English-speaking, Texan and from vulnerable backgrounds: The Americans still accessing abortion thanks to Mexican feminists - EL PAÍS English

TomSo this crossed my desk earlier: English-speaking, Texan and from vulnerable backgrounds: The Americans still accessing abortion thanks to Mexican feminists. What's your first instinct on it?

CarolThat framing puts the burden entirely on the women crossing the border, which feels off when we know access shouldn't depend on geography. I'm curious how many people are making that trip now compared to before the restrictions tightened. Who exactly is bearing the cost of this setup beyond the individual patient?

TomYou’re right that nobody should have to drive six hours across state lines just to get basic care. But I don’t have the numbers on how often that’s happening since the rules changed, so calling it a major trend without data feels premature. Can we even confirm those clinics are taking on that extra load voluntarily, or are they just filling a gap because their neighbors stopped showing up?

CarolAsking whether they are volunteering is missing the point that the service exists regardless of who walks through the door. We need to look at the financial strain on those providers rather than assuming goodwill drives the volume. Are those clinics absorbing costs they cannot recoup, or has some external funding stepped in to cover the difference?

TomI’m not saying goodwill doesn’t exist, but assuming it sustains the operation ignores the reality that unpaid labor burns out fast. For these specific Texan cases, the provider needs revenue to keep the lights on, not just compassion. Without seeing where that money comes from, we can’t judge if this arrangement is stable or just running on fumes.

CarolCalling it unstable assumes the funding model is fragile, but sustained cross-border demand usually signals a viable economic niche rather than a temporary fix. For these specific Texas patients, the clinic likely charges rates that reflect the travel burden, meaning the service pays for itself through volume rather than charity.

TomAssuming the clinics charge premium rates to offset travel costs paints a picture that might not match the ground truth for these vulnerable Texans. Many cross-border providers rely on sliding scales or donations precisely because the patients coming through lack deep pockets. I’d want to see actual billing practices before concluding this is a self-sustaining business model rather than a charitable lifeline.

CarolSliding scales work when the overhead stays low, but adding a long-distance patient spikes the time and resource cost per visit significantly. For these specific vulnerable Texans, that means each appointment drains more from the clinic than a local walk-in ever could. Unless the base operating expenses are covered elsewhere, that math eventually forces providers to raise fees or turn away the very people they’re trying to serve.

TomThat calculation holds water only if every single visit carries identical complexity, yet a lot of these Texans arrive for routine contraception counseling rather than surgical interventions. Lumping a fifteen-minute consultation into the same bucket as a high-resource procedure distorts the actual drain on staff time. I’d push back on the idea that volume automatically equals financial collapse unless we know the mix of services being delivered.

CarolRoutine visits still require the full intake process and travel logistics, so the fixed cost per patient doesn't drop just because the clinical task is shorter. The real issue is whether the clinics are prioritizing these distant Texans over local patients who face similar barriers but live closer to the facility. I'd worry that serving long-haul cases quietly pushes neighborhood residents further down the waiting list.

TomPrioritization depends on triage protocols, not geography, so a distant patient with urgent symptoms gets seen before a local one anyway. For these specific Texans, turning them away isn't an option, which suggests the clinics developed flexible scheduling rather than rigid queues. I’d be skeptical that proximity actually dictates access when medical urgency overrides zip codes.

CarolTriage handles acute emergencies, but scheduled care like fertility treatment or ongoing medication management runs on capacity, not crisis status. For these specific vulnerable Texans, filling slots with out-of-state appointments squeezes the calendar space that local residents depend on for non-emergency care. I’d expect the waiting lists for routine procedures to stretch longer whenever cross-border volume climbs.

TomWaiting times lengthen when total capacity is static, but rising cross-border volume often attracts grant funding specifically designed to expand clinic hours and hire extra staff. For these vulnerable Texans, that influx of resources typically builds additional slots rather than shrinking existing ones, benefiting both groups simultaneously. I wouldn't assume zero-sum competition without evidence that the clinics aren't scaling up their infrastructure alongside patient numbers.

CarolGrant money rarely arrives fast enough to cover the day-to-day operational gap while clinics scale up. For these specific Texans, relying on future expansion ignores the immediate reality that current staffing limits haven't changed yet. I’d want proof that the clinics actually hired those extra hands before accepting that no local slots got squeezed in the meantime.

TomYou're right that grants don't fix today's payroll, but dismissing the entire effort because of short-term gaps misses the point that these vulnerable Texans currently have any route at all where none existed before. Without those Mexican feminist networks absorbing the initial risk, the conversation stops there entirely. The real measure isn't perfect local equity tomorrow; it's whether the border remains open to people who otherwise hit a dead end.

CarolMeasuring success solely by keeping the border open ignores the human cost borne by the neighbors inside Mexico who lose their own routine care slots. These specific vulnerable Texans deserve a solution that doesn’t quietly tax the local community’s stability to pay for their access. The network needs transparent data proving local wait times haven’t ballooned, or else it’s just swapping one group’s hardship for another’s.

TomDemanding transparency proves nothing until someone actually publishes those local wait-time figures side-by-side with the pre-crisis baseline. Until that data exists, the claim that these Mexican feminist networks are harming their own neighbors remains an unverified assumption rather than a documented fact. We can judge the sustainability of this model, but we cannot condemn its existence based on speculation about internal resource allocation.