ALBUQUERQUE, New Mexico -- With sympathy in their voices, the receptionists at the University of New Mexico Center for Reproductive Health relayed the same news into the phone over and over again Wednesday morning.
The video featured above is from a previous report.
"We're scheduling about four weeks out," the receptionists said.
The people on the other end of the line, mostly Texas women, were told those four weeks could mean they would become ineligible for abortion medication in lieu of a procedure, or they would have to spend two days at the Albuquerque clinic instead of one.
The university's clinic is one of three providing abortion procedures in New Mexico, which has become the destination state for many Texans wishing to terminate a pregnancy.
Aside from breaking the news about growing wait times, the front-desk responsibilities of what was once a quiet clinic have grown to include referring out-of-state patients to possible funding sources that could cover the hundreds of dollars they will have to pay out of pocket. The receptionists also help people navigate logistical hurdles, so patients can miss as little work or line up as little child care as possible.
"She's under eight weeks, for an appointment at 8 a.m.," one clinic employee whispered to her coworker while on the phone with a Texas patient. "But the latest flight out (of Albuquerque) is 5:25 p.m. - do you think she would make that flight?"
Another employee walked in to tell the receptionists not to count one woman who was supposed to be in the clinic about an hour earlier as a no-show. She was on the way, the staffer said, still driving in from Oklahoma.
Before September, the university clinic performed a relatively low number of abortions. With about 2 million residents in the state, the small handful of New Mexico abortion clinics and providers performed fewer than 6,000 abortions in 2020, according to the Guttmacher Institute, about a tenth of those performed in Texas.
The clinic was instead able to focus more on its training program for medical students and residents, and it had more availability to provide birth control services and other reproductive health care, according to physicians at the clinic.
But when Texas banned abortion at about six weeks into a pregnancy last year, their patient load skyrocketed. The demand for abortion care is only expected to grow after the U.S. Supreme Court ended the right to abortion last week, promptly followed by Texas and a growing number of states moving to ban almost all abortions.
"It's a different job now," Dr. Eve Espey said on Tuesday evening, sitting in her quiet, stucco-covered home after a long day at the clinic. "I would say 75% of our patients have been from Texas for the last several months."
Doctors said more people have recently been coming from Oklahoma, which banned abortions in late May. And others are starting to trickle in from places like Kansas and Arizona. But the clinic is still bracing for the eventual full impact of the overturning of Roe v. Wade.
"There's only so much we can do," said Espey, chair of the university's OB-GYN department and a founder of the clinic. "We're booking out to the end of July because we can't book more patients in a day."
Beyond an overwhelming increase in out-of-state patients, doctors at the clinic said even more concerning is the increase of patients who are further along in their pregnancies.
Espey said since September, local clinics have provided abortions for more than double the number of patients they would have seen before Texas' abortion ban after about six weeks of pregnancy. What increased even more was patients more than 14 weeks pregnant and even more for those between 18 and 20 weeks.
"If they'd just been able to go to Dallas, and they live near Dallas, they could go tomorrow," said Dr. Amber Truehart, the clinic's medical director. "But they have to figure out how to travel here and get child care and funding, and all of that stuff is delaying them."
"That's not ideal for abortions because it puts you a little further along and things can get a little more complicated," she added.
A mother's decision
Medical staff walked into the Albuquerque clinic early Wednesday morning, leaving behind the bright blue skies and pink-hued mountain range.
Truehart huddled with nurses, medical assistants, trainees and a newly hired physician's assistant to hear details about the dozen or so abortion patients scheduled for the morning. At least half were from Texas, a point staff made note of since, unlike for New Mexicans, Medicaid and private insurance will not pay for their abortions.
One of the patients was Adriana, who at 23 is the mother of two children, ages 4 years and 7 months.
"The reason why I'm deciding to do this is just because financially I can't afford it," Adriana said while waiting for an ultrasound Wednesday, her silky brown hair trailing down her petite frame. "I'd rather not put myself in a tough situation where I know that I might become homeless because I'm trying to provide for three kids."
The Texas Tribune is using a pseudonym for Adriana, who asked not to be identified out of concern for her privacy.
Adriana is from Las Cruces, so she originally planned to go to El Paso for an abortion, about 30 minutes away from the southern New Mexico city. But with Texas' abortion bans, she instead took the day off of work and her partner drove her about three and a half hours to Albuquerque the night before.
Based on the timing of her last period, which Adriana acknowledged was irregular since she was still breastfeeding, the mother and clinic staff estimated she would be more than 10 weeks pregnant. But after Truehart scanned her uterus and measured the size of the embryo, she determined Adriana was less than eight weeks along.
"Oh, that's so much better," Adriana sighed in relief on the table.
At eight weeks, she can safely have a medication abortion, Truehart told her, instead of an outpatient procedure. She would take two pills within 48 hours to induce an abortion, with symptoms similar to a miscarriage.
Back in the waiting room with the news from her ultrasound, Adriana visibly relaxed. She rested her head on the shoulder of her 7-month-old son's father. They spoke in hushed tones, often interrupted by him kissing the top of her head.
Still, Adriana said she was upset over Texas' ban on abortion and the overturning of Roe V. Wade, not only for herself but for so many like her.
"There's a lot of women out there that choose to do these things," she said, her arms wrapped protectively around herself in the ultrasound room. "Either financially they can't afford to take care of an infant or, if you're a rape victim - and I'm a rape victim - if you get pregnant, it could cause suicide."
An overlooked state
Their priority is their patients, but leading doctors in New Mexico abortion care have other concerns during this time of upheaval in their field.
They're worried about staffing shortages, already ever-present in the burnout much of the health care industry struggled with during the crush of the pandemic. And they're concerned about a chilling effect on health care providers in states with abortion bans who may not take steps to save a pregnant person's life for fear of criminal prosecution.
In Texas, the state's abortion ban will not allow for exceptions in cases of rape or incest, only allowing an abortion if the pregnant person's life is in danger.
"Even in cases it would be allowed for exceptions, who wants to put their neck out for that? Everybody's afraid of 'aiding and abetting,'" Espey said, quoting the language of Texas' Senate Bill 8.
And in New Mexico, abortion rights advocates and providers are afraid new clinics seeking to provide more care for patients from across the country will bring the wrong kind of attention to a state that typically goes unnoticed by the rest of the country.
"When folks come in from out of town, there's the concern that they're going to upset the political balance and the community relationships," Espey said, noting that local abortion rights groups have worked for decades to cultivate an acceptance of abortion care.
"I think these organizations and, frankly, me too, would prefer it was New Mexicans that provide that care," she added. "That said, there's a big gap. It would be one thing if we could fill that gap, but right now, we can't."
New Mexico has no major restrictions in place on abortion access, but it is a poor, largely rural state that often falls short in providing reproductive health care to its own residents.
All three of New Mexico's clinics that provide abortion procedures are in Albuquerque in the northern half of the state. A handful of other clinics provide abortion medication for early stage pregnancies, but, as evidenced by the backlog at Espey and Truehart's clinic before Roe's reversal, the doctors say the state needs more abortion providers.
But the new spotlight makes them wary of the longevity of the state's new role as a haven for abortion care.
"They're afraid of exactly that," Truehart said, walking around the clinic in purple scrubs and Crocs. "That (new providers) are going to bring too much attention to New Mexico as like this hub of abortion and then the tide is going to change and then bam, New Mexico goes out, too."
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