Conservatives, not fully satisfied with criminalizing abortion and pregnancy outcomes across the country, are now attempting to prevent pregnant people from accessing information about abortion care and seeking abortions outside of states where it is banned. In March, Idaho Attorney General Raúl Labrador issued a legal opinion that said the state’s abortion ban prevented Idaho medical providers from referring a woman across state lines for abortion care or prescribing abortion pills to be picked up in another state. In response, providers in Idaho stopped giving out-of-state abortion referrals in fear of criminal prosecution or licensure penalties. Planned Parenthood sued, and in August, a federal judge enjoined Idaho from enforcing the legal opinion.

The continued legality of abortion referrals is crucial to helping pregnant people access abortion care and ensuring health-care providers can supply their patients with information. Abortion referrals are also sometimes a next step after pregnancy options counseling, where a clinician or counselor provides pregnant people with unbiased, nondirective information about parenting, pregnancy termination, or adoption.

State abortion bans have created an environment of fear and uncertainty among health-care providers about what information they can provide to pregnant patients. That fear is especially troubling for providers and patients at Title X clinics, which are federally funded and provide reproductive and sexual health care to low-income people. In March, the Biden administration withdrew Title X funding from clinics in Tennessee because of the conflict between Title X’s directive that providers offer patients pregnancy options counseling and the state’s abortion ban.

Stephanie LeBleu, the Title X project director at Every Body Texas, an organization that supports sexual and reproductive health-care providers in Texas, said the state’s myriad of abortion bans and regulations have increased providers’ perceived risk of offering information and abortion referral services to clients at Title X clinics in Texas.

“The expectation under Title X regulations is that clinics who receive Title X funding have to provide neutral, factual, nondirective pregnancy counseling on all the options [to patients who request it],” LeBleu said. “That is the framework we’ve been working under since the beginning of Title X, and it’s how all of our clinicians and providers are used to operating. But because of all the nebulous prohibitive laws in [Texas], we definitely have providers that have assessed the risk for themselves—or the legal counsel has assessed that risk—and they’ve decided to forego [offering abortion referrals out of state]. And I would say it’s not necessarily because they wanted to. It’s because of all of the uncertainty.”

LeBleu said that Title X and Planned Parenthood clinics are some of the few spaces in Texas that are mandated to provide unbiased and neutral pregnancy options counseling at the patient’s discretion.

“That is one of the ways that Title X is important and related to pregnancy options counseling,” LeBleu said. “Clients should be able to receive medically accurate information about their options from the health-care providers that they trust, that [are] in their community, and to be able to ask questions with people that they trust. Without access to a space within the health-care infrastructure where they can get medically accurate information and valid service referrals, clients are kind of left to navigate all of that.”

The cooldown of comprehensive pregnancy options counseling in Texas is especially detrimental to pregnant Texans, given that misinformation about pregnancy exists online and fake abortion clinics, abundant across Texas, spread misinformation about abortion and pregnancy. Fifty-eight percent of Title X patients in Texas are uninsured and may face financial barriers to getting health care, and subsequently pregnancy options counseling, from other providers.

It’s also particularly detrimental to pregnant people of color: According to the 2021 Family Planning Annual Report, Title X clinics provide services to diverse groups of people. Women of color make up a substantial amount of Title X patients, and a recent study found evidence that Black pregnant people were significantly less likely than white pregnant people to receive complete pregnancy options counseling from providers. State abortion bans will likely exacerbate these disparities.

In Florida, where abortion is currently banned at 15 weeks, Rachel Stein, a senior nurse practitioner at Planned Parenthood of South, East, and North Florida, counsels pregnant patients on their options and provides them with information about community resources. Stein said that since some pregnant patients may be less informed about their pregnancy options because of barriers to education or health care, it is the provider’s job to make sure that patients leave with the knowledge they need to make decisions about their pregnancies.

“Some patients come in knowing information, and some don’t,” Stein said. “So we ensure that all of our patients, once they come to see us, have access to medically accurate information about their options, whether it’s continuing, choosing adoption, or ending their pregnancy.”

LeBleu said 70 percent of patients in Texas’ Title X network are at or below 100 percent of the federal poverty level, making the provision of Title X funds necessary to provide these patients with reproductive and sexual health care.

LeBleu added that unbiased, nondirective pregnancy options counseling is essential to ensuring reproductive justice.

“The ability of a person to receive accurate information and referrals about their pregnancy options supports their ability to exercise their rights to have a child or not have a child,” LeBleu said. “If you don’t have the information and you can’t find a trusted person to share that information with you, this probably won’t lead you to a place where you can actualize your autonomy over your body and what you want to do about your pregnancy.”