Kari White

Introduction: This study explores pregnant Texans' expectations of and experiences with crisis pregnancy centers (CPCs) following implementation of Texas Senate Bill 8 (SB8), which in September 2021 prohibited abortions in Texas after detection of embryonic cardiac activity. Methods: We analyzed in‐depth interviews with English‐speaking Texans over 18 years of age who were or had recently been seeking abortion, focused on their care‐seeking experiences, including with CPCs. Between October 2021 and August 2022, we recruited participants via online ads in Texas and flyers in abortion‐providing facilities in seven other states. Using thematic analysis, we identified themes in CPC experiences and developed a CPC client typology. Results: Of 120 participants, 36 described contact with CPCs; we categorize them into three client types, based on awareness of CPCs' anti‐abortion position and expectations of CPC services. Fifteen were “deceived clients”: unaware of CPCs' position, they contacted a CPC expecting abortion care or all‐options counseling. Most remaining participants ( n = 11) were “pragmatic clients”: also unaware of CPCs' anti‐abortion position, they expected only pregnancy information or support. A minority ( n = 8) were “strategic clients”—aware of CPCs' anti‐abortion position and therefore expecting only pregnancy information, they used CPC services strategically to determine eligibility for in‐state abortion care or medication abortion. Conclusions: In addition to contacting CPCs because they were deceived or pragmatic, pregnant Texans considering abortion after SB8 drew on CPC services strategically. In an abortion‐restrictive setting, pregnant people may try to use CPCs for free services that they cannot get as easily from licensed medical providers.

Introduction: Judicial bypass is a legal process that allows pregnant minors to obtain abortion without mandated parental involvement after obtaining approval from a judge. However, courthouse staff's familiarity with bypass and quality of information provided about the process may vary. Methods: Between July 2019 and February 2020, we conducted mystery shopper calls to county courthouses in three states mandating parental involvement: Alabama, Georgia, and Mississippi. Research assistants called courthouses and asked about the bypass process, using a semi‐structured script. We calculated the percentage of counties where courthouse staff could not provide callers with sufficient information about the process and conducted a content analysis of the call transcripts. Results: Courthouse staff in 50% of the 214 contacted counties suggested bypass might be possible, but could not provide specific information and 28% communicated bypass would not be possible. Lacking familiarity with the process, staff often referred callers to places that did not handle judicial bypass (e.g., health departments) and sometimes conflated bypass with emancipation, or said abortion was not legal. In 21 counties, courthouse staff stepped outside their professional role and engaged with callers in a personal manner that was often unsupportive of a minor's abortion decision. Discussion: Minors attempting to access judicial bypass information directly from courthouse staff may not receive sufficient information or support despite state laws' requirements. Absent the repeal of parental involvement laws, courthouse staff need training on judicial bypass, and policymakers and advocates should enhance resources and pragmatic support for minors navigating the complex legal landscape.

Introduction In 2021, Texas Senate Bill 8 (SB8) prohibited abortion after detection of embryonic cardiac activity and was often referred to as a “6-week ban.” Limited evidence exists about how these laws intersect with people’s processes seeking pregnancy confirmation and navigating barriers to abortion care. Methods Between October 2021 and August 2022, we recruited Texans ≥ 15 years of age who were seeking abortion using online ads and flyers placed in out-of-state abortion-providing facilities. Participants completed in-depth interviews, and we coded transcripts using inductive and deductive coding. This analysis explores participants’ discussions of time needed for pregnancy confirmation, decision making, and access to care in the context of SB8. Results Most of the 107 participants identified their pregnancy soon after a missed period, but they often sought additional pregnancy confirmation, which delayed care. Participants expressed urgency around their search for abortion after learning about the “6-week ban.” Those who experienced financial, transportation, and work-related barriers felt there was insufficient time to get in-state care; others felt rushed to make a decision. Many recounted difficulties scheduling in-state appointments and were upset when facility staff denied care based on medical conventions for pregnancy dating and detection of cardiac activity before 6 weeks’ gestation. Discussion Framing SB8 as a “6-week ban” created stress among Texas abortion seekers, and the accumulation of small delays limited access to in-state care. Policy Implications Clearer messaging around when abortion is prohibited and free, accessible pregnancy confirmation services inclusive of all care options would better support pregnant people’s abortion care navigation.