On the evening of March 5, Texans gathered to mark the closure of abortion clinics in two Texas cities—one a public vigil, another a private gathering, both befitting the particular politics of two Texas communities that, for the first time since Roe v. Wade, are without a legal abortion provider.

The Whole Woman’s Health clinic in McAllen had been the last operating abortion clinic in the sprawling and largely rural Rio Grande Valley, while in Beaumont, another Whole Woman’s clinic served East Texas and an area known as the “Golden Triangle,” a swath of Gulf-bordering land where about 20 percent of the population lives below the federal poverty line.

At Whole Woman’s Health in McAllen, bordering Reynosa, Mexico, clinic owner Amy Hagstrom Miller hosted a candlelight vigil for her employees and their supporters. They took turns reading, often through tears, snippets of stories from the thousands of Whole Woman’s patients treated over the years.

“This is very similar to my actual story,” read one young woman, quoting her anonymous patient: “I am 23 years old. I live in McAllen. I’m a single mother, with one child.” Another: “I’m from Mercedes, I’m 33 years old, a mother of two, and I’m living with my parents.” And another: “I just turned 18 years old. I am unemployed and a full-time college student. I cannot afford to have a child.”

But in Beaumont, about an hour east of Houston and a world away from its snarled traffic and high-rise towers, Hagstrom Miller decided to do something more private, inviting her employees there to gather at their clinic behind closed doors.

Abortion just isn’t something folks in East Texas talk about with company—let alone gather in public to support. If abortion makes a public appearance at all, it’s in the form of the sun-faded anti-choice billboards that dot the landscape between clusters of pine trees and rolling farm and ranchland, featuring toddlers in biker gear who are “Born to Ride!” Others show grinning infants excited about heartbeats that began either at 18 or 24 days after conception—the consensus seems to vary from one two-lane highway to another.

And so Hagstrom Miller’s Beaumont staffers joined their McAllen colleagues and supporters at a virtual vigil, linking in by video conference, their voices broken both by tears and an occasionally spotty Internet connection.

“Personally, I’m simply devastated,” said Marva Sadler, surrounded by a handful of her former Beaumont colleagues as the crowd in McAllen shaded their eyes from the setting sun to see their East Texas counterparts on a projection screen.

“I am so very worried about the women and their families in Beaumont, the Golden Triangle, and the southwest region of Louisiana,” she continued.

The stories of East Texans who seek abortion care—many of whom call the Lilith Fund, a hotline that provides financial assistance for Texans who need help funding their procedures—are as varied as the folks who live there: there’s the woman left “high and dry” by an ex who “didn’t really care” about her pregnancy, the newly pregnant woman already raising a 10-month-old, the woman whose partner “disappeared as soon as she told him about the pregnancy,” the woman who went in for a prenatal check-up only to find her baby had no cranial structure.

And the one refrain that seems to tie them together: “This was the best decision she could make for her and her family.”

And so the number of legal abortion providers in Texas dropped once again in the wake of the passage of Texas’ omnibus anti-abortion law, HB 2. Its four provisions—restricting medication abortions, banning abortion after 20 weeks, requiring doctors who provide abortions to obtain hospital admitting privileges, and mandating that abortion clinics operate as ambulatory surgical centers—are expected to eventually leave Texas with just six legal abortion providers come September.

The Valley’s clinic mourners closed their vigil with a somber candlelight walk, their chants of “We will not forget!” echoing off the buildings of downtown McAllen as a handful of anti-choice protesters stood on a nearby street corner, praying in celebration.

In Beaumont, the closure was similarly marked with candlelight, but quietly—no public mourning or protests—with a handful of clinic workers gathered in just one small room in a small Texas town where residents have been left without safe, legal abortion care for the first time in 40 years.

Behind the Pine Curtain

Cross an unfamiliar threshold in East Texas—anywhere in the 200-mile or so stretch from the eastern borders of Dallas, Waco, and Houston all the way to the Louisiana state line—and you won’t know whether to expect the warmest reception of your life, or the coolest. I once spent an hour and a half trying to strike up idle conversation over Jell-O shots and tallboys at a Beaumont dive, to no avail, but have also met gas station attendants who wanted to tell me their life stories—and hear mine—before handing over the bathroom keys.

My parents, and their people going back five or maybe even six generations, hail from the smattering of tiny towns between Dallas and Texarkana and Shreveport—towns charmingly twanged and, in some cases, aspirationally named: Annona (Ann-OWN-uh), Avery (EH-v’ry), Detroit (DEE-trawt), Paris (Pairse). Northeast Texas tends to be more white and Hispanic; southeast Texas has more Black folks, especially out toward southern Louisiana.

It is a geographically beautiful place, as anyone who has seen the “pine curtain” first-hand will attest. It is a place where neighbors get together to fry frog legs and eat hundreds of pounds of crawfish on Sunday afternoons. A place where a stranded motorist can depend on the next passing car to pull over with a helping hand, where folks poking down backroads on tractors never fail to give a wave or a tip of their hats.

A lot of East Texans work in the oil fields out in the Gulf of Mexico. A lot of people work farms and ranches. And a lot of people can’t find decent-paying work at all—especially not when the plant and factory jobs dry up. People drink. People make, deal, and use a fair amount of methamphetamine. Sometimes even the police chief gets in on the drug game.

One East Texan I talked to described their experience spending 30 minutes trying to work—at a state-funded institution—while a fellow employee “laid hands” on them, praying to Jesus Christ for the swift recovery of their sick parent. Unpaved beer-joint parking lots—usually set off to the sides of the two-lane blue highways that snake through East Texas farmland and into the piney woods—quickly get full up with oversized trucks and gargling motorcycles come 7 p.m.

Dallas and Houston, the westernmost metropolitan gateways to northeast and southeast Texas, tend to lean blue—both cities have, for example, non-discrimination ordinances that protect people on the basis of race, religion, sexual orientation, or gender identity.

But outside of these urban loops, things get redder. Much redder. The kind of red where gay couples are called “f*gs” by restaurant employees. The kind of red where a woman can lose her substitute teaching job because she is transgender. The kind of red where it’s weirder if a roadside stand selling sweet tea, decrepit lawnmowers, and “We Don’t Dial 911” signs doesn’t have a prominently displayed confederate flag on the premises.

And indeed, race relations in East Texas are particularly complicated; the area is home to Jasper, where in 1998 three white men dragged a Black man named James Byrd to his death, behind a pick-up truck. Last fall, in nearby Hemphill, a Black man named Alfred Wright was found dead in a field after local law enforcement leaders—all white men—appeared to delay an investigation into his disappearance, bringing up simmering tensions between a Black community hoping to have, at last, a serious conversation about racism, and a white community that would rather pretend those tensions didn’t exist in the first place.

And somewhere on the road between Beaumont and Orange, Texas, this last spring, a Ford F-250 gunned past me on a two-lane highway, boasting an “I <3 BIG OIL” bumper sticker on its back window.

Red.

While the Rio Grande Valley has seen national and international coverage of the impact of Texas’ new abortion restrictions and family planning budget cuts there, a similarly serious situation exists in East Texas—though its manifestation differs somewhat from the reproductive health-care crisis unfolding in the blue-tinted Valley.

Cultural taboos around having sex—and around talking about sex—are especially strong in rural and suburban East Texas, and the extreme right-wing Tea Party has a firm—and strengthening—hold on voters and public officials in an already deeply socially, politically, and fiscally conservative area. A decade ago, redistricting turned East Texas’ once-Democratic First Congressional District into an easy-win playground for native son Rep. Louie Gohmert, a now five-time congressman who believes the Obama administration is teeming with members of the Muslim Brotherhood and that terrorists are birthing babies on U.S. soil to create a secret army of future spies. East Texas is also home to Texas A&M University, a proudly conservative stronghold in the Texas public university system.

Budget cuts championed by conservative state legislators have forced Planned Parenthood to shutter three East Texas clinics, none of which provided abortion care, in 2013. That reproductive health-care organization has been able to keep only one of its East Texas clinics, in Tyler, open thanks to a federal Title X grant that also helped it re-open a facility in the Rio Grande Valley last fall. (Full disclosure: I have a friendly relationship with Planned Parenthood Gulf Coast, which operates clinics in Southeast Texas and Louisiana, and have spoken at the group’s annual Roe v. Wade anniversary luncheon.)

Abortion providers in Waco, Bryan, and Beaumont—two Planned Parenthood locations, and that Whole Woman’s Health clinic—have all either shuttered or ended abortion care in the last year. Today, East Texans must travel hundreds of miles roundtrip to Houston, Dallas, or Shreveport for legal abortion care. And unlike in the Rio Grande Valley, where health-care professionals worry about pregnant people crossing the border to and from Mexico to buy the abortion-inducing drugs that can be purchased over-the-counter at pharmacies there, there is no easy access to the drugs that, while illegal, may be the safest, and one of the most common, methods that Texans choose to self-induce abortions when they cannot access a legal provider hundreds of miles away.

Marva Sadler at Whole Woman’s Health estimated that their Beaumont clinic alone saw about 3,000 patients per year. She now works at the Whole Woman’s Health in Fort Worth, which will close in September along with all but six of Texas’ existing abortion providers. Then Texans will need to travel to one clinic in San Antonio, one in Fort Worth, one in Dallas, one in Austin, or two clinics in Houston for legal abortion care inside state lines. But some of them are already heading to Louisiana, because as one anonymous Dallas abortion provider wrote in Women’s eNews in May, providers in Texas are “swamped,” often working through the night to see desperate patients.

“We are getting calls from [Texas] women who can’t get into any of the available clinics without a waiting period,” said Kathaleen Pittman at the Hope Medical Group for Women in Shreveport. At Hope, Pittman can get clients in the next day for patients early in their pregnancies. In Dallas and Houston, patients now often have to wait a week or more for their first appointment—the one that precedes Texas’ mandated 24-hour waiting period unless a patient can prove they live more than 100 miles from any legal abortion provider—and many Texas providers have stopped prescribing medication abortions altogether due to the provision of HB 2 that mandates patients visit the clinic four separate times to take two abortion-inducing pills.

For now, at least, Hope can see patients quickly, though they still must obey a mandated 24-hour waiting period law, just as Texas providers must. And soon, Hope’s abortion providers—indeed, all Louisiana abortion providers—will be forced to obtain hospital admitting privileges, thanks to a Texas-style omnibus anti-abortion access bill that passed the Louisiana legislature 88-5 in late May. When that law goes into effect, Hope is expected to become one of two remaining legal abortion providers in Louisiana, with the other located just a few miles away in nearby Bossier City—300 miles from New Orleans. The last abortion clinic in Mississippi, in Jackson, is 200 miles from Shreveport and New Orleans.

There isn’t a looming reproductive health-care crisis in the South. It has already arrived.

“We Don’t Even Talk About Good Sex Here”

2010: “The sexually transmitted disease syphilis is on the rise in East Texas.”

2012: “Houston’s health department reported a near doubling in the number of new infectious syphilis cases during the first eight months of 2012 compared to the same period last year.”

2013: “Worst syphilis outbreak in 60 years.”

2014: Primary and secondary syphilis “concentrated primarily along the I-35 corridor and eastward.”

In terms of common sexually transmitted diseases (STDs) like gonorrhea, chlamydia, and syphilis, Texas is the eighth most infected state in the country, with its highest concentration of STD outbreaks located in East Texas. Neighboring Louisiana ranks number one. Trailing Louisiana: Mississippi, Georgia, and Alabama.

Sex education for public school students is wholly optional in Texas, where the vast majority of districts choose abstinence-only programs; in Louisiana, sex education is also optional, but when it is included in curricula, it must be abstinence-only, and it may not be provided by any abortion-affiliated person or group. In May, Louisiana legislators also rejected a proposal that would have let the state’s Department of Education ask students questions about “risk behavior associated with chronic health conditions, including those related to sexual health.”

It’s no wonder, then, that along the porous border between rural East Texas and western Louisiana, folks really don’t like talking about abortion.

“If there wasn’t a stigma attached to abortion, people here could talk about it all day long,” joked Kathaleen Pittman when I met with her and her colleagues at Hope Medical Group in Shreveport this May. Folks in her neck of the woods can talk—and talk, and talk—but they get quiet when the subject of reproductive health care comes up.

Hoping to speak with supporters of women’s health care in East Texas, I reached out to the Temple Foundation, a philanthropic organization that in 2006 made a “generous lead donation” to a new $1.5 million Planned Parenthood facility in Lufkin, a two-hour drive northeast of Houston. Previously, the Planned Parenthood facility there had been operating out of a Junior League-provided location since 1977.

Today, that $1.5 million facility has shuttered, and Lufkin’s Junior League declined to talk to me about their involvement with Planned Parenthood. The Temple Foundation eventually began hanging up on my calls when I telephoned hoping for an interview with its leadership. Other private citizens who’ve done fundraising and reproductive health-care outreach in East Texas backed off of interview asks—one demurring because their spouse is a public official in a rural county, and they feared it would have negative political repercussions.

So I turned to East Texans and Louisianans who talk about taboos for a living. People like Brooke King, the director of programs and services at the Women’s Center of East Texas, a domestic violence shelter and rape crisis center with several locations in the area.

“We don’t even talk about good sex here,” she cracked, laughing in her cozy, dimly lit office in the back of a Tyler strip mall. Bad sex? Negative consequences of sex? Rape? Out of the question.

King says she especially walks a fine line when she does healthy relationship education in schools, because parents are especially wary of outsiders giving their children “permission” to have sex outside of marriage.

“Our parents aren’t talking to their kids about it,” she told me. “It’s this idea that if we talk to our kids about it, it’s only giving them permission. We only believe in abstinence. Which is fine! And abstinence is the safest way to be, hands down. We get that. But we also get that when we have, continuously have, 13-year-olds who are in school who are pregnant, abstinence is not something you can force.”

But in particular spaces, like university classrooms, abortion clinics, and King’s domestic violence shelters, the walls come down—for East Texans of all ages.

King says she often works with her shelter clients who are especially burdened by religious mandates to obey their spouses and partners, who feel as though they cannot, biblically, say no to sex or say yes to planning their families.

“Religion.” King sighed.

“God love religion. It serves such a great purpose, but it’s twisted so much. It makes it really easy for abusers to get their point of view across.”

King keeps a special book in her office, a kind of Bible study guide to help battered women better understand the scriptures that are so often used to keep them silent and submissive. Rarely, said King, does she meet women who have been explicitly told not to take birth control, or whose husbands have outright taken it away from them. Instead, the pressure to bear children, and to submit to coerced sex, is more subtle.

“We see reproductive coercion,” said King, but she says it’s frequently “masked” by religion. “People don’t recognize it as such,” she said, until they get to talking with someone like her, usually in the aftermath of a domestic violence call or visit to a SANE—Sexual Assault Nurse Examiner.

Before the Whole Woman’s Health clinic in Beaumont closed, Marva Sadler told me, they were the unofficial health-care “navigators” for the Golden Triangle area. When Sadler would work on clinic scheduling, she would always make sure to block out extra phone time for callers—once they got on the phone with a Whole Woman’s receptionist, they would unburden themselves of their entire back-stories, or explain complicated health situations that might have had nothing to do with abortion, but which they hoped Whole Woman’s could provide answers to.

“When [clients] called on the phone, from the moment they call and make their appointment, you nine times out of ten know their life story,” remembered Sadler. “You have to allot extra time on the phone, because she is going to tell you everything from the moment she got pregnant. You develop that relationship from the beginning.”

“If I close my eyes,” said Sadler, “I still remember their faces.”

When people couldn’t get information about sex and contraception from their families—”If you get pregnant or you’re having sex and you need contraceptives, you ask grandma, and if she can’t tell you, you just don’t get it,” said Sadler—they turned to Whole Woman’s Health.

And low-income East Texans also once turned to the now-shuttered Planned Parenthood facilities in Lufkin, Huntsville, and Bryan. Today, those Texans must wait weeks, or sometimes months, for Pap smear and contraception appointments at county health clinics when they find themselves uninsured. And about half of working-age, low-income adults in East Texas are uninsured.

Now that East Texans have lost so many of the resources that were available to them in recent years, some residents are particularly trying to open up conversations about health and sex that start before that phone call to Planned Parenthood or Whole Woman’s Health. Often, those conversations start on college campuses.

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“I Feel Like I’m on Another Planet Sometimes”

“It’s almost like it’s the 1950s out here,” Savannah Anderson-Bledsoe, a student at Lamar University in Beaumont and one of the founders of the school’s nascent feminist club, told me. Driving through the campus to meet her, I pass a crisis pregnancy center adjacent to a sand volleyball court filled with undergraduates in tank tops and bikinis.

One of the very first things that Anderson-Bledsoe explains is that “the gender norms down here are so rigid.” That’s not something she’s necessarily used to.

A Georgia native and child of a single mother who spent her high school years in Austin, 20-year-old Anderson-Bledsoe said she loves Beaumont, and she loves her college, but “coming from Austin, I feel like I’m on another planet sometimes.”

With her group, Feminists of Lamar, she says she’s trying to “change things one day at a time” by starting small conversations with her fellow students—students who, she says, feel immense pressure to find a spouse in college, and to marry soon after, if not during, the course of their schooling. Her club’s hosted screenings of Miss Representation, the documentary that examines the objectification of women in popular media, have hosted clothing drives for local women’s shelters, and they’re hoping this year to work with young teens in middle school on a self-empowerment project.

Anderson-Bledsoe told me she hates to see her fellow students—many of them, like her, “Black women who are empowered, strong”—put such an emphasis on finding a (heterosexual) relationship to avoid single motherhood, and she feels for the men in her community who she says are pressured to fulfill an unattainable version of masculinity, unable to hug their brothers or cry when they are upset.

“Women, a lot of them out here feel like they should want to take care of a man and a family,” explained Anderson-Bledsoe, from a booth in the comfortable, cool-toned common room of her campus dorm. And the guys? “The men out here are helpless,” she jokes.

But what really gets her, she says, is her fellow students’ difficulty separating the sin from the sinner when it comes to topics like premarital sex and abortion.

Almost everyone I talked to in East Texas stressed the importance of Christianity in their and their neighbors’ lives—for better and for worse. Church is inextricably entwined with a broader, socially enforced mandate to avoid premarital sex—or at least avoid letting anyone know you’re having it—to marry early, and to, ideally, settle down to have children, with “Dad” going to work and “Mom” staying home with the kids, in the same town you grew up in.

And of course all of this is drowned in mandated heteronormativity and traditional gender roles, within a social system that is set up not for prevention, but for punishment.

“When someone has an abortion, it’s an abomination,” said Anderson-Bledsoe. But if you don’t have an abortion, and you’re a single mom working to support your family, “you’re judged.”

Anderson-Bledsoe’s fellow Feminists of Lamar founder, Shelby Murphy, echoed her classmate’s concerns. A 20-year-old who’s lived her entire life in her parents’ home in Beaumont, Murphy said that while East Texans her age are especially taking “baby steps” toward more open-minded thinking, “it’s hard.”

Murphy said she was “scared” when she heard that the Beaumont Whole Woman’s Health clinic had closed, though as she was growing up, she didn’t even know Beaumont had an abortion clinic at all. It simply wasn’t discussed. Now, she worries that in a community that can be as tight-lipped about social issues as Beaumont can be, “they won’t see the after-effects” of diminishing access to abortion care.

Talking to these norm-defying college feminists, the thing that stuck with me the most was a casual joke that Anderson-Bledsoe made near the end of our chat.

“When it’s 2020 in the rest of the world, in Beaumont it’ll be 1992.”

Planned Parenthood: Texas’ Only Abortion Provider?

But willful blindness and ignorance to the consequences of bad health policy is certainly not unique to East Texas—it’s a statewide affliction, particularly among the conservative, Republican, and anti-choice Democrat legislators who have spent the past several years finding new ways to restrict abortion and to cut family planning funds.

The particular target of their ire has been Planned Parenthood, an organization which they have relentlessly tried to force out of the state. But Texas’ restrictive abortion laws may have had an unforeseen side effect—at least one unforeseen by the state lawmakers who have been saying for years that they hope to regulate the provider out of business. It’s a side effect that has to do with the choice within a choice—or perhaps, that very limited choice within a very limited choice: where Texans can go for their legal abortion care.

When the ambulatory surgical center provision of HB 2 is put into effect on September 1, half of the six remaining abortion providers in Texas will be Planned Parenthood facilities. If Planned Parenthood is able to open another projected San Antonio ambulatory surgical center by that deadline, it will then run four of the state’s seven existing legal abortion providers.

Instead of ushering Planned Parenthood out the door, conservative and anti-choice lawmakers have ensured that patients who seek legal abortion care are more likely than ever to get it—if they can make it to a legal provider at all—at Planned Parenthood. And it’s important to remember that legislators simultaneously slashed family planning funds and dismantled, then relaunched, a low-income contraception program—now called the Texas Women’s Health program—that today sees a fraction of the clients it served at its peak.

The bright new Planned Parenthood Center for Choice ambulatory surgical center in Houston will likely become the de facto destination for East Texans who might otherwise have chosen care at a smaller, more local provider like Whole Woman’s Health. Depending on the legislative situation in Louisiana, and whether doctors there are able to secure admitting privileges in their home communities, it may also become the only option for pregnant folks from Baton Rouge and Lake Charles who would otherwise have chosen Whole Woman’s Beaumont, or even Hope Medical, with their hot tea service in recovery rooms and clinic-style procedure facilities.

Because while the Planned Parenthood Center for Choice is a beautiful medical facility, it feels like a hospital—just as ambulatory surgical centers are meant to be. The hallways are wide enough for two large gurneys, and procedure rooms must be maintained for temperature and humidity at all times, making them chilly and also hard to regulate with the Texas sun pouring through the former bank building’s windows.

Before their procedures, says Tram Nguyen, the director of the Center for Choice ASC, “Patients stop in the doorways. ‘I thought you told me it was minor,’ she says they tell her. ‘This is an operating room.’”

Nguyen has worked at Planned Parenthood for years, the most tenured member of the staff in Houston. She told me that she complies with the ASC regulations because, legally, she has to—but she, and a number of mainstream medical professionals and organizations, see the ASC regulations as totally medically unnecessary. She fondly recalls days in Planned Parenthood’s smaller, homier abortion clinic, but is dedicated to defying legislators’ efforts to shut down legal abortion care in Texas.

“We’re not going anywhere,” she said, after walking me through the facility, peppering her tour with stories: the patient from the South Texas oyster fields who traveled hundreds of miles for her procedure, the sobbing, screaming patients she couldn’t help after Texas passed its 20-week abortion ban, the woman who drove all night from Mississippi and slept in the parking lot.

“We’ll figure it out,” Nguyen told me. They have to. “It’s kind of a kick to prove that to the state.”

But while Planned Parenthood in Houston—and other urban-area abortion providers who can afford to rent or build ambulatory surgical centers—may have the resources to keep their doors open in the coming months, a larger question looms: whether any but the wealthiest abortion-seeking Texans, with access to cars and time off work and child care for the children they already have, will be able to walk through those few remaining doors.