Step by step, Texas has driven away doctors like Bhavik Kumar. After the state legislature in 2021 enacted a ban on abortions beyond roughly the sixth week of pregnancy, the family medicine physician, who worked full time for Planned Parenthood, began providing abortions in Louisiana, where the procedure was still legal at the time. After the Dobbs decision wiped out abortion access across much of the South less than a year later, he started seeing patients in Kansas and Ohio a few days each month.
Now his new job has put him in what he describes as a bewildering position. He works mostly from the Houston area, in a state where he could go to prison for life if he performed the procedure, while helping to expand access to abortions 1,300 miles away. In July, he was appointed chief medical officer of Planned Parenthood of Greater Ohio. “It’s not beyond me that I’m in Texas, where people don’t have access to this care,” he says. “And I’m working on undoing things in another state. It’s night and day, completely different.”
Kumar is straddling life in two states that have taken vastly different courses since the U.S. Supreme Court struck down the constitutional right to abortion more than two years ago. Prior to Dobbs, Ohio and Texas had enacted similar restrictions on the procedure. But while Texas fully outlawed abortions (with rare exceptions), Ohio voters last fall chose to enshrine abortion rights in their state constitution. That vote led a judge to block the state’s mandatory 24-hour waiting period and other restrictions this summer. Clinics that Kumar now oversees were soon offering same-day abortions.
The potential for such changes helped persuade Kumar to take the new position with Planned Parenthood, far from home. “It was very exciting to think about all the things that I dealt with in Texas that were similar in Ohio sort of going away,” he says, “and what I would have done if I didn’t have to navigate those restrictions for my patients, and how we could open up access.”
Meanwhile, in Texas, even obstetrician-gynecologists and family doctors for whom abortion isn’t a core element of their practices have found it alarmingly difficult to care for patients facing medical emergencies. The state’s ban offers only vaguely worded exceptions to save the pregnant woman’s life or prevent “substantial impairment of a major bodily function.”
Physicians in Texas say the laws continue to pit their obligations to provide necessary care against their fear of incarceration. Doctors have received little clarity about when abortions are legal from the Texas Medical Board and from the courts, which have largely declined to intervene. This week the U.S. Supreme Court upheld a ruling that Texas hospitals do not have to perform the procedure during medical emergencies if it conflicts with state law.
Over the last couple of years, I’ve spoken with many Texas doctors who have fled the state or stopped practicing here. A new survey of hundreds of Texas OB-GYNs published this week found that more than three-quarters believe they can’t practice medicine to the standard of care under the state’s abortion bans. Nearly 10 percent say they have left the state, will no longer practice obstetrics, or are leaving medicine entirely. Another 13 percent are planning to retire early.
This survey and other research have also shown that medical residents are avoiding states with abortion bans, further jeopardizing long-term access as Texas contends with a serious physician shortage. The majority of the state’s 254 counties have no practicing OB-GYN, according to the state health department. For doctors like Kumar, the decision of whether to stay or go has involved weighing the desire to serve patients here with a feeling that they could do more—clinically and in terms of advocacy—elsewhere, including places where abortion access may still be tenuous but available.
For now Kumar plans to continue living in Texas, where his family and home are, and where he has set down roots. He travels to Ohio for about a week each month to see patients, while doing much of his administrative and planning work remotely. But that arrangement could become untenable, he says, particularly if Texas lawmakers during next year’s legislative session attempt to ban travel across state lines for abortions. That could make his cross-country travel riskier. “It’s been extremely difficult for anyone to predict exactly what’s going to happen and how the landscape will look,” Kumar says. “It’s just important for all of us, unfortunately, to be nimble and on our toes and ready to pivot.”
Across the country, doctors and their patients are contending with an ever-shifting patchwork of abortion regulations. In North Dakota, a judge recently struck down the state’s abortion ban—but not before the only clinic moved out of state. In Georgia, where recent reporting detailed two preventable deaths under the state’s six-week ban, a judge temporarily blocked the law in late September—until it was reinstated by the state Supreme Court about a week later.
Reproductive rights are also on the ballot on the state and federal level in November. If elected president, Vice President Kamala Harris has promised to push for federal legislation to reinstate abortion rights nationally. Her opponent, former President Donald Trump, has said he’s proud of his role in having appointed three Supreme Court justices who were instrumental in overturning Roe v. Wade. Meanwhile, voters in ten states will directly weigh in on abortion access. (Seven states, including Ohio, have already voted on such ballot measures, with supporters of abortion rights prevailing every time.) Although polling indicates that a majority of Texans support less restrictive abortion laws, Texas, unlike many other states, does not give its citizens the power to call for a vote on the issue.
Dr. Samuel Dickman, an abortion provider who left San Antonio for Montana in the spring of 2022, has been involved in lawsuits challenging various restrictions in his new home state, and has helped to orchestrate a ballot measure that will allow Montanans to further protect abortion access in its state constitution. “I’ve seen what those abortion bans lead to, and we don’t want to see those consequences here in Montana,” he told residents in April. Montana has fewer restrictions on providers than Texas had previously, but Dickman told me that he’s learned from his experience in Texas that that can change in a moment. “It doesn’t feel secure at all,” he said.
Dr. Lauren Thaxton, an OB-GYN who left Austin for Colorado this spring because of Texas’s abortion bans, sees patients who have traveled there from Texas daily. Voters in Colorado are among those who will decide whether to protect abortion rights in their state constitution next month. Yet even though the procedure is already legal there at all stages of pregnancy, Thaxton isn’t taking anything for granted. “This is care that has unfortunately always been tied to legislation and politics and constantly at threat anywhere you are,” she says. “I think we need to keep hearing these cautionary tales of what is happening in Texas for people in Colorado to still feel like this is relevant to them, because it is.”
For Kumar, leaving Texas was never something he had considered prior to the abortion bans. He grew up in the state and he considers helping those who need abortions here his priority. But he’s recently begun to think that change in Texas may be too far away to wait it out.
When I spoke to him about two years ago post-Dobbs, Kumar said he hoped to stay in Texas for as long as it felt like he was able to help and “show up for the people in Texas,” whether through providing nonabortion care, speaking about his work, training medical students, or other forms of advocacy. But the newfound opportunity to help more patients in Ohio has won out for now. “I’m not abandoning Texas but it has felt difficult to stay in Texas and fight and have to deal with sort of barrier, after barrier, after barrier,” Kumar told me recently. “Being able to pivot and focus on a state where there is a lot more opportunity does give me a feeling of joy, and being able to advocate for people in that state, but also affect the people in surrounding states [who travel there for care], does help me feel like I’m actually doing something now and making a difference every day.”
