Verónica Cruz Sánchez, a Mexican activist who has sent hundreds of abortion pills across the border since 2022, was in Los Angeles being honored at Time Magazine’s “Women of the Year” gala on March 8, 2023, when the flood of phone calls began. She was sharing a table with celebrities like actress Cate Blanchett and singer-songwriter Phoebe Bridgers, but she couldn’t focus on the ceremony.
That night, her team had planned to deliver abortion pills to a pregnant domestic abuse victim in Texas while the woman’s husband was out working. But he had returned home sooner than expected. “If they (the pills) get here,” the victim texted Cruz Sánchez, “he will kill me.”
Cruz Sánchez spent a good part of the dinner coordinating with people across the border to stop that from happening. Finally, they managed to contact the driver and told him not to deliver the package. The victim later texted Cruz Sánchez that she would have to have the baby.
Similar stories are happening across Texas. Since the landmark U.S. Supreme Court decision that overturned Roe v. Wade in 2022 — also known as the Dobbs decision — and the 2021 Texas ban on abortions after a fetal heartbeat is detected, a growing number of domestic violence shelters are taking in more pregnant women or mothers with newborns.
Pregnant survivors present an additional burden for the shelters, which are also having to reject more victims because of lack of space. In 2023, 59% of survivors in Texas had to be referred elsewhere, compared with 39% in 2021. The Texas Council on Family Violence has warned of a “capacity and safety crisis in our state” due to the shortage of beds.
Asked to comment on the situation, a spokesperson for Texas Health and Human Services pointed to the agency’s Family Violence Program, which “promotes safety, self-sufficiency, and long-term independence of adult and child survivors of family violence.”
In an email to Public Health Watch, Molly Voyles, director of public policy at the Texas Council on Family Violence, said that while she recognized the state Legislature’s efforts to support shelters, survivors’ need for services keeps increasing. “TCFV looks forward to continuing our partnerships with legislators to include funds that address this capacity crisis,” she wrote.
Family Violence Prevention Services, the largest domestic violence shelter in Bexar County, has seen a 12% increase since 2022 in clients who are pregnant or have newborns.
Administrators at three other Texas shelters — Wise Hope Shelter & Crisis Center, Family Time Crisis & Counseling Center and Hays Caldwell Women’s Center — told Public Health Watch they also have witnessed an increase in pregnant women seeking help.
“Things are very complicated for these women,” said Marta Prada Peláez, CEO of Family Violence Prevention Services. “Looking for help, going out of the city, leaving the state to have an abortion is completely impossible.”
In July 2022, just a month after the Dobbs decision, a woman who already had a child and had recently found out she was pregnant arrived at Wise Hope Shelter & Crisis Center in Decatur, a rural community north of Fort Worth.
The victim was “extremely worried” about her and her child’s safety and very afraid of her abuser finding out, Brittany Mott, the shelter’s director, said. The woman managed to travel out of state to interrupt the pregnancy but had to jump through many hoops.
In that case, the woman’s abuser had been trying to get her pregnant to stay connected to her “forever,” Motte said. That type of abuse, known as reproductive coercion, is relatively common, said Melissa Prentice, the outreach, education, and prevention director at Bay Area Turning Point, a domestic violence shelter in the Houston area.
Sometimes men will frankly state their intentions, Prentice said. “But most of the time what we see is them interfering with contraception. So, not using a condom or poking holes in condoms.”
As in the Wise Hope Shelter survivor’s case, women often realize that it will be harder to cut ties with an abuser once there is a child involved. Even if they already have a child, “they know this is another 18 years that I am going to be connected with or expected to deal with the other parent,” said Christina Allen, the CEO of Family Time Crisis and Counseling Center, a domestic violence shelter in Humble, near Houston.
A common misconception about domestic violence is that abusing the child’s mother will disqualify the father from having parental rights, said Melissa Rodríguez, CEO of the Hays-Caldwell Women’s Center, but that is often not the case. “It’s extremely rare to have a judge terminate supervised visitations when there is domestic violence,” she said.
One of the most requested services in Rodriguez’s organization is a support group focused on co-parenting with an abuser. It’s not easy for survivors to see their abusers constantly, even if it’s just to exchange the children. “From a mental health perspective alone, that can be very traumatizing for a domestic violence victim,” Allen said.
While reproductive coercion has long existed, Rodríguez said, “the difference is that now the options are fewer” since the Dobbs decision and the Texas law barring abortion after six weeks. Most women don’t know they are pregnant by then and the number of abortion providers fell by half after the law went into effect.
“A six-week ban — it’s a total ban. Let’s be honest,” said Emilee Dawn Whitehurst, president of the Houston Area Women’s Center. “But when we lost [constitutional abortion protections] completely, it was another blow.”
Earlier this month, a study by Tulane University found that the Dobbs decision more than doubled the distance a woman had to travel to get an abortion in Texas. The 2021 state law increased the distance by an average of 213 miles; after the Dobbs decision, that number rose to 457 miles, a trip that typically would take at least six hours. After Louisiana, Arkansas and Oklahoma passed abortion bans,it became even harder for women on the Texas Gulf Coast to reach abortion clinics.
“With the original restrictions [imposed by Texas], we found that neighborhoods in the south part of Texas were most disadvantaged by abortion bans,” said Sydney Sauter, a doctoral student at Tulane and the lead author of the recent study. “With Dobbs in place, we saw the burden [also] shifted to the Gulf Coast.”
Women are still interrupting their pregnancies with abortion pills like the ones Cruz Sánchez sends. In July, researchers at the University of California San Francisco published a paper showing that the percentage of women taking the pills, a procedure known as medical abortion or self-managed abortion, rose from 2021 to 2023. But medical abortions are only recommended by the World Health Organization until 12 weeks.
Research shows marginalized women are more likely to seek care later in pregnancy, Sauter said. Having to find child care or to take time off work can delay a patient’s ability to seek care. “During that time, you are just getting more and more pregnant,” she said. “And you don’t have the option to do a medical abortion anymore.”
Allen recalled the case of a woman who did not find out she was pregnant until she was staying at the Family Time Crisis shelter. It was “devastating” to her, and the therapist on staff feared the woman was in the midst of a mental breakdown. “I am barely holding it together with the children I have now,” Allen quoted the woman as saying.
In August 2023, Rachel, a 22-year-old mother, got to the Family Violence Prevention Services shelter after running away from her abusive partner. He had been denying food to her children the night before — something he often did. When she complained, he threw the candy for her son’s upcoming birthday on the floor. “They can eat that,” she recalled him saying.
The couple started arguing, and he tried to set their bedroom on fire, threatened her and her children with a gun and said he would bury them in the backyard. It took her a few minutes to decide to leave the next morning. “If he wakes up and sees us leaving, it’s going to get worse,” she recalled thinking.
Rachel, who asked that her real name not be used for this story, was watching her 6-year-old play on the shelter’s patio and drinking coffee when her stomach began to hurt. Months before, she had suspected she was pregnant but had seen some blood and assumed she’d had a miscarriage. A few days later, a doctor confirmed that Rachel was pregnant. Her baby was born in March.
Like many women, she hadn’t had any medical follow-up before getting to the shelter. She never went to the doctor because her ex-partner never took her. She and her children could barely leave the room they were staying in. “Sometimes women come to us, they know they are pregnant and that’s all they know,” Allen said.
With more pregnant women among their clients, domestic violence shelters must plan where the baby will be born and make sure women have the prenatal care and the nutrition they need. “We have had to buy many more diapers,” said Prada Pélaez, of Family Violence Prevention Services.
The scientific literature on intimate partner violence has consistently found that violence tends to escalate during pregnancy. In September 2022, a paper in the American Journal of Public Health found the risk of homicide was 35% higher for pregnant and postpartum women, compared to those who weren’t pregnant. That same year, another study by Harvard University found homicide to be the leading cause of death among pregnant women.
Moreover, data shows a generalized increase in domestic violence in Texas. In 2023, for instance, Texas domestic violence centers received 43,000 more calls than in 2022. The National Domestic Violence Hotline took 63% more calls from Texas in 2023 than it did in 2021.
And local shelters are also dealing with the consequences. The number of nights survivors spend in domestic violence centers increased by 23% in the 2023 fiscal year compared to 2021, and 59% of victims who requested shelter in 2023 were referred elsewhere “due to lack of space,” according to the Texas Council on Family Violence. This year, the referral rate was 50%.
Finding shelter can be even more challenging for those who are pregnant. Sarah Nejdl, whose organization, Families to Freedom, provides transportation for domestic abuse victims, has seen shelters decline to accept pregnant ones. “A lot of our domestic violence shelters are not equipped to handle the care and what’s needed for a victim who comes in pregnant,” she said.
Last year was a “historical year for TCFV and the domestic violence field,” a spokesperson for the Texas Council on Family Violence wrote in an email to Public Health Watch. The Texas Legislature allocated $88 million to family violence centers across the state for core services like counseling or housing and also for prevention and education. While state funding increased for the 2024-2025 biennium, some federal funding sources have decreased. A few weeks ago, Mother Jones reported that the balance of the federal Crime Victims Fund, a pot of money that helps support shelters nationwide, had plummeted. Texas, for instance, went from receiving $155 million in 2017 to $68 million this year.
The Houston Area Women’s Center is building a new facility to increase its capacity from 120 women and children to 360. The project began in 2019, when the center was already turning away clients for lack of space. The Dobbs decision and the lack of gun safety legislation in Texas have exacerbated the situation, Whitehurst, the shelter’s president, said.
“We do not have enough beds for those who need them,” she said, “even when we know they are in lethal danger.”