflage what their mission really is with iced coffee and a thrift shop,” said Molly Davis, a sophomore at Texas A&M in Corpus Christi, who leads Islander Feminists, an abortion rights group that plans to protest Pinson’s new building.

Since Roe was overturned, several of the five existing locations of the Pregnancy Center of the Coastal Bend have been busier than ever, said Pinson, who plans to stay open an extra three hours each night to meet demand.

At the meeting with the architect, Pinson closely surveyed her floor plan for the future, pointing out the components she says will help her reach tens of thousands of women in South Texas over the next 50 years. The facility will have nine counseling rooms, six sonogram rooms and a “man cave” with a pool table, where men will be approached by a certified marriage counselor as they wait for the women they impregnated.

A few years from now, Pinson thought they might add a kayak launch and a few chairs beneath the palm trees, so women could spend an afternoon of reflection looking out at the bay.

“Perfect time, perfect space,” Pinson said with a smile. “I call it the post-Roe building.”

***

When Pinson took over the Pregnancy Center of the Coastal Bend in 2014, the organization had seven employees and a budget of about $125,000, tax returns show. The center looked like “grandma’s house,” Pinson said, with a hodgepodge of discarded furniture donated by local churches.

“It was the way all the old pregnancy centers were,” she said.

A pastor’s wife and former marketing executive, Pinson carries her iPad with her everywhere she goes, tucked inside a leather Kate Spade tote. She has become a known entity within the Texas antiabortion movement, taking her place beside Gov. Greg Abbott (R) when he signed the Texas Heartbeat Act in the spring of 2021. Her phone is always dinging, and no matter what she’s doing, she always checks the message. It might be a new donor, eager to write her a check.

Pinson’s first mission as executive director was to do more to target “AMs,” what she calls “abortion-minded” women. The organization had purchased an ultrasound machine — widely regarded within the pregnancy center movement as the best way to reach people considering abortion — but they were still mainly seeing “LTCs,” or “likely to carrys.”

And so Pinson took to Google, she said, paying thousands of dollars to bid on key search terms. Now, whenever someone in Corpus Christi searches for phrases like “need an abortion” or “abortion cost Texas,” the Pregnancy Center of the Coastal Bend is regularly the first item on the list.

Pinson simultaneously revamped the website, adding stock photos of girls gazing out at the ocean — and using the word “abortion” as many times as possible. Patients who visit the center’s homepage today can click on “I Want An Abortion,” which directs to a page that says: “CONFIDENTIAL ABORTION CONSULTATION — NO COST TO YOU.” There are detailed descriptions of both surgical and medication abortions, estimated costs and several buttons that allow you to schedule an appointment.

Looking at the center’s website, even antiabortion donors are confused. Occasionally, Pinson said, she’ll get angry phone calls from conservative members of the community, demanding to know why the Pregnancy Center of the Coastal Bend is talking about abortion.

“I’m like, ‘What am I supposed to talk about?’ ” she said. “How else do you get an abortion-minded girl to know that you’re there?”

Eighteen-year-old Brooke Alexander — whose story was depicted in a Washington Post article in June — was one of the hundreds of abortion-minded women who found herself at Pinson’s pregnancy center in 2021. Like every client who arrives seeking an abortion, Alexander was advised on what a counselor told her were the potential risks of the procedure, including infertility, breast cancer and death. Those claims are widely disputed by leading medical organizations.

Even after leaving the pregnancy center — and deciding to continue her pregnancy — Alexander had no idea the organization had an antiabortion mission.

Pinson has no qualms about her strategies, which she says have been highly effective: The first year she started Google advertising, she said the number of “abortion-minded” clients at the center increased by almost 90 percent.

Now they have 50 employees and an annual budget of approximately $2 million, Pinson said. Last year, she said, they convinced 583 women to carry their pregnancies to term.

On a recent Wednesday morning in July, Pinson drove 30 minutes to a branch of her pregnancy center in Calallen, Tex., where she has been piloting what she refers to as their “prenatal care program.” Housed in a medical plaza, next to several doctor’s offices, the center offers blood tests, ultrasounds and ultimately a referral to an OB/GYN during the client’s second trimester.

“Post-Roe needs to have prenatal,” Pinson said. “We’re taking care of the whole woman.”

When she became executive director, Pinson quickly amped up what she calls the center’s medical offerings. They purchased several state-of-the-art ultrasounds, including a $65,000 machine Pinson calls her “Ferrari,” following a broader national trend among crisis pregnancy centers to appear as professionalized medical facilities. In almost all cases, these centers have no doctors on staff, said Andrea Swartzendruber, a professor at the University of Georgia College of Public Health who studies crisis pregnancy centers.

On the website for the Pregnancy Center of the Coastal Bend, a disclaimer appears at the bottom that reads, “Information is provided as an educational service and should not be relied on as a substitute for professional and/or medical advice.”

The bulk of the medical offerings are administered by seven registered nurses, a nurse practitioner and two diagnostic medical sonographers, one of whom, according to Pinson, orchestrates and oversees a 40-hour training to teach the nurses how to read ultrasound scans. While Pinson says she can’t afford to hire doctors, two local OB/GYNs volunteer as “medical directors,” reviewing ultrasound scans and calling in to consult on any potentially high-risk situations via FaceTime. As a “kindness,” Pinson said, a doctor might come into the center to see a patient every six months or so.

Whenever Pinson’s staff sees what they think might be an ectopic or a molar pregnancy — potentially life-threatening conditions that crop up at her centers a few times a year — they text a photo to one of the medical directors, who advises on whether the client should be sent to the emergency room. Even without a doctor on-site, Pinson said she feels “phenomenally confident” that they will catch any serious complications.

Leading medical organizations see it differently.

“These places are incredibly dangerous for our patients,” said Nisha Verma, an OB/GYN and a spokesperson for the American College of Obstetricians and Gynecologists.

ACOG has voiced concern about the medicalization of crisis pregnancy centers, arguing that the trappings of health care lead patients to believe that center staffers are fully trained to identify potential complications. Because pregnancy centers aren’t licensed medical facilities, Verma said, they are exempt from the laws and statutes that govern medical clinics — putting them in the extraordinary position of providing unregulated medical services.

The Texas Health and Human Services Commission, which licenses health-care facilities, does not monitor crisis pregnancy centers because they do not fall within its “regulatory scope,” said Christine Mann, a spokeswoman for the HSCC.

In her new building, Pinson says she will offer more medical services than ever before, including an expanded prenatal program. Along with the sonogram rooms, the building’s floor plans include a nurses’ station, two “medical services offices,” two rooms for “blood drawing” and a doctor’s office.

She also plans to expand their “abortion reversal” offerings over the next few years, as more women in South Texas take abortion pills obtained illegally or in Mexico. The practice — denounced by ACOG as potentially dangerous but widely embraced by the antiabortion movement — involves administering the hormone progesterone to a patient soon after they take the first of two abortion pills, in an attempt to “reverse” the abortion.

A clinical trial for abortion reversal ended abruptly in 2019, after several patients started hemorrhaging so severely that they had to be rushed to the hospital.

Andrew Folley, Pinson’s only medical director who will participate in abortion reversal, said he has “no concerns” about the procedure, which he says he has facilitated a handful of times since Pinson’s center started offering the service a year ago. The doctor is open about his reasons for prescribing progesterone and volunteering at the center.

“I feel that conception is the beginning of life,” he said. “I don’t see where there’s a woman’s right or a human right to murder an unborn baby.”

Every week, Pinson sits down at her desk with a stack of thank you letters, signing a few dozen notes to donors. Since Roe was overturned, the center has seen a spike in support, Pinson said — and she is determined to keep it going.

Pinson, who according to the center’s treasurer was paid $75,000 in 2021, said she raised more money in the first half of 2022 than any six-month period in the center’s history, with donors energized by the prospect of a post-Roe future. For the center’s annual banquet in March, over 2,800 people packed into the entertainment megacenter downtown — a space that has hosted Flo Rida and the WWE SmackDown — to hear about the pregnancy center and see Tim Tebow, an NFL player turned antiabortion activist. After the audience enjoyed a barbecue dinner, Pinson directed their attention to 15-foot-wide mock-ups of the center’s new building.

That night, the center raised over $850,000 — a sum Pinson will mostly put toward her daily operations.

To finance her grandest ambitions, she relies on the state.

Texas started funding crisis pregnancy centers in 2006, when lawmakers allotted $5 million for what they called the “Alternatives to Abortion” program. Since then, the Texas program has grown exponentially alongside similar initiatives in about a dozen other states, where legislation has often accompanied abortion bans.

The Texas program has garnered sharp criticism for its failure to provide detailed information on how this ballooning pot of money is used.

“It is very frustrating that the legislature has continued to pour funds into a program where there is practically no transparency, no accountability and basically no metrics to the tune of $100 million without any medical or health services being provided,” said state Rep. Donna Howard (D), a member of the appropriations committee. “Half of what they do is give out pamphlets.”

The Texas Pregnancy Care Network, the contractor that administers the state funds and is responsible for monitoring the Pregnancy Center of the Coastal Bend, does not oversee any service considered “medical,” Pinson said, including ultrasounds. John McNamara, the network’s executive director, has not responded to calls and emails from The Post.

The Texas money comes with one condition that has led many pregnancy centers to turn down state support, Pinson said: To qualify, centers have to ask a client’s permission before they broach anything spiritual. While Pinson agreed to those terms when she began accepting the funding in 2018, the center’s clients are incentivized to sign up for Bible study classes, where attendance is rewarded with “points” redeemable for diapers and baby clothes.

“We have staff that are committed to share Christ with every girl that walks through that door,” Pinson said in a 2019 promotional video, calling the center a “ministry.” Pinson will refer women who need additional support to local churches, which she says do “a beautiful job of coming around mamas and walking them through.”

Since Roe was overturned, Pinson said she’s heard from a lot of angry abortion rights advocates, demanding to know how she intends to help the women she helps convince to carry to term. Sometimes she offers to give them a tour of her stock room, where diapers are stacked to the rafters.

“We gave out 200,000 diapers last year.” If there’s a woman in need, she says, “there is absolutely nothing we couldn’t help them with.”

According to government estimates, the average cost of raising a child in the United States is $233,610.

Pinson’s final stop of the day was the church where her husband preaches. Eight women had already arrived, waiting for her with thick white binders, ready to be trained as volunteers.

“Abortions are closed in Texas,” she told the group: The closest abortion clinics to Corpus Christi, in San Antonio and McAllen, had just announced plans to shutter and move to New Mexico.

That was a great sign, Pinson said — but they could not allow themselves to become complacent.

Other threats still loomed.

By the end of 2023, Meg Autry, an OB/GYN based out of the University of California at San Francisco, plans to sail a vessel into the Gulf of Mexico and provide abortions for women on federal waters, nine miles out to sea. Deep in South Texas, with no direct flights out of state, Corpus Christi will be a priority, she said.

“It’s the most critical point,” said Autry, who got the idea from gambling boats that sail up and down the Mississippi River, skirting local laws. “If your idea is to try to provide abortion access to the most number of people on the water in the U.S., this is the place to do it.”

If her efforts are successful, she will provide the people of Corpus Christi with the most convenient abortion access they’ve had since the local clinic closed in 2014.

“I’m going to need a pregnancy center boat,” Pinson told her husband as soon as she heard about Autry’s plans on the news.

If they can get an “abortion-minded” woman to have a conversation, Pinson feels confident that the center’s staff can change her mind. In their counseling sessions, Pinson says, they “pour into girls,” persuading them that, no matter the obstacles in their lives, they can become successful mothers.

Pinson welcomes even the most devastating cases.

“I’ve seen a lot of 13-year-olds do phenomenal, absolutely phenomenal,” she said. “It doesn’t have to be a negative thing.”

She closely followed the case of the 10-year-old rape victim who was denied an abortion in Ohio last month. If that girl came into her center, Pinson would suggest she consider adoption, she said, adding that abortion would not fix the girl’s problems.

“That life is still a life and, even at 10, she knows a life is inside her.”

***

Whenever a new crisis pregnancy center opens in South Texas, Pinson says, she usually hears from its leaders. They call her up, asking for advice — and she invites them to shadow for the day.

In the wake of the Roe decision, Pinson met up with Nelda Flores, who plans to open a small center in Mission, Tex., in August.

“You’ve absolutely got to go medical,” Pinson said, hands on the steering wheel, shuttling Flores from one of her centers to another. “I will beg, borrow and steal to get you an ultrasound machine.”

Flores took furious notes all morning as Pinson advised her on how to attract volunteers, which grants she should apply for and how to find a medical director.

“God will grow your center as fast as you will step out in faith,” Pinson said.

Just look at what they’d done in Corpus Christi, she added.

In 10 years, Flores could build an operation just like hers.

An emotional scene unfolded as this Texas clinic turned away patients as soon as the Supreme Court overturned Roe

HOUSTON — The phones started ringing, as they always did, moments after Houston Women’s Reproductive Services opened for business at 9 a.m. on Friday — with patients in need of abortions calling to secure a spot on the schedule.

Then, 12 minutes later, it all came to a stop. The Supreme Court had overturned Roe v. Wade.

“Can we still do abortions today?” asked patient advocate Marjorie Eisen, thinking about the 20 women they had booked for appointments.

Several were already in the waiting room, scrolling through their phones as they waited.

“No,” said Kathy Kleinfeld, a co-owner of the clinic. “We’re done.”

A silence settled over the staff as they reckoned with the stunning news — and what it would mean for the patients they served every day.

For the first time since 1973, Americans would not have a constitutional right to abortion. The seismic ruling will transform life for millions of women years into the future. But on this steamy Friday morning in Texas, it came as an abrupt, life-altering change for the patients who would sit down in the waiting room that day, thinking they had found a solution to their unwanted pregnancies.

The state had already banned abortions at six weeks, but the end of Roe reinstituted an existing all-out ban enacted before the landmark precedent, making it instantly illegal for the doctors at the clinic to perform the procedure. And while the clinic’s lawyers plan to challenge that law in court, the most they can do is buy the clinic a little more time: In 30 days, a trigger ban will take effect in Texas, banning abortions across the state.

Suddenly, the staff had to decide what to tell their patients. Some of the women on the schedule that day had kids, others didn’t. They were White, Black and Hispanic. At least one had driven hundreds of miles to get to Houston, because the lone clinic in her home state of Mississippi was scheduling appointments several weeks out — and she wanted to put her pregnancy behind her.

Kleinfeld began taking the women out of the waiting room, one by one, to deliver the news.

The second woman she spoke to walked out of the clinic in tears.

Since she opened Houston Women’s Reproductive Services in 2019, Kleinfeld had worked hard to create a space where her patients would feel comfortable. She keeps a vase of lilies in the waiting room and lines the walls with motivational posters in various pastel shades.

As Kleinfeld told patients about the ruling, a Spotify playlist called “Peaceful Guitar” played in the background.

Meanwhile, other patient advocates turned to the phones: They had 35 scheduled patients to call.

Eisen, who had worked in abortion care for 30 years, hadn’t really prepared for this moment. Even after a draft of the decision leaked in May, she hadn’t wanted to believe Roe could really fall.

“We don’t even know what states to send them to,” Eisen said, talking to the other patient advocates. “California?”

She looked over a map of America, the states with abortion bans shaded gray, then picked up the phone. She would start with the earliest appointments and work her way through the afternoon, she decided: Better to minimize the number of patients they had to turn away in person.

One of the first patients on the list was Victoria, a 25-year old single mother who was five weeks into her pregnancy.

Victoria, who spoke to The Washington Post on the condition that only her first name be used to protect her privacy, was 30 minutes away from the clinic when she got the call, stopped at a red light. As soon as she heard the news, she said, she broke down crying, trying to figure out what she would do now.

“There are a lot of women who just can’t,” she later said in an interview. “And right now I just can’t.”

Even though she couldn’t get her abortion, Victoria decided to come into the clinic to talk through her options. The staff gave her a magazine article about ordering abortion pills online and mentioned a few states where the procedure was still legal.

New Mexico. Colorado. Florida. Illinois.

Victoria would have to line up child care, she said, and ask for extra time off work. She would be able to cover her travel expenses, but just barely: After her abortion, she said, she’d be back living “paycheck to paycheck.”

The news was particularly painful, Victoria said, because she’d found out about her pregnancy so early. As restrictive as Texas’s six-week ban had been, she said, she’d still managed to “beat it.”

“I’m five weeks, there’s no heartbeat.” And still, she said, “my rights were just taken.”

After Victoria left the clinic, Eisen continued to move through her calls. Some of the patients took the news in stride, calmly asking questions about various clinics in other states. Others asked if she was sure about the ruling. One begged.

“I can pay extra,” the woman said.

“It’s not an issue of expense,” said Eisen. “It’s just an issue of legality.”

The phones kept ringing through much of the morning with new patients calling to schedule appointments, completely unaware of the Supreme Court’s ruling. Eisen and others kept repeating the same message: We have a decision from the Supreme Court. Think about who you might be able to stay with in other states. It’s devastating. I’m so sorry.

Finally, Kleinfeld decided that she needed to record a new outgoing message.

“I’m sorry to report that as of today, Friday, June 24, 2022, Roe v. Wade, the right to legalized abortion, has been overturned,” Kleinfeld recited. “As of today, we are no longer able to provide abortion services.”

She paused, then added one more thought.

“We hope you all remember this when it’s time to vote.”

Turning away patient after patient, Kleinfeld was frustrated by how little help she could offer. When the Texas abortion ban took effect in the fall, she had sent patients to a sister clinic in Oklahoma. When Oklahoma banned abortions in the spring, she diverted them to providers in New Mexico or Colorado.

Now, most of the Southeast and Midwest would be dark.

All morning, Kleinfeld had been handing out copies of a Ms. Magazine article titled “People Are Getting Creative Obtaining Abortion Pills Online,” which outlined various places to buy abortion pills — both legally and illegally. She marked “Aid Access” with a yellow highlighter, drawing attention to an Austrian-based organization run by Dutch physician Rebecca Gomperts, which mails abortion pills to all 50 states, including many states that have banned abortion by mail.

She couldn’t advise people to order abortion pills illegally online, Kleinfeld said with a smile — but she could hand out recommended reading.

The doorbell rang, and Kleinfeld looked over at their external video camera.

Another patient was waiting to come in.

Three women face unexpected pregnancies in states with abortion bans

It’s a moment of panic that has played out again and again for people in more than a dozen states since the Supreme Court overturned Roe v. Wade in June.

Once they find out they’re pregnant, there isn’t much time to act. The closest open abortion clinics that once offered next-day appointments are now often fully booked three, four, even five weeks in advance. Pills purchased online can take up to a month to arrive.

Every day, the fetus gets a little bigger — and the anxiety builds.

In polarized, post-Roe America, the experiences that draw widespread attention are often the most harrowing: a 10-year-old rape victim forced to leave her state to end her pregnancy, or a woman denied an abortion for a fetus without a skull.

Often lost in the discussion are the more routine stories. The mother of two who can’t afford a third child. The teenager who can’t tell her parents she’s pregnant. The 25-year-old who isn’t ready to be a mom.

Over the next decade, if recent trends hold, more than a million people with unwanted pregnancies are likely to run up against an abortion ban. Some will find a way, traveling hundreds of miles or securing illegal pills through the mail. Others will resign themselves to parenthood.

The Washington Post made contact with three pregnant women who were seeking abortions while living in states with strict abortion bans. These women, reached early in their pregnancies, communicated regularly with The Post, sharing their experiences through calls, text messages and other documentation that supported their accounts. They participated on the condition that only their first names be used to protect their privacy.

Here are their stories, from the minute the two pink lines appeared.

Lillith, 17, Oklahoma

Lillith rolled into the emergency room in a wheelchair, her cramps so bad she could no longer stand up.

The pain had been building for a few weeks, mild at first, then suddenly sharp enough to wake her up every day at 5 a.m. Weighing just 95 pounds, Lillith assumed it was some kind of nutrition issue: Maybe she wasn’t eating the right foods, or enough of them.

Then a nurse pressed an ultrasound probe into her stomach and informed her that she was almost 20 weeks pregnant.

“You can put this in your baby book,” the doctor said as he handed her the results of the pregnancy test.

Lillith burst into tears.

She knew all about the recent Supreme Court decision that had banned abortion across much of the South. As a teenage girl in Oklahoma — where abortion is now almost entirely illegal — you had to keep track of these things, she said.

Lillith looked at her dad in the chair next to her, his eyes wide. As comfortable as they were with each other, with just the two of them living at home, she could tell this news had thrown him. Still, he reached out to hold her hand.

“I’m not mad,” her dad recalled saying once they got in the car. While he would need some time to process — he wanted to take a close look at the ultrasound of the fetus and learn the gender — he promised he would support whatever decision his daughter made.

Before the positive test, Lillith hadn’t even considered the possibility that she could be pregnant. She’d been on birth control until a few months earlier, when her prescription lapsed and she hadn’t prioritized going back to the doctor. She only had sex once every few months — casual hook ups with a friend — so birth control hadn’t seemed that important, she recalled thinking.

Lillith waited until her dad went to sleep that night to start researching abortion clinics. She would have to drive three hours to Kansas or eight hours to New Mexico, the closest states where abortion was legal. At 20 weeks along, a surgical procedure would cost over $1,000, on top of the price of gas and a hotel.

Her job at a sandwich shop paid $9.25 an hour.

Just after midnight, Lillith texted her best friend. Their messages were usually silly and low-stakes, easy banter about their next TikTok video or which shade of orange would look best in Lillith’s hair. Nothing like the news she was about to share.

Lillith started to panic even more the next morning, once she started making calls. Kansas wasn’t an option: Lillith couldn’t find an appointment there for another two or three weeks, which would put her beyond the state’s 22-week limit.

The wait in New Mexico would be long, too. When one clinic told her they would have to induce labor and deliver a stillborn — their standard practice for someone 23 weeks along — Lillith said she started hyperventilating. She could not imagine pushing a fully formed baby out of her tiny body. Childbirth scared her so much, she said, she’d always planned to adopt.

Lillith couldn’t stop fixating on the fetus inside her. Roughly the size of a mango, it kept growing as she spent her nights at home, knowing her friends were out drinking until 4 a.m., thoroughly enjoying the summer after their senior year.

She finally got good news a few days after her first round of calls, when a New Mexico clinic reached out with an open appointment the following week.

Once she started looking, she couldn’t believe how easy it was to find the money. A quick internet search led her to the National Abortion Federation and its Hotline Fund, a nonprofit backed largely by billionaire Warren Buffett, which agreed to cover the full cost of her $2,400 procedure, she said. She just had to get herself to New Mexico.

Lillith and her dad started the eight-hour drive at 5 a.m., a cooler in the back seat stocked with Pringles and pudding cups. In her comfiest sweatpants and Crocs, Lillith recalled, she closed her eyes right around the one-hour mark, drifting off to Bon Jovi and AC/DC, a soothing mix of what she liked to call “dad rock.”

The procedure itself took two days. Because Lillith was further along in her pregnancy, the doctor had to insert dilation sticks to soften and open the cervix, before starting the abortion about 24 hours later.

When Lillith woke up after the procedure, she said later, her dad was there waiting for her. One day, she thought she might ask him whether the little thing inside her had been a boy or a girl.

But for now, she decided, she didn’t need to know.

Kae, 24, Ohio

Kae drove to her ultrasound appointment with one question on her mind: Did her fetus have a heartbeat?

She’d scheduled her scan at a facility that offered “abortion consultations” as soon as she found out she was pregnant, well aware that she was up against a deadline. An Ohio law, which took effect when Roe fell and would later be blocked at least temporarily in the courts, banned abortion as soon as an ultrasound could detect cardiac activity, around six weeks of pregnancy.

If she’d been tracking her period correctly, she only had a few days to get an abortion.

When Kae pulled into the parking lot for her appointment, she was surprised to find it free of protesters. While the place she’d selected didn’t actually provide abortions, its website advertised free ultrasounds and other services for women seeking the procedure. With the Supreme Court decision so fresh and emotions raw, Kae figured any kind of abortion-friendly place would be a target.

Right away, Kae said, a few things seemed a little off. One counselor gave her a bottle of prenatal vitamins. Another offered to pray for her. Then the sonographer said the vaginal ultrasound wasn’t clear enough to date the pregnancy: Kae would have to come back in a week.

“You can’t give me an estimate?” Kae asked, fairly sure she was at least five weeks along. “Nothing?”

At Kae’s next appointment — seven days after her first — the sonographer played a sound she identified as a heartbeat.

“You’re measuring at approximately six weeks and three days,” Kae recalled the sonographer saying as Kae lay flat on the exam table.

Kae couldn’t believe what she was hearing.

“Do you want a picture to take home?” Kae recalled the sonographer asking.

No, Kae thought to herself: All she wanted was to put her pants back on and leave. She stared up at the ceiling, trying to tune out the sound and keep her breath steady. How could this be happening, she wondered? How had the fetus developed so quickly?

A one week delay was the difference between a legal and an illegal abortion.

By that point, Kae said, she’d started to suspect that the clinic was not an abortion-friendly place at all. She’d heard people talk about crisis pregnancy centers, often religiously-affiliated organizations that try to talk women out of abortions.

A sonographer can see a gestational sac with a vaginal ultrasound around four to five weeks of pregnancy, according to a spokesperson for the American College of Obstetricians and Gynecologists, which means they can roughly identify the pregnancy one to two weeks before cardiac activity is detected.

When Kae told her boyfriend the news, he was immediately suspicious, pointing to the pregnancy center’s clear antiabortion stance. “To go from seeing nothing to being too far in a week, it just didn’t make sense,” he told The Post.

There had been a moment, right after the pregnancy test, when Kae briefly considered keeping the baby. She’d been with her boyfriend for almost a year. He owned a home. She had no doubt he was the guy she wanted to spend the rest of her life with. But Kae had just gone back for her college degree, still a few years away from launching her dream career.

When she sat down to write her list of pros and cons, she could only think of one “pro”: the chance to start a family with her boyfriend. Meanwhile, the “cons” quickly filled a whole page in her notebook.

Kae felt even more sure of her decision after hearing what the counselors called the “heartbeat.” She didn’t feel at all attached to the sound, she said. Angry that the pregnancy center may have tried to thwart her plans, she informed the counselors that she still planned to have an abortion. She would take pills from Aid Access, she told them, a Europe-based online service that supplies abortion pills illegally to women in states where abortion is banned.

“You have no idea what’s in them,” Kae recalls one of the counselors saying before she fled the building. (Aid Access is widely regarded in the medical community as a safe resource for medication abortion.)

Kae heard the counselor’s voice in her head when the abortion pills arrived in the mail a week later. Some of the pills were small and hexagonal, she said, while others were more circular.

“I don’t know why they’re different,” she told her boyfriend. “I’m worried.”

He said he reminded her that she’d done her homework: She’d read a bunch of articles about Aid Access before she paid $105 to place her order. The organization had been around for years. If these were the pills that arrived, he told Kae, they should trust them.

The next few hours played out exactly as the internet had led Kae to expect. The cramps came, sharp and fast, as she curled up on the couch with her golden retriever, trying to concentrate on an episode of “Breaking Bad.” She threw up a few times, then turned on the shower, the hot water dulling the ache in her back.

When Kae imagined all she might lose by having a baby, she thought about roller coasters and the kind of reckless freedom they represented. She loved the feeling of the wind in her hair and her hands in the sky, screaming as she plummeted 300 feet at 100 miles an hour.

She’d already planned a post-abortion amusement park trip with her friends, where they would ride one of the tallest, fastest coasters in the state.

“Suck it up,” she said out loud to herself, fixating on the dips and drops she could experience once she was no longer pregnant. “Just a few more hours to go.”

Taylor, 27, Georgia

Taylor checked the time as soon as she woke up on the morning of her abortion appointment. It was 6 a.m. The clinic expected her at 8:10 a.m.

She had just over two hours to decide whether she wanted to become a mom.

When Taylor first found out she was pregnant, she had not even considered keeping the baby. Her boyfriend of two months had just moved 600 miles away. She had no savings. After working as a greeter in a fancy downtown office building, she’d finally scored an entry-level job in finance making $50,000 a year. But she had to pass an exam to stay on the payroll, and the studying had not been going well.

Based on her last period, Taylor estimated that she was at least seven weeks into her pregnancy, too far along to get an abortion in Georgia, which had enacted a “heartbeat ban.”

She would have to go to Florida.

Taylor knew she was in for a long wait. She couldn’t take any time off at her new job, so she could only travel to Florida on weekends. Flooded with patients from states that had banned abortion, the clinic’s earliest available Saturday appointment was two weeks away. Because Florida law requires patients to have an in-state ultrasound at least 24 hours before an abortion — and the clinic wasn’t open on Sundays — Taylor would have to make two trips.

She secured a pair of Saturday time slots at a Florida Planned Parenthood: one for the ultrasound and another, three weeks later, for the abortion. Her boyfriend, who Taylor said advocated for the abortion, agreed to cover half the cost of the $250 round trip flights.

It wasn’t until the ultrasound that Taylor started to wonder whether she was making the right decision. As the nurse walked her through a script of state-mandated information, describing every step of the surgical procedure, Taylor seized on a few of the details.

A tube inserted inside her uterus. A pump. Suction.

Taylor said she had only ever thought about abortion in a vague, abstract kind of way, as a medical procedure central to reproductive health care. Now she couldn’t stop picturing a vacuum cleaner inside her vagina.

The ultrasound photo made her even more anxious. At nine weeks, she said, the fetus “looked like a little person.”

After returning home from her first trip to Florida, Taylor spent hours scouring the internet for information: How much do you bleed in a surgical abortion? Do fetuses feel pain?

Eager for a sympathetic ear, Taylor posted in an antiabortion forum she found online.

“I am pro-choice and I’m weirdly having second thoughts about my appointment next week,” she wrote. “Advice???”

Her post quickly generated over 100 responses.

Money wouldn’t be a problem, promised dozens of people Taylor had never met: There were resources for mothers like her. They told her to call her local crisis pregnancy center. Several users offered to donate to Taylor’s baby registry. One asked for her address so she could send some baby clothes.

“The feelings you have right now is your conscience telling you something isn’t right,” one user wrote. “It is very likely that you will feel worse if you have the abortion.”

Taylor wasn’t sure whether she could rely on these strangers, or the resources they touted. But she was desperate for some kind of support, and she wanted to believe them.

As the appointment neared, Taylor still couldn’t settle on what she should do. She texted her boyfriend at 2:30 a.m. on the morning of her flight to Florida.

Taylor told herself she would make up her mind once she packed her bags. Once she got to the airport. Once she landed.

Then it was 7:30 a.m. on the day of her appointment, and she finally accepted that she wasn’t going to get out of bed.

In a few months, she would become a mom.

As soon as she got back to Georgia, Taylor started to shop. She would swing by Target after work and linger in the baby aisle, picking up wipes or a few packs of diapers, eyeing the other women with rounded bellies as they filled their carts with everything you needed to care for a child.

Taylor felt like she was playing a part. She said she had just started renting her first apartment. She didn’t know how to drive. In a few weeks, she might fail her company’s required exam and lose her job. Still, she thought, maybe if she did the things mothers were supposed to do — bought the things mothers were supposed to buy — she could somehow handle this.

“I don’t really have control of anything right now,” she said. “So it’s nice to know, okay, I have the stuff.”

About two and a half months later, by then 22 weeks into her pregnancy, Taylor sometimes found herself doubting whether she’d made the right decision. In part, she blamed the Georgia law that forced her to leave the state for an abortion. The delay complicated a choice that once might have been simple, she said, leaving her to stew in ultrasound photos and antiabortion talking points.

“Sometimes I just feel like I should have gone to my appointment,” she said.

After every trip to Target, Taylor deposited her new baby purchases in a pile in the middle of her living room. She wanted to make herself look at it: a growing reminder of everything that was coming.

“This is the first adult thing that’s ever happened to me,” she said, taking stock of the pacifiers and baby cream.

“I don’t know if I’m ready to be a mom … But it’s my responsibility now.”

CORRECTION: A previous version of this article misspelled the name of one of the women. The correct spelling is Lillith, not Lilith. The article has been corrected.

Illustrations by Carson McNamara. Design and art direction by Alla Dreyvitser. Design editing by Madison Walls. Visual editing by Kainaz Amaria. Editing by Peter Wallsten.

Six months after their Supreme Court victory, conservatives complain that strict new laws are not being sufficiently enforced

The largest antiabortion organization in Texas has created a team of advocates assigned to investigate citizens who might be distributing abortion pills illegally.

Students for Life of America, a leading national antiabortion group, is making plans to systematically test the water Erin Brockovich-style in several large U.S. cities, searching for contaminants they say result from medication abortion.

And Republican lawmakers in Texas are preparing to introduce legislation that would require internet providers to block abortion pill websites in the same way they can censor child pornography.

Nearly six months since the Supreme Court overturned Roe v. Wade, triggering abortion bans in more than a dozen states, many antiabortion advocates fear that the growing availability of illegal abortion pills has undercut their landmark victory. Now they are grasping for new ways to crack down on those breaking the law.

Antiabortion advocates had hoped the June decision would significantly decrease the number of abortions in the United States. But abortion rights activists have ramped up efforts to funnel abortion pills — a two-step regimen of mifepristone and misoprostol that is widely regarded as safe — into states with strict new bans, working with rapidly expanding international suppliers as well as U.S.-based distributors to meet demand.

Now many conservatives are complaining that the abortion bans are not being sufficiently enforced, even though much of the illegal activity is happening in plain sight, as abortion rights advocates seek to reach women in need. Leaders interviewed on both sides of the debate had not heard of any examples of people charged for violating abortion bans since Roe fell, a crime punishable by at least several years in prison across much of the South and Midwest.

“Everyone who is trafficking these pills should be in jail for trafficking,” said Marjorie Dannenfelser, the president of Susan B. Anthony Pro-Life America, who has started to speak with Republican governors about the prevalence of illegal abortion pill networks. “It hasn’t happened, but that doesn’t mean it won’t.”

Abortion bans include penalties only for people involved in facilitating illegal abortions, not for the pregnant women themselves.

The push on the right for enforcement reflects the extent to which both sides of the abortion battle are recalibrating after a tumultuous year that has challenged many long-held assumptions about the politics of the issue — and left the state of abortion access in the United States hard to assess. Interviews with more than 30 of the most influential advocacy group leaders, policymakers and litigators on the abortion issue found that far from settling the decades-old abortion question, the fall of Roe has triggered a major new phase of combat set to play out over the next few years in courtrooms, state capitals and the next presidential election.

While a study from the Society of Family Planning found that at least 10,000 fewer clinical abortions took place in the first two months after Roe was overturned, researchers can’t say how many women were able to obtain pills through the mail. One major pill supplier in Mexico estimated that her organization is on track to help terminate 20,000 pregnancies by year’s end, while another Europe-based group says that, after the Supreme Court decision, it received roughly 3,600 queries per month, with about two-thirds of those coming from women in states with abortion bans.

Many Republican lawmakers have been reluctant to further restrict abortion since the June ruling, especially after this year’s midterm elections confirmed that abortion rights are popular with voters across party lines. Backlash from the court decision was widely credited with helping Democrats score some critical wins, including a state legislative majority in Michigan and control of the Pennsylvania House, while voters even in heavily Republican states turned out in droves to oppose antiabortion ballot measures.

Abortion rights advocates say they are exploring 2024 ballot measures in at least a dozen states to enshrine abortion rights in their state constitutions. Momentum is building in many states with strict abortion bans, including Oklahoma, Missouri, Arkansas, Ohio and South Dakota, according to several national abortion rights advocates with knowledge of early conversations across the country.

“Democrats should not be shy about being bold and using every tool to fight for individual rights,” said Michigan Gov. Gretchen Whitmer (D), who won easy reelection in a state that also voted to protect abortion rights through a ballot measure. States that have the ability to do a Michigan-style ballot initiative “should certainly be exploring it,” Whitmer said.

While abortion rights advocates appear largely united in their approach, the rise of abortion pills and the election results have combined to highlight tensions among conservatives over what to do next.

The next few months could pit the “true believers” — those who genuinely care about limiting the number of abortions — against those who back antiabortion policies to score political points, said Jonathan Mitchell, the antiabortion lawyer behind the novel Texas abortion ban that took effect in 2021.

Mitchell said he has been involved in discussions about aggressive and unconventional measures that he thinks are necessary if Republicans are determined to actually limit the number of abortions. But he is unsure whether Republicans will have the political will to pursue those ideas.

“Especially after this election, a lot of Republicans will want to change the subject, and going after abortion pills is not the way to change the subject,” he said.

Antiabortion advocates search for an ‘airtight’ case

After the Supreme Court overturned Roe, Texas antiabortion advocates stepped up efforts to find local prosecutors most inclined to enforce antiabortion laws.

They quickly zeroed in on Jacob Putman, the prosecutor in Tyler, Tex., a small city that bisects 200 miles of mostly open road between Dallas and Shreveport, La. Larger than a lot of other heavily conservative counties in Texas, several Texas antiabortion advocates said, Putman’s district has the resources to investigate and prosecute those who violate the state’s near-total abortion ban.

Putman is also staunchly opposed to abortion.

Since the June ruling, the prosecutor has made several public statements expressing his commitment to enforcing the state’s abortion ban. Growing up in Smith County, he told The Washington Post, he volunteered at his local crisis pregnancy center, a religiously affiliated organization that aims to dissuade women from having abortions. He and his wife have donated money to the group. As the county prosecutor, he said, he would be “proud” to bring a case against someone caught violating the abortion ban, a felony punishable in Texas by up to life in prison.

But Putman hasn’t had any of those cases. And he doesn’t expect to have one anytime soon, in part, he said, because it’s difficult to determine who is breaking the law and where the crimes are being committed.

“If it’s happening in my county, I’m not aware of it,” said Putman, sitting beneath a mounted pair of horns from a Texas Longhorn. “In order for one of these cases to get to a prosecutor’s office, someone is going to have to tell, and I don’t know who that would be.”

Texas Right to Life, the state’s largest antiabortion group, is positioning itself to help. A designated team within the organization has been searching for an “airtight” case to bring to a district attorney like Putman who is willing to prosecute, said John Seago, the group’s president.

“We’re not going to get involved until we have evidence, something credible we can take,” Seago said. “We’re trying to actually confirm who’s involved in these networks, how it’s being done.”

While there hasn’t been much evidence of enforcement since Roe fell, there is a long history in the United States of prosecuting people for pregnancy-related crimes. Between 2000 and 2020, 61 people were criminally investigated or arrested for either ending their own pregnancy or helping someone else end theirs, according to a preliminary report from If/When/How, a legal advocacy group that supports abortion rights.

Abortion rights advocates say new efforts to prosecute will exacerbate the fear and isolation of those facing unwanted pregnancies in states where abortion is banned.

“It will paralyze people from getting help and health care when they need it and are entitled to it,” said Aimee Arrambide, executive director at Avow Texas, an abortion rights advocacy group.

Seago said he hopes the upcoming legislative session in Texas — which has established itself as a testing ground for new and aggressive antiabortion legislation — will yield tools that will help antiabortion advocates in their fight against illegal abortion pills.

Texas lawmakers are drafting legislation that would compel internet providers to block people from accessing abortion pill websites like Europe-based Aid Access and other online pharmacies within state borders, said Seago, though even antiabortion lawyers say that effort would raise free speech concerns. Another proposal would refashion the enforcement mechanism behind the six-week abortion ban that took effect in Texas in 2021, empowering private citizens to enforce the law through civil litigation at any stage of pregnancy, not just after six weeks.

National advocacy groups are also pivoting to focus on enforcement. Early in the new year, Dannenfelser of Susan B. Anthony Pro-Life America said she plans to strategize with antiabortion governors about how best to deal with the illegal pill networks.

She said she has already discussed the matter with Georgia Gov. Brian Kemp, one of several GOP governors to sign a strict abortion ban and win reelection this year. According to Dannenfelser, Kemp is widely supportive and “already engaged” on the abortion pill issue.

“Every governor, especially governors who have passed ambitious laws, have it in their interest to make sure that laws in their states aren’t de facto overturned by pills going into every part of their state, through organizations that are directly violating the law,” Dannenfelser said.

Andrew Isenhour, Kemp’s deputy director of communications, declined to comment on any potential legislation, adding that the governor remains “committed to supporting life at all stages and protecting the lives of the unborn.”

Some are exploring other unorthodox approaches.

Antiabortion advocates filed a lawsuit against the U.S. Food and Drug Administration in November challenging its decades-old approval of one of the pills used in medication abortions. Their arguments have been widely discredited by legal experts.

Students for Life of America is focused on the environmental harm it says is caused by medication abortions, specifically from fetal remains flushed down the toilet, as often happens when women take abortion pills at home. (There is no direct evidence that abortion pills contaminate the water supply, and environmental experts have dismissed the arguments made by Students for Life.)

At an internal meeting in Indianapolis on Nov. 30 attended virtually by The Post, employees expressed frustration that state officials are not already testing the water for contaminants related to abortion pills.

“You mentioned Erin Brockovich,” said Students for Life of America President Kristan Hawkins, speaking to another member of her advocacy team and referencing the famous legal clerk who exposed groundwater contamination around a major gas and electric facility. “Let’s just get the damn water samples ourselves since we already know they’re not doing it.”

By the end of the meeting, the group had developed several action items, including finding a lab willing to help with testing, and recruiting a team of “student investigators.” Hawkins said she will be meeting with Republican attorneys general in the new year to discuss issuing statewide injunctions against abortion pills, based on the group’s claims about toxic wastewater.

Looking toward 2024

Abortion rights advocates are newly energized coming out of the midterms, eager to capitalize on public opinion and build on the gains they made in Michigan, Kentucky and beyond after the Dobbs v. Jackson Women’s Health Organization decision invalidated Roe.

“From the day that the Dobbs opinion was leaked, until right now, a new fury has burned through the women of this country,” said Sen. Elizabeth Warren (D-Mass.), an outspoken proponent of abortion rights, who says she is committed to helping more states pass abortion protections.

As abortion proponents turn their attention to 2024, ballot initiatives that aim to protect abortion in state constitutions are now the “strategy du jour,” said Jessica Arons, senior policy counsel for the American Civil Liberties Union.

But ballot measures should not be seen as a cure-all, several abortion rights advocates warned. Because of their high price tag — abortion rights advocates spent tens of millions of dollars on the one in Michigan — these campaigns can’t happen everywhere simultaneously, said Rachel Sweet, who worked closely with the ACLU and ran the abortion rights campaigns this year in Kansas and Kentucky.

In several states that allow citizens to add issues to the ballot by collecting signatures, conservative lawmakers are already discussing various proposals to make it harder to put issues directly to voters. Soon after the midterms, Ohio Secretary of State Frank LaRose introduced an effort to require 60 percent of voters to pass certain constitutional amendments, instead of the current system, which requires a simple majority. LaRose dismissed claims that his proposal was related to the abortion issue, according to the Columbus Dispatch.

As they push for more restrictive bans in states such as Florida and North Carolina, antiabortion advocates across the country will have to contend with moderate Republicans who have been increasingly vocal on the issue. In Indiana, West Virginia and South Carolina — three states that have convened for legislative sessions since Roe fell — Republicans struggled to agree on a path forward on abortion, as moderate factions within the caucus pressed for less severe restrictions.

West Virginia Senate Majority Leader Tom Takubo (R), a practicing physician, brought debate on the issue to a standstill in July, refusing to back a bill that included criminal penalties for doctors. In private conversations with other Republican leaders, he said, he warned of a massive public backlash.

“If Republicans aren’t willing to come and meet a little bit more towards the middle, then what they’re actually doing is going to hurt their cause and cause a major swing in the opposite direction,” said Takubo, who ultimately voted for a near-total abortion ban.

Both sides of the debate are now gearing up for the 2024 presidential election, which will be critical for the future of abortion access. While President Biden has been limited in his ability to protect abortion access, an antiabortion president could significantly alter the current landscape, cracking down on abortion pills in both Democratic- and Republican-led states.

Under a Republican president, the FDA could alter the restrictions around abortion pills. For example, the agency could try to limit the period of time when patients can legally take abortion pills, from 10 weeks of pregnancy to six or seven, said Greer Donley, a professor at the University of Pittsburgh School of Law who specializes in abortion — a move that would force tens of thousands of people every year to have surgical, rather than medication, abortions.

National antiabortion advocates are also carefully considering the ways in which a president could restrict illegal pill networks. An antiabortion president could direct several agencies to bear down on the issue, including the U.S. Postal Service, as many pills are sent through the mail, and the Department of Justice, said Stephen Billy, vice president of state affairs at Susan B. Anthony Pro-Life America.

When Dannenfelser meets with Republicans who may run for president in 2024, she said she asks them first about a national abortion ban, preferring candidates who advocate for a ban after six, 13 or 15 weeks of pregnancy.

Her next question is about the “cataclysmic problem of the abortion pill.”

“We don’t have to dictate their solution,” Dannenfelser said. “But they have to have one.”

CLARIFICATION: This story has been updated to reflect that Rachel Sweet worked with the ACLU on the abortion rights campaigns in Kansas and Kentucky.