Throughout their early teens, DakotaRei Frausto struggled with premenstrual dysphoric disorder, a severe form of premenstrual syndrome, as well as anemia and chronic nausea. In 2021, at age 16, Frausto went to a handful of clinics in their home state of Texas to seek out a birth control prescription, hoping it would help address their symptoms. But each of the clinics brushed off their pain or referred them to brochures rather than getting them in front of doctors, and Frausto, feeling defeated, gave up on trying to access birth control.

Soon after, when Frausto was 17, they started to experience more severe PMDD symptoms than usual. A pregnancy test confirmed they were eight weeks pregnant. “When I did test positive, I knew for a fact abortion in Texas wouldn’t be an option for me,” Frausto said, noting that the state’s six-week abortion ban went into effect in September 2021. “My immediate next thought was: How am I going to scrape together the resources to travel?”

Out-of-state travel has become the primary option for pregnant people in anti-abortion states to get the reproductive care they seek. But the logistics of visiting a state with fewer abortion restrictions come with legal risks and high costs, especially for teenagers. In Texas—a state with some of the most restricted abortion access in the country—a network of nonprofits is working together to usher minors over state lines.

Texas’s Senate Bill 8, also known as the Texas Heartbeat Act, prohibits physicians from performing abortions once a fetal heartbeat is detected, usually at around six weeks of pregnancy. Given the strict law, there are now two primary ways for women in Texas to get abortions after six weeks of gestation. The first is the abortion pill, which is not legal in Texas, even when purchased through the mail, but can be procured through an underground network of online providers. Still, those providers are subject to felony charges if they are caught distributing the pills. Also, the pill is recommended only until the 10th week of pregnancy—meaning that many women, particularly teens, won’t catch their pregnancies in time and will need to pursue the second alternative: to travel to one of the states where abortion is still protected.

Texas has one of the highest rates of pregnancy among teens between 15 and 19. Nationwide, people pay an average of $478 for abortion care, and nearly half of abortion patients delay other important expenses or sell personal belongings to cover their costs. But adolescents are less likely to have an income, making those costs especially prohibitive, according to a report from the Guttmacher Institute, a sexual and reproductive health research organization. Teens are also prone to irregular periods and mistaking early signs of pregnancy for PMS, meaning they usually find out they’re pregnant later than older women and are more likely to need second-trimester abortions.

In 2022, the rate of teen pregnancy in Texas increased for the first time since 2007, according to the latest data from the University of Houston. That may be because it has become progressively harder in Texas for minors to get confidential sexual health care and contraception. As of 2022, Texas clinics that receive federal funding for reproductive care can’t provide contraception without parental consent.

“People try to paint abortion patients as irresponsible,” says Frausto, who is now 19. “But this wasn’t my presumed irresponsibility but the negligence of my state legislatures, both when it came to sex education and access to contraception. My situation was completely preventable. It made me feel like a failure, even though I did everything right.”

Frausto drove 700 miles to a Planned Parenthood in Albuquerque—with the help of their mother and partner—for their abortion. They raised money via an awareness campaign on TikTok, which helped cover a portion of the $2,000 travel and clinic costs.

“My abortion saved my life,” says Frausto, who while in New Mexico got a prescription for birth control that has significantly reduced their PMDD symptoms. “It allowed me to find myself and not be stuck as a child in a situation being thrown into adulthood.”

The hostility in Texas toward abortion, even in the most egregious circumstances, is a major hurdle for young people seeking care. Women in Texas who become pregnant as a result of rape or incest are barred from terminating their pregnancies. Doctors or providers who perform or aid abortions at any stage of pregnancy in Texas face criminal charges, and they are restricted from performing even medically necessary abortions, threatening the health of mothers. Meanwhile, local governments including those representing Mitchell, Lubbock, and Dawson counties have passed ordinances in the last two years that prohibit Texans from traveling through their jurisdictions for an abortion outside the state.

“The purpose of the laws is fear, misinformation, and cruelty,” says Neesha Davé, executive director of Lilith Fund, which provides financial support to Texans seeking abortion. “Each time new abortion laws are passed, there’s new confusion and fear for abortion seekers about what they can and cannot do.”

Almost a quarter of Texas women incorrectly believe their state as a whole has passed a blanket law prohibiting travel to another state to get an abortion, according to a 2023 survey by Resound Research for Reproductive Health, a Texas-based research collaborative. And in 2023, nearly 6,000 teens reached out to Jane’s Due Process, which helps the state’s youth get birth control and abortions, in many cases to ask whether or not abortion was legal in Texas.

“Young people see one scary headline and they’re led to believe that they can’t access the care that they want,” says Jane’s Due Process youth advocacy and community engagement manager Ariana Rodriguez. “We remind teens that they have the right to travel and make those decisions for themselves.”

Ariana Rodriguez (right) and Brenda, a former youth fellow for Jane’s Due Process, attend a Planned Parenthood South Texas event.

Despite Texas’s antagonism toward reproductive freedom, organizers there and in other states where abortion is restricted haven’t given up. The Austin-based Jane’s Due Process funds travel for minors seeking abortions outside of Texas. That includes road trips or flights to nearby states like New Mexico or Colorado, where people under 18 can get abortions without parental consent. Lilith Fund, also based in Austin, helps Texans of all ages, including minors, book and pay for abortion procedures at out-of-state clinics. Together, the two organizations—along with others, like Fund Texas Choice and Buckle Bunnies—have built a grassroots network that has maintained Texans’ access to abortion even as the state’s laws become increasingly threatening to pregnant people.

Funding for these organizations comes from a number of sources, including donations, national grants, and, in some cases, local governments. Last year, a group of five reproductive rights organizations—including Jane’s Due Process, Lilith Fund, and Buckle Bunnies—joined together to advocate for a reproductive justice fund administered by the city of San Antonio. In September, the majority-female city council approved the fund in its annual budget process, and $500,000 was allocated to the city’s health department for reproductive care and out-of-state abortion travel.

Almost immediately after the council approved the fund, anti-abortion advocates filed a lawsuit that aimed to shut the San Antonio program down, arguing that funding out-of-state abortion violated Texas’s laws against “aiding and abetting” abortion procedures. In May, the judge on the case threw out the suit because it was premature—the funds hadn’t even been allocated yet.

Abortion access has been found to reduce teen pregnancy rates and increase women’s enrollment in college, particularly among Black women. At Buckle Bunnies, which helps young people in Texas get the abortion pill or find funding for out-of-state travel, “thousands of people have been equipped with abortion information, and because of that, we get to see them graduate high school or college and be better parents,” says founder and co-director Makayla Montoya Frazier.

In 2018—before the U.S. Supreme Court overturned Roe v. Wade in 2022, rendering abortion effectively illegal in much of the country—Montoya Frazier got an abortion in Texas at age 19. “Buckle Bunnies wouldn’t exist without my abortion,” she said. “So many people get to live the rest of their lives the way they want to because I was able to access an abortion.”

The lengths these Texas nonprofits go to, to fund and organize abortion care, bring to mind underground networks like the Jane Collective of the 1960s and 1970s, which helped women in Chicago get abortions when they were banned in most of the United States. While modern Texas reproductive organizations operate within the bounds of the current legal environment, there are parallels.

“Women speak to women and they almost always find ways around a gender hierarchy that is controlling them,” says Mary Fissell, J. Mario Molina professor of the history of medicine at Johns Hopkins University and author of a forthcoming book on the history of abortion. “History echoes, it doesn’t repeat. But there are moments where you think: Wow, that feels familiar. That’s where we are now.”

Lilith Fund operates “in broad daylight because we want our organization to be able to serve people for a long time to come, but of course you cannot help but make corollaries and comparisons to what people are facing now and what they faced in pre-Roe America,” executive director Davé says. “These restrictions hit all pregnant people. Anytime anyone’s access to health care is restricted, their health outcomes are harmed.”

Thanks to a temporary injunction from a federal judge in Austin, organizations that support out-of-state abortion can’t be prosecuted for funding a legal procedure outside Texas. But the case is ongoing, meaning the legal landscape could change at any moment.

Even if the decision in Austin holds, San Antonio City Attorney Andy Segovia says he expects the city to be sued if dollars from its Reproductive Justice Fund go to organizations that support out-of-state travel, because of the aggressive nature of both the Texas state government and anti-abortion groups.

While San Antonio is still determining which organizations will receive the funding, it has allocated 40 percent of the total funds for what’s known as “downstream” care, which includes emergency contraception, travel to receive abortion care, and testing and treatment of sexually transmitted infections, says the city’s medical director, Dr. Junda Woo.

The efforts in San Antonio signal that despite Texas’s strict anti-abortion state laws, organizers and local governments are having some success when it comes to expanding access to reproductive care. “Texas may seem to be a red or an anti-abortion state,” Davé says. “Fundamentally, Texas is a state with anti-abortion state leaders, but it’s not what everyone in Texas wants or needs.”

HK Gray, a youth program coordinator at Jane’s Due Process, found out she was pregnant at 17, about a year after having a daughter at age 16. At the time, Gray was waitressing to support her family and studying for her GED on the side. She didn’t have help from her parents because her father was homeless and her mother was incarcerated, so raising a second child was financially impossible.

Gray, now 23, was able to get an in-state abortion because Senate Bill 8 hadn’t passed yet, but she says if she were in a similar situation today, the trajectory of her life would be completely different. “Now, I would’ve had to continue the pregnancy because I wouldn’t have had someone to watch my daughter while traveling out of state,” Gray says. “Instead, I live with my daughter, I’m able to work from home and dedicate my time resources to her in a way I couldn’t if I had two children. At the same time, I’m putting myself through college. There wouldn’t have been money to pay for school with another child.”

Jane’s Due Process youth advocacy manager Ariana Rodriguez and Serena, a former youth fellow, at a table at a social worker conference

For all Texas women, particularly those from low-income households, leaving the state to get abortion care is costly and logistically challenging. But minors “have more significant barriers than anyone we serve,” says Anna Rupani, executive director of Fund Texas Choice.

Many people under 18 don’t have driver’s licenses or access to a vehicle, and others have never been on a plane. They can’t book hotel rooms, rent cars, or go to medical appointments alone, so they need an adult to accompany them when they travel. And many teens have trouble calling out of high school classes or finding substitutes for part-time jobs.

In many states where abortion is legal, parental consent is required to get an appointment, meaning that teens often get later-term abortions because they either have to wait for judicial bypass—a petition from a judge that allows a minor to get an abortion with parental consent—or face long wait times in states where bypass isn’t required, says Rodriguez of Jane’s Due Process.

And as backlogs mount and wait times increase, requests for assistance are higher than ever. In all of 2023, Lilith Fund committed about $1 million to clients—a figure that was exceeded in the first half of 2024. Fund Texas Choice, meanwhile, gets up to 400 monthly calls from patients seeking abortion travel support, about 10 times the average three years ago. As demand goes up, services are getting more expensive and donations have slowed. Since the ruling in Dobbs v. Jackson Women’s Health Organization, which overturned Roe, the cost per client at Jane’s Due Process has tripled.

“When people see these terrible things in the news, they want to be part of the solution and this work that they care about,” Davé says. “But often, the shock can wear off and people are busy with their lives and their challenges, so we have seen a slowing in that outpouring of support.”

Reproductive rights organizations are also facing higher expenses, including information security costs and legal fees. “We are under such scrutiny and we are targets,” Davé says. “We work really hard to comply with the laws that are in place, though they are wildly unjust.”

The biggest risk for the Texas organizations is the regularly shifting legal environment, which could shut down their services at any moment. Rodriguez says Jane’s Due Process is gearing up for a “brutal” legislative session next year.

Out-of-state abortion travel is at risk in a handful of states outside Texas. In Missouri, which also has an abortion ban, the city of St. Louis in 2022 created a $1 million fund for abortion travel that is now held up in court. Missouri Attorney General Andrew Bailey sued the city, arguing that the fundviolated state law, and was granted a preliminary injunction to stop the city from allocating the monies to reproductive rights organizations.

“Hope is a discipline, and every day we get up and strap on our shoes and do what we need to do,” says Rodriguez. “If they do pass more bills, we’ll be out here fighting.”