Clinicians and patients normalize the mental labor of contraceptive use.

Birth control pill

 The burden of preventing a pregnancy has long fallen disproportionately on those who would actually carry a baby. Yes, there are vasectomies and condoms, but it’s the uterus-owners among us who are tasked with taking pills, getting IUDs, or tracking ovulation in order to control reproduction. But according to a new study published in the Journal of Sex Research, there’s not just a physical burden of not getting pregnant, but a mental and emotional burden that comes along with it. And both clinicians and patients assume that the latter has to go with the former.
The study, done by Dr. Katrina Kimport of Advancing New Standards in Reproductive Health (ANSIRH), a reproductive health research organization based at UCSF, tracked 52 contraceptive counseling visits with women who said they didn’t want children in the future, and for whom all available contraceptive methods were an option. It showed that clinicians “articulated responsibilities associated with contraception that were integral to the physical work of using a method, but still fundamentally mental and emotional tasks.” The study also showed “clinicians generally did not question that these responsibilities were assigned to women.”

The clinicians, most of whom were women, also showed reluctance in offering a permanent option like sterilization, thus legitimizing the assumption that women are responsible for fertility work. “In the visits, clinicians regularly expressed doubt or dismissed women’s desire not to have future children, thereby reifying ongoing fertility, and the attendant mental and emotional burdens of contraception, as normative,” wrote Dr. Kimport.

In an interview with, Dr. Kimport said that often assigning the work of fertility to women seems like common sense. After all, most contraceptive methods work in the female body, and the stakes of pregnancy seem higher for women. However, she says it’s important to distinguish physical work from the mental and emotional labor that we tend to throw in with it. “It’s not just about having the medication in your body, it’s about the time, attention and stress that is associated with it,” she said. Picking up prescriptions, remembering to take the pill, the fear of the side effects. And most clinicians tended to normalize those aspects, figuring it came with the territory of preventing pregnancy. There was no “imagination that you could distinguish the physical experience from that mental and emotional labor.”

As much as women are socialized to assume this labor, men are also socialized against it. Dr. Kimport pointed to the research of Nelly Oudshoorn on clinical trials for male contraceptives, and why, though it is a technical feasibility, there is no male pill yet. Recently, a study for a male pill was halted, after side effects of depression (and one death by suicide) were reported. And though that was serious enough for the study to be halted, many women pointed to initial studies for women’s hormonal birth control having nearly identical results, and to how depression is a common side effect of hormonal birth control women are expected to endure. “That is definitely a manifestation of our social belief,” says Dr. Kimport, “that it’s important enough to women to prevent pregnancy that they would have a higher threshold of acceptability for some of the side effects.”

As for sterilization, Dr. Kimport says that, from a medical perspective, it would make sense for a clinician to favor a long-term, non-surgical option like an IUD rather than sterilization surgery, in terms of going for the least invasive procedure first. However, “a piece of that is a social comfort with the idea that women would continue to do fertility work,” and moving forward, we should be “pushing on how much people are using social criteria instead of medical criteria” to inform their decisions.

In general, Dr. Kimport hopes for an increase in “articulating the ways in which men are involved in some decisions around contraceptives.” That won’t necessarily apply to single women, women with multiple partners, or women who want to make these decisions on their own, but often men just aren’t expected to be part of the conversation. It also means a change in structure, whether that means birth control pills being available over the counter so men can take on the work of refilling them, contraceptive conversations being part of men’s doctor’s visits, or more options for male birth control being researched. “If the structure can be more welcoming, that’s a systemic way of encouraging a shared burden for fertility work.”

Source: Elle

Democrats must learn the right lessons from the recent kerfuffle over supporting anti-abortion candidates

Democrat Heath Mello, who has sponsored and voted for anti-choice legislation, is running for mayor of Omaha. Charlie Neibergall/AP

Since we’re apparently doomed to repeat 2016 until the heat death of the universe, Democrats are fighting again about Bernie Sanders and women’s rights. Sanders, along with Democratic National Committee Chair Tom Perez, took some heat last week for making a stop on the DNC’s “unity tour” to support Heath Mello – the Democratic candidate for mayor of Omaha, Nebraska, who turns out to have either sponsored or voted for a long list of anti-abortion bills during his time in the state legislature.

Mello is within striking distance of unseating the Republican incumbent mayor of Omaha, so he may have seemed to the DNC like a good poster boy for how Democrats can reclaim political power in red states. But in light of his voting record, many advocates argued that Democrats were treating women’s basic reproductive freedom as an acceptable bargaining chip to try to win elections in Republican-leaning areas. Again.

They wondered why it was OK for Sanders, that self-styled champion of progressivism, to shrug off Mello’s abortion record by saying, “I am 100 percent pro-choice, but not every candidate out there has my views 100 percent of the time” – while blasting Georgia Democratic congressional candidate Jon Ossoff as “not progressive” because he didn’t use the words “income inequality” on his website.

They wondered when Democrats, beyond Sanders, will live up to their own 2016 platform – which, by calling for the repeal of the Hyde Amendment and the restoration of federal funding for abortion, implicitly recognized abortion as an economic justice issue for poor women in particular. They wondered if Democrats will ever stop automatically treating reproductive freedom like a mere “social issue,” and start recognizing it as critical to women’s economic and social equality.

A number of commentators said these concerns were not just overblown, but also impractical for a party that wants to win elections. Panelists on Morning Joe argued that Democrats have “forgotten how to win,” and that they’ll shrink their tent unnecessarily if they insist on ideological “purity tests” for abortion. On Meet the Press Sunday, Chuck Todd challenged Nancy Pelosi on whether it’s possible to be both pro-life and a Democrat. “Of course,” she said – predictably, given that she has plenty of self-identified pro-life Democratic colleagues in the House.

But the idea that the Democratic Party is somehow “excluding” pro-life Democrats if it takes a hard line against abortion restrictions misses something incredibly important. And if Democrats want to win in 2018, and make good on their commitment to protect reproductive rights, and avoid having the same circular fights over and over again, they need to learn the right lessons from this mini-debacle.

For many Americans and politicians alike, “being pro-life” is an identity. It’s a moral worldview. That moral worldview often – but, crucially, not always – includes a commitment to outlawing or restricting abortion.

Believe it or not, while about 44 percent of Americans tell Gallup pollsters that they’re “pro-life,” only 28 percent of Americans actually want to overturn Roe v. Wade and end legal abortion. When you give people the option to say whether they’re pro-choice, pro-life, both or neither, more Americans say “both” or “neither” than either “pro-choice” or “pro-life.”

We get such conflicted and wide-ranging responses to abortion polling because many Americans feel morally ambivalent about abortion. But for the vast majority of Americans, that moral ambivalence doesn’t translate into a desire to outlaw abortion, or to put medically unnecessary legal barriers in a woman’s way to try to stop her from getting one.

According to a Vox/PerryUndem abortion poll I reported on last year, most Americans have no idea that states are proposing or passing hundreds of new anti-abortion laws every year. But when they learn about those laws – like the admitting privileges or ambulatory surgical center requirements that closed about half of all Texas abortion clinics – and what they actually do to restrict abortion, solid majorities oppose virtually all of the major abortion restrictions pollsters asked about. (The one exception was parental notification requirements.)

But for the modern pro-life movement, and for most Republicans in office, erecting these legal barriers is pretty much the whole point of being a pro-life lawmaker. Their ultimate goal is to outlaw all abortion. The intermediate goal is not to reduce abortions through better birth control access, but to make life more difficult for doctors who perform abortions, and women who seek them, in the hopes that more women who have unintended pregnancies will just decide to carry them to term – despite clear research showing that once a woman has decided to get an abortion, she very rarely changes her mind.

But not every lawmaker who calls themselves “pro-life” shares these goals, especially when it comes to Democrats. Heath Mello now insists that while his faith guides his “personal views,” as mayor he “would never do anything to restrict access to reproductive health care.” If Mello is true to his word, he’d be a “pro-life Democrat” like Joe Biden and Tim Kaine – one who has personal moral qualms about abortion, but still firmly believes that the government has no business telling women and doctors what to do about it.

Still, pro-choice advocates have good reason to be skeptical of Mello from a pure policy perspective. It’s not clear why Mello voted for multiple abortion restrictions from 2009 to 2011 in the state legislature, but now vocally defends Planned Parenthood on the campaign trail. Sure, the same can’t be said for Mello’s Republican opponent – incumbent mayor Jean Stothert, who opposes abortion rights – but that doesn’t mean pro-choice advocates can expect Mello to actively defend their position.

And right now, given the constant barrage of hostile state lawmaking and court battles, active defense is the minimum requirement to protect reproductive rights in America. That’s why many pro-choice groups have started going on the offense, from proposing laws that make it easier to access abortion to having women tell their personal abortion stories in public to fight stigma.

As Perez has now made abundantly clear, the Democratic Party supports abortion rights and opposes unnecessary restrictions, full stop. But to prevent this kind of kerfuffle in the future, the conversation should move away from bickering about who is a “pro-life Democrat” and whether they should be excommunicated from the party. Instead, it should focus very specifically on what those “pro-life Democrats” stand for. Every pro-life politician should be able to explain, in detail, exactly which restrictions – if any – they would ever find it acceptable for the government to impose on women seeking abortions or on doctors who perform them.

Source: Rolling Stone

Abortion providers have also seen a rise in intimidation and hate speech.

Abortion opponent Mary McLaurin, left, challenges clinic defenders who have blocked her sidewalk access from a car transporting a patient to the Jackson Women’s Health Organization Clinic in Jackson, Miss.

There was an increase in intimidation outside abortion clinics and obstruction of abortion providers in 2016, according to a National Abortion Federation report released on Wednesday.

Although incidents of extreme violence, such as murder, attempted bombings, and arson fell last year, incidents of hate speech and Internet harassment rose, and intensified after the election. Since the election, negative online commentary about abortion care and abortion providers has more than tripled from the pre-election monthly average in 2016.

The reported number of picketing incidents increased sharply and incidents of obstructed access to health care families more than doubled.

Extreme anti-abortion activists can shut down facilities and delay abortion care. For instance, last July a Virginia clinic received a bomb threat, which closed the clinic for the day. Police searched the facility and didn’t find any explosives on the premises. The closure delayed care for 36 patients, according to the report.

There is a long history of anti-abortion activists picketing outside of clinics and intimidating patients walking inside, but the reported number of picketing incidents in 2016 — 61,562 — exceeded those in every year since NAF began tracking incidents in 1977. Last year, there were 21,175 picketing incidents.

Given all of these trends, NAF said it’s important that law enforcement take threats against abortion providers seriously. Although police reacted swiftly to some of the incidents cited in the report, volunteers whose role it is to shield patients from activists’ aggressive tactics say that they wish the police would do more.

Ashley Gray, a clinic volunteer based in New Jersey, told ThinkProgress in 2015, “They’ve pretty much asked us not to call. To deal with it on our own.”

In its report, NAF said it is concerned that Attorney General Jeff Sessions “will not adequately enforce the laws that protect abortion providers and their patients from violence.”

Sessions could dial down enforcement of the Freedom of Access to Clinic Entrances Act (FACE), which prohibits the use of physical force, threat of physical force, or physical obstruction to injure, intimidate and interfere with accessing reproductive health care — as well as the intentional damage or destruction of a health care facility.

Sessions has the ability to use discretion in the prosecution of people who violate FACE. President Bill Clinton’s Department of Justice prosecuted 10 people a year on average under FACE, but those prosecutions dropped 75 percent under the Bush administration, according to Salon. As a United States senator, Sessions also voted against an amendment intended to stop anti-abortion activists from using bankruptcy laws to get out of paying fines for destruction of property.

Source: Think Progress

“I’m in a constant battle to help women and it can get exhausting sometimes, but the good days outweigh the bad ones.”

Forty-four years ago, the US Supreme Court affirmed a woman’s legal right to have an abortion in the Roe v. Wade decision. Today, abortion access is still being fought over in many states — but while you hear all the time from activists on both sides, the doctors who perform these procedures are often left out of the conversation.

BuzzFeed Health reached out to abortion providers across the country to find out what they wish people understood about the job, the procedure, and the women they treat.We heard from physicians who practice in conservative Southern states, liberal coastal cities, the rural Midwest, and in between. The following is a selection of perspectives and anecdotes from 11 physicians (some of whom asked to remain anonymous) that illustrate their day-to-day and the current landscape of abortion care in the US.

Drew Angerer / Getty Images / Via

BuzzFeed Health reached out to abortion providers across the country to find out what they wish people understood about the job, the procedure, and the women they treat.

We heard from physicians who practice in conservative Southern states, liberal coastal cities, the rural Midwest, and in between. The following is a selection of perspectives and anecdotes from 11 physicians (some of whom asked to remain anonymous) that illustrate their day-to-day and the current landscape of abortion care in the US.

[Editor’s note: This article is meant to be informational and educational, but it does not speak on behalf of all providers or all patients. Although all quotes are from physicians, this is not meant to replace advice from a medical professional. If you are seeking an abortion or have any questions about abortion, talk to your doctor or a health educator.]

1. Abortions are just one part of the job. These are OB-GYNs, family physicians, maternal-fetal medicine specialists, medical directors, and more.

“The majority of my practice is full-scope OB-GYN care, so I provide abortions but I also work in infertility, obstetrics, gynecological surgery such as hysterectomies, family planning, [I treat] abnormal uterine bleeding, and I also work at a local country jail providing gynecological care for incarcerated women. Some people think I terminate pregnancies but I deliver babies too, and I love that part of my job.”

—Dr. Rachna Vanjani, OB-GYN, San Francisco, California, fellow, Physicians for Reproductive Health

“I get to care for women during these monumental times throughout all the stages of their lives. That may mean providing prenatal care, helping a woman through a miscarriage or stillbirth, helping women who choose adoption, providing care during menopause, or safely terminating pregnancies — and for me, it’s a great honor.”

—Dr. Lisa Perriera, OB-GYN, Philadelphia Women’s Center, Pennsylvania, fellow, Physicians for Reproductive Health

Dola Sun for BuzzFeed News

2. Abortion providers don’t feel like they’re on the fringes of the medical community.

“Because of the stigma around the word abortion, there’s this idea that an abortionist is some unprofessional on the fringes of the medical community, but that’s not true at all — I very much tie my identity to professionalism and the tenets of medical ethics and that’s what drew me to this field in the first place.”

—Anonymous OB-GYN, New Mexico, fellow, Physicians for Reproductive Health

3. Most pursued training in abortion care because they wanted to help women.

“I perform a simple medical procedure all day and walk out of work knowing I impacted the lives of 15 to 20 women. In most cases, I took away the biggest worry or obstacle in their lives at that moment so they could follow their dreams or finish their education, get a better job, and have the family they want in future. In that sense, I feel like I get to save women’s lives every day.”

Dr. Sara Imershein, OB-GYN, clinics in the DC area

4. Patients should expect to be treated with kindness and compassion when they come in for this procedure.

“I remember the first patient I ever had took my hand during the procedure and said thank you for being there and being so kind and it just broke my heart and still makes me tear up that she was so shocked at our kindness and thought maybe she didn’t deserve that or shouldn’t expect it.

“My patients are the reason why I go to work every day. I know that many of them have experienced so much hostility and judgment and they are very grateful to have a compassionate provider. So if I can do that, if only for a short period of time, it means the so much.”

—Anonymous OB-GYN, Oregon

5. They don’t see their role as judging you or your decision — they just want to give you safe, professional care.

“My patients should never feel like they need to justify their decision to me — if it helps them to talk through it, I am always happy to listen — because I will never judge their reasoning and all I want is for them to be as healthy and safe as possible, regardless of the circumstances.”

—Dr. Raegan McDonald-Mosley, chief medical officer, Planned Parenthood Federation of America, OB-GYN, Maryland

6. Legal abortions are safe and do not affect your ability to get pregnant in the future.

“Abortion is much more common and safe than anybody unfamiliar with the procedure realizes. Medical and surgical abortions do not have any impact on future fertility, and the body goes completely back to normal. It’s a simple medical procedure that doctors have been doing for a long time and it’s very low-risk.”

—Dr. Imershein, Washington, DC

“Abortions are very safe and most are done in a doctor’s office exam room. Any patient can go to a hospital, but they really only need to if they are high-risk or they have a medical condition that requires extra care or monitoring.”

—Anonymous OB-GYN, Michigan

7. In fact, childbirth is riskier than an early (legal) abortion.

“This is one of the safest medical procedures a woman can have. There’s a higher risk of something going wrong when you continue a pregnancy than there is when you get an abortion, especially if the abortion is done early in the first trimester.”

—Anonymous OB-GYN, Oregon

8. The vast majority of abortions occur in the first trimester.

“There’s this perception about abortions among the public and in the media that abortions are always done later in a pregnancy, but that’s not true — most abortions in the US happen before 21 weeks, and the majority of those happen in the first trimester.”

—Anonymous OB-GYN, Oregon

9. The phrase “partial-birth abortion” isn’t actually a medical term used to describe abortions.

“There are a lot of misconceptions about second-trimester abortions and when they are performed. Most happen well before 23 or 24 weeks, because [after] that point we’re getting into the third trimester and the fetus is reaching viability [the point at which it can survive on its own outside the womb, which varies] and most states prohibit abortions this late anyway.

“But even though second-trimester abortions are done later in the pregnancy, the phrases ‘late-term abortion’ or ‘partial-birth abortion’ you hear are not medical terms we use to describe abortion. They often describe a fetus being removed from the womb in the final days of a pregnancy, which is essentially a cesarean section.”[Politicians have used this term] to describe a fetus being removed from the womb in the final days of a pregnancy, which is essentially a cesarean section, [not an abortion].”

—Dr. Perriera, Pennsylvania

10. Surgical abortions aren’t technically surgeries — they require no incisions or sutures — and they usually last around 10 to 15 minutes.

“Surgical abortions should really be called procedural because there’s really no surgery involved — there is no knife involved and no cutting or scraping or sewing incisions back together — all we do is go through a natural orifice in the body and remove the lining of the uterus and everything attached to it, either by using suction or sometimes forceps. And we usually do the procedure in a doctor’s office, not in a surgical center or operating room.”

—Dr. Imershein, Washington, DC

11. They want people to understand what actually happens during an abortion. (Some readers may find these details graphic.)

“The abortion is usually the fastest part of the whole appointment. If it’s early enough in gestation, we can do medical abortion — it’s a two-step pill process. First you take mifepristone, then 24 hours later you take misoprostol — these expel the pregnancy from the uterus and you bleed like you do in a miscarriage.

“First-trimester surgical abortions only take about 2 to 7 minutes and second-trimester abortions take around 10 to 15 minutes. We lightly sedate the patient and insert a speculum, then we numb the cervix with a shot of lidocaine before we dilate it a few millimeters using a tapered metal rod. Then we place a small tube that’s thinner than a drinking straw through the opening in the cervix, and it’s attached to a suction machine so it draws the uterine lining and pregnancy into the tube and out of the body.

“If it’s a second-trimester pregnancy, we dilate the cervix a few centimeters so sometimes we might need to put synthetic dilators in the day before to help the cervix soften overnight. We typically give the patient more anesthesia and we usually have to use forceps in addition to suction to remove the fetus from the uterus. I think it’s important to explain the procedure very clearly, because demystifying what happens can dispel many of the myths and false information.”

—Dr. Deborah Oyer, family physician, medical director of Cedar River Clinics, Seattle, Washington

12. How a patient feels after the procedure varies from person to person.

“After the procedure, some women really grieve the loss of a pregnancy and they’ll ask for an ultrasound picture to take home, but many women also feel very relieved and like a huge weight has been lifted off their shoulders. [Those women may also ask for an ultrasound picture to remember the pregnancy and value it, but not feel like they made the wrong decision.] And whatever a woman feels after the procedure, she is allowed to feel that.”

—Dr. Perriera, Pennsylvania

Dola Sun for BuzzFeed News

13. They don’t see their job as convincing anyone to have an abortion; they simply give them the information they need to make a decision.

“There’s this huge misconception that I make decisions for other people — but I don’t decide anything for anyone. I provide counseling, and support so that they can make the right decision for themselves. As a medical professional, it’s my legal, ethical, and moral obligation to give a patient all the information they need to make informed, competent decisions.”

—Dr. Sarah Wallett, medical director, Planned Parenthood Greater Memphis Region and OB-GYN, Memphis, Tennessee

14. They want to make certain that a patient is 100% sure of their decision and that they made it on their own.

“We don’t perform abortions for woman who seem unsure — we never want a patient to feel like someone talked them into it. If I ever sense that a patient isn’t comfortable with their decision, I’ll stop and make sure they’re ready. So yes, that means some women change their minds at the very last minute. I’ve even stopped a procedure right as I was putting a patient under anesthesia. And if that’s the right decision for them, we always respect it.”

—Dr. Imershein, Washington, DC

15. They don’t all work at Planned Parenthood.

“Abortion care is often synonymous with Planned Parenthood, but that’s not the case. Actually, the majority of abortions are done by independent providers at either private or public clinics. And it’s not as if it’s ‘Planned Parenthood versus independent providers’ or one is better than the other — they are just different, usually in terms of which services they provide.”

—Dr. Oyer, Washington

16. They provide abortions to all different kinds of women, for all different reasons.

“I may perform [multiple] abortions in one day and every single woman will have a different reason why she’s there. For example, on a typical Saturday [I’ve seen] these patients: One woman had her GRE book on her lap and was studying during every free minute of her appointment, and she said she got an abortion so she could go to grad school; one woman really wanted a baby but there was a severe fetal anomaly and the pregnancy wasn’t viable; one woman had been trying to get pregnant with her husband for two years, then she was [sexually assaulted] and didn’t know if the baby was his and was very traumatized, so she chose to get an abortion. There is no one reason why a woman gets an abortion, but every reason is valid.”

—Dr. Vanjani, San Francisco

17. That includes women who identify as “pro-life” or who are very religious.

“I practice in Memphis, where there’s a church on practically every corner and my patients are from the Mississippi Delta region. So most of the women I provide abortions to are religious. Sometimes I think those religious patients feel even more stigma and feel more alone than other patients because society teaches us that religious people just don’t agree with or have abortions. But that’s not true.”

—Dr. Wallett, Planned Parenthood, Tennessee

18. Sometimes they care for women dealing with substance abuse who’ve been using during their pregnancy.

“We have a large population of substance abuse patients who are dependent on illegal drugs [such as heroin] or alcohol, and many are either afraid or know that they’ve caused harm to the pregnancy because of their drug use. They often feel like they need to terminate the pregnancy so they can get sober, because otherwise they’d keep using and harm the baby even more.”

—Anonymous OB-GYN, Michigan

19. Other times that’s mothers who — for whatever reason — cannot have another child at this time.

“We see all different kinds of women, but a lot of them are mothers who know how challenging and expensive raising a child can be. They often decide to get an abortion so they can allocate their resources and care and time toward the children they already have.”

—Dr. McDonald-Mosley, Planned Parenthood, Maryland

20. And other times patients are ending a desired pregnancy because something went wrong.

“Many of my patients deeply desire to carry their pregnancy to term and to go home with a healthy newborn but complications occur that make the prognosis for the mother and/or the fetus very dire. In those circumstances, some families choose to end the pregnancy, and often to minimize suffering for a baby that will be born very sick with no or minimal chance of survival. For these patients, the decision to end a pregnancy is very difficult and made from a place of love and compassion. The rhetoric on both the pro- and anti-choice sides often overlooks these patients.”

—Anonymous maternal-fetal medicine physician, Utah

21. Those cases can be hard on the doctors, too.

“When a woman or a family hears bad news about a desired pregnancy, it shakes them to their core. The information I need to convey is sometimes the worst news they have ever, or will ever, hear. A woman that goes to the doctor and receives terrible news about a pregnancy is not the same woman that comes home.”

—Anonymous maternal-fetal medicine physician, Utah

22. You probably know someone who’s had an abortion.

“One in three women has had an abortion in America, so statistically, you know someone — she might be your mother or your sister, your aunt, your daughter, your neighbor, your co-worker — there’s this societal sense that any women who have had abortion are the ‘other’ but she is us, she is all of us.”

—Anonymous OB-GYN, New Mexico

“Every woman thinks she’s the only woman she knows who’s had an abortion, but it’s actually very common. We only think it’s rare because it’s taboo to talk about.”

—Dr. Oyer, Washington

Dola Sun for BuzzFeed News

23. False information about abortions can cause unnecessary paranoia and delay care.

“By the time we see patients, they might believe that the procedure will impair them for life or it’ll cause them to get breast cancer or they’ll never be able to have a baby again. It’s very difficult for us as doctors because we only get to see these patients for an hour or two, yet we still have to gain their trust in that time, enough to dispel all of the myths and erase the fear that they’ve caused [patients].”

—Anonymous OB-GYN, Michigan

24. Nobody thinks they’re going to need an abortion — just like no one expects an unplanned pregnancy.

“Nobody thinks it’ll happen to them, just like nobody expects an unplanned pregnancy. You truly don’t think you’ll need an abortion until you need one.”

—Dr. Perriera, Pennsylvania

25. In the providers’ experience, most women who get abortions have carefully thought about their decision for a long time before their first appointment.

“People think because the legislature mandates a waiting period that women haven’t thought carefully about their decision to get an abortion by the time they come into the clinic. But they have thought about it extensively, from the moment their period was late or they saw a positive pregnancy test or the day they called to make an appointment. Most people know pretty immediately if it’s the wrong time in their life to be pregnant.”

—Dr. Imershein, Washington, DC

26. Talking about abortion can help de-stigmatize it, but not every woman wants to talk about her abortion — and that’s okay.

“We want women to feel comfortable enough to talk about their abortions because its real and it happens every day. The silence around abortion can be harmful and increase the stigma, and we need to stop it.”

—Dr. Perriera, Pennsylvania

“A lot of people will say women should talk about their abortions to fight the stigma, but that also might be too much to ask for some women — especially if they have to parade their stories in front of men who don’t understand at all. Abortion, just like any health issue or medical procedure, is still a private matter and we should respect that. There is no one way to de-stigmatize abortions.”

—Anonymous OB-GYN, Michigan

27. Some doctors are open about what they do, some aren’t.

“There’s a spectrum of being ‘out’ as an abortion provider. Some of us are very public about it and some people keep it private, but it really depends on the context — their comfort level, where they live, their family’s beliefs, the threat of harassment around them.

“I’m very open about my work and what I do, despite the risks. One of my favorite stories is about this time I was at a farmers market and I struck up a conversation with this big, burly bearded man covered in tattoos. He asked me about my job and I told him, then there was a nervous pause. Suddenly, his face just lit up and he told me he used to volunteer as a patient escort at a clinic in rural Pennsylvania, and we ended up having this amazing conversation. You can never expect how people will react, but in my experience it’s often positive.”

—Dr. McDonald-Mosley, Planned Parenthood, Maryland

28. The threats and harassment can be scary, but it doesn’t stop them from doing their jobs.

“People have made postcards with my face and address on them in an attempt to discredit me as a physician or put me in danger. It can get scary, but I really worry more for my partner and my kids. I can’t live in fear every day as a provider.”

—Dr. Perriera, Pennsylvania

“There were fliers in the neighborhood saying I was a murderer, so I had to explain to my kids pretty young that if a pregnant woman isn’t ready to have a baby, I help her get ‘un-pregnant.’ But otherwise, it doesn’t bother me.”

—Dr. Imershein, Washington, DC

29. The protesters outside the clinics don’t make women change their minds, they just make them feel more guilt and self-blame.

“The protesting doesn’t change anyone’s mind, it just makes patients feel terrible and internalize the stigma. I don’t think the protesters realize that they are forcing these women to suffer a trauma, and sometimes they’ll come into the clinic so upset and they’ll think they deserved it. Nobody deserves that. It’s so terrible and unkind. I often try to listen and understand the anti-choice rhetoric because I’d love to engage in a productive dialogue, but I don’t feel like I’m being met halfway. And when they harass or disrespect my patients, that’s just not okay.”

—Dr. Perriera, Pennsylvania

Dola Sun for BuzzFeed News

30. Abortions are not federally funded. Most women pay out of pocket or use their insurance.

“Either the patient pays for an abortion or their insurance pays for all or part of it. The Hyde Amendment makes it illegal to use federal funds for abortion services except to save a woman’s life. We can offer low-income women grants from national funds, for example through the National Abortion Federation — otherwise, it’s really up to the state and insurance companies. Some states will fund ‘medically necessary abortions’ under Medicaid, but there are usually restrictions. In most cases, the patient pays out of pocket,”

—Anonymous OB-GYN, Michigan

31. Some abortion providers also care for undocumented immigrants and people who cross the border to get health care.

“We get to practice global health domestically in border cities, such as San Diego and El Centro, where our clinics are truly steps away from Mexico. At Planned Parenthood, we don’t ask our patients if they are citizens or not — we just provide care to anyone comes through our door. But if we do take care of undocumented immigrants, they pay for services out of pocket, often in cash. And we’ll sometimes have patients come across the border from Mexico just for the day to get an abortion, and go back at night. Regardless of immigration status, we believe women should have access to quality health care.”

—Dr. Sierra Washington, medical director and chief medical officer, Planned Parenthood Pacific Southwest, OB-GYN in San Diego, California

32. State restrictions often act as a barrier to getting safe and timely care.

“Most restrictions are rooted in making abortion inaccessible, not science or medical literature. And it’s very frustrating because they influence what I do — Tennessee state law requires state-mandated counseling and a 48-hour waiting period, so two in-person visits — but I know these extra steps aren’t medically necessary. All they do is make the process seem more scary and confusing, or make it harder for women to get the care they need, when they need it.”

—Dr. Wallett, Planned Parenthood, Tennessee

“The state you practice in can definitely dictate the kind of care you provide to women. I’m very lucky to practice in Maryland where there aren’t many restrictions or non-evidence-based barriers to care — there’s no wait period, we can waive parental consent, and it’s a safe and calm environment. I don’t ever really have to turn women away who desperately want an abortion.”

—Dr. McDonald-Mosley, Planned Parenthood, Maryland

33. Doctors can’t diagnose many fetal anomalies until later in the pregnancy, which is why many doctors oppose 20-week bans.

“When biology and nature do not work as planned, it is imperative that patients have options available to them, including pregnancy termination. The ways in which a normal pregnancy can go awry are so numerous and varied that even my colleagues and I can’t predict them all, and we are experts! If we can’t predict every complication that can arise, politicians and lawmakers certainly cannot do so.”

—Anonymous maternal-fetal medicine physician, Utah

34. It can be stressful to feel like their job is in constant threat or that the way they care for their patients might change because of new legislation.

“It’s funny because they always say ‘keep politics out of the exam room,’ but [what’s not funny is that] politics are [then] constantly threatening how I do my job and practice medicine. It’s so stressful to think that on a monthly or yearly basis, the way I provide care is threatened.”

—Dr. Vanjani, San Francisco

“It always feels like I’m fighting to defend a procedure that is shown over and over again in the medical literature to be safe and effective and positive for women and families. I’m in a constant battle to help women and it can get exhausting sometimes, but the good days outweigh the bad ones.”

—Dr. Wallett, Planned Parenthood, Tennessee

Dola Sun for BuzzFeed News

35. They think the concept that people will use abortions as birth control is pretty ridiculous.

“Anti-choice individuals will say that ‘people will get abortions over and over again and [better access will allow] them to be irresponsible.’ Never once in my career of being an abortion provider have I ever felt that to be true. I think it’s ridiculous and it’s just a way to stigmatize abortion. Even if abortion is made more accessible, it’s still a difficult thing to go through and no one would want to do it all the time.”

—Dr. Vanjani, San Francisco

36. Many patients choose to go on some form of birth control after their abortion; some even get an IUD during their procedure.

“After a patient gets an abortion, [and she was terminating an undesired pregnancy], it’s a great time to talk about contraception because she already knows she doesn’t want to be pregnant at that time. I’d say [the overwhelming majority] of the women I provide abortions to end up choosing some form of contraception afterward.”

—Dr. Vanjani, San Francisco

“Many of my patients decide they want to prevent pregnancy for several years so they choose to get either a hormonal or copper IUD, and we’ll implant this right after we perform the abortion, while the cervix is still dilated and we have the speculum inside you. We just do it all in one procedure.”

—Dr. Oyer, Washington

37. It’s not as simple as being either pro–abortion rights or anti–abortion rights; there’s a huge gray area in the middle.

“Abortion has become so polarized in US, and people think that there’s only pro-abortion and anti-abortion sides, so the gray area of abortion gets completely lost. It’s honestly a very complex thing, and the reality is that nobody wants to have an abortion — nobody wakes up and thinks, Hey I think I’d really like to get an abortion today.

“So it’s very frustrating when people oversimplify it and think women and doctors are either good or horrible people, and it’s either right or wrong. The reasons why someone chooses to get an abortion are so complex. As a provider, I’m just here to respect women and help them regardless of the circumstances or how I feel.”

—Dr. Washington, Planned Parenthood, San Diego

38. In their eyes, the best way to decrease the abortion rate is to increase access to effective, reliable contraception.

“If more women are able to access highly effective forms of birth control, there will be fewer unplanned pregnancies and fewer abortions — it’s pretty simple. Unfortunately, many states have restrictions not just on abortion but all reproductive health care, which isn’t good for health outcomes.”

—Anonymous OB-GYN, Oregon

39. Being an abortion provider can be incredibly rewarding, especially in the long-term.

“Abortion providers have some of the lowest rates of physician burnout. Medicine can be very frustrating because we try really hard to fix things that are often out of our own control, and some problems like type I diabetes or heart disease we can never fully ‘fix,’ but in this specific aspect of women’s health care, we can do this simple, safe procedure that has the potential to change a woman’s life — and that’s pretty beautiful.”

—Anonymous OB-GYN, New Mexico

40. They are all physicians. But, now, many of them are activists, too.

“Many of us went into the job to take care of women and came out being activists even though some of us are total nerdy introverts and would be happy being quiet. But we see all the setbacks and you feel compelled to stand up and make a difference and defend access to care; and these days I only feel more and more encouraged to speak up.”

—Dr. McDonald-Mosley, Planned Parenthood, Maryland

41. Abortion won’t stop happening if it becomes illegal.

“No matter how bad the stigma, the protesters, or the barriers, women still come in. There are even women who come in after hearing all these misconceptions who think the procedure is scary or they’ll never get pregnant again — and despite all that, they still show up. It just shows how important this procedure is to women and their lives, that they’re willing to take all of that on. The women who really want abortions will get abortions.”

—Anonymous OB-GYN, New Mexico

“The more restrictions on abortions, the more likely it is for women to resort to illegal and unsafe practices to terminate a pregnancy — abortion has always existed, even when it was illegal, and it will always exist in the future.”

—Dr. Perriera, Pennsylvania

Originally published on April 20, 2017 11:00 am

Updated at 11 a.m. April 20 with Gov. Eric Greitens’ comment — A federal judge on Wednesday blocked Missouri’s restrictions requiring abortion doctors to have hospital admitting privileges and abortion clinics to meet the specifications of ambulatory surgical centers.

U.S. District Judge Howard Sachs said two weeks ago that he planned to enter a preliminary injunction against the requirements, so the ruling came as no surprise.

But in his 17-page decision, Sachs made clear that he was bound by the U.S. Supreme Court’s decision last year in Whole Woman’s Health v. Hellerstedt striking down similar abortion restrictions in Texas.

“The abortion rights of Missouri women, guaranteed by constitutional rulings, are being denied on a daily basis, in irreparable fashion,” Sachs wrote of Missouri’s abortion restrictions. “The public interest clearly favors prompt relief.”

In Hellerstedt, the Supreme Court found that, “in the face of no threat to women’s health,” Texas had required women to travel to distant surgery centers.

The two Planned Parenthood affiliates that challenged the restrictions said that, in the wake of the decision, they would soon be offering four more locations in Missouri where women would be able to obtain abortions. The only clinic in Missouri that currently performs surgical abortions is Planned Parenthood’s facility in St. Louis.

Bonyen Lee-Gilmore, a spokeswoman for Planned Parenthood Great Plains, said the locations that will be offering abortions are in midtown Kansas City, Columbia, Springfield and Joplin.

Mary Kogut, the president and CEO of Planned Parenthood in the St. Louis Region and Southwest Missouri, said it was a “great victory.”

“And what it will do is it will expand access to safe and legal abortion throughout the state of Missouri,” she said.

Attorney General Josh Hawley, who defended the restrictions blocked by Sachs, said he plans to appeal.

“Today a federal court struck down large portions of Missouri law that protect the health and safety of women who seek to obtain an abortion,” Hawley said. “This decision was wrong. I will appeal. Missouri has an obligation to do everything possible to ensure the health and safety of women undergoing medical procedures in state licensed medical facilities.”

Gov. Eric Greitens weighed in on Twitter on Thursday morning, saying: “Missouri is a pro-life state. We will beat this on appeal and keep fighting every day to protect the innocent unborn.”

In his ruling, Sachs said that accepting Missouri’s contention that he should reappraise the abortion safety issue would be akin to trying to undermine the Supreme Court’s 1954 school desegregation decision in Brown v. Board of Education.

Sachs noted that the Supreme Court found that the hospital affiliation requirement in Texas cured no significant health-related problem. And he cited the high court’s finding that tens of thousands of women in Texas would have been forced to travel more than 150 miles to find an open clinic had the affiliation requirement been allowed to stand.

“This case is not a close one in any event, as the absence of a clinic in central Missouri requires hundreds of miles of travel, round-trip, with two trips needed unless a woman has the means and time available for a long stay in St. Louis or other rather distant clinics,” Sachs wrote. He added that the hospital affiliation requirement, rather than furthering women’s safety, probably creates health hazards for them.

Missouri’s hospital affiliation requirement forced the Planned Parenthood facility in Columbia to stop offering abortions there in 2015.

Similarly, Sachs blocked the ambulatory surgical center law requiring abortion clinics in Missouri to have facilities suitable for major surgery. The requirements include wide hallways and other physical specifications.

Sachs pointed out that the law would require Planned Parenthood’s Kansas City facility, which offers only medicinal abortions, to remodel the facility at a possible cost of millions of dollars.

The lack of necessity and “nearly arbitrary” imposition of the requirements, Sachs wrote, “adequately establishes that these plaintiffs are very likely to receive relief” – a requirement for the issuance of a preliminary injunction.

Sachs said the likelihood that the plaintiffs in the case – Planned Parenthood Great Plains and Planned Parenthood of the St. Louis Region and Southwest Missouri – would prevail at trial “is very high.”

“The ability to function as abortion clinics and to perform abortions is crippled in Columbia, Springfield and Joplin, and to some extent in Kansas City, by reason of the statutory and regulatory hospital affiliation requirement for doctors,” Sachs wrote.

“Especially in Springfield and Joplin, but to a lesser extent in Columbia and Kansas City, the ASC (surgery center) requirement imposes burdens that have closed or prevented development of clinics.”

He went on to say that a failure to act promptly would “seriously frustrate the opportunity to open clinics in Springfield and Joplin and the restoration of clinical service in Columbia and Kansas City.”

In a joint statement, the Planned Parenthood plaintiffs said, “Today’s victory means countless Missourians will have expanded access to safe, legal abortion. It is also the resounding affirmation we’ve long awaited – that medically unnecessary restrictions like admitting privileges and ambulatory surgical center requirements are state mandated laws thought up by extremists in Jefferson City. We will continue to fight these restrictions until they are permanently blocked in the state of Missouri.”

Source: KSMU

Even in a medical emergency.

Credit: iStock

An extreme anti-abortion bill in Montana is poised to deal a major blow to abortion rights in the state, should the governor sign it.

The bill, S.B. 282, defines fetal viability at 24 weeks’ gestation and prevents abortions past that point, even in a medical emergency. A pregnant person whose fetus stands a 50 percent chance of survival outside the womb would be forced to undergo a C-section or induced labor. Additionally, under the proposed law, a doctor who provides an abortion past 24 weeks could face charges of homicide.

The bill passed the Montana House on April 6 and enjoyed final passage in the Senate five days later. It will now be sent to Governor Steve Bullock (D).

“It is the policy of the state to preserve and protect the lives all human beings and to provide protection for the viable human life,” said Rep. Theresa Manzella (R), who carried the bill on the floor.

Manzella and her conservative colleagues are leveraging S.B. 282 to advocate for questionably viable fetuses at the expense of (undeniably viable) pregnant women. Most people who have later term abortions do so out of necessity, not flippancy. Discounting this reality oversimplifies the complexities of such a situation and infantilizes people by confiscating their bodily autonomy. What’s more, forcing a patient to undergo a major surgical procedure like a C-section out of political ideology — not medical necessity — is dangerous and unethical.

Not every legislator agrees with Manzella. “I don’t think the legislature should stand in the way of a doctor’s ability to decide what is best for his patient,” Rep. Virginia Court (D) told Montana Public Radio. “This is the right of a woman and her doctor, in the privacy of the doctor’s office. These decisions should be made between the two of them with open, careful, honest, truthful consults. Not by the body of the Legislature.”

It is unclear whether Governor Bullock, a Democrat, will sign the bill. He has previously gone on record in defense of women’s right to choose, saying, “As governor, I will defend a women’s right to choice. I think these are complicated and difficult decisions, but they shouldn’t be made by the government. They should be made by women and their doctors.”

This fetal viability bill is the latest in a string of attempts to curtail abortion in Montana. The state has a rich history of introducing anti-choice measures, from fetal anesthesia bills to restricting performance of abortions to licensed physicians to redefining life at conception.

Nevertheless, according to the Guttmacher Institute, Montana “does not have any of the major types of abortion restrictions — such as waiting periods, mandated parental involvement or limitations on publicly funded abortions — often found in other states.” And NARAL Pro-Choice America grades the state as having “strongly protected reproductive rights access.”

In other words, try as they might, Montana legislators haven’t been wildly successful in getting anti-choice laws on the books.

Montana’s anti-abortion crusade (albeit an unsuccessful one) isn’t an isolated case; it fits neatly within an alarming national trend. Legislators across the country, emboldened by an anti-choice president and administration, are doing their best to undermine abortion access however they can.

Dangerous 20-week abortion bans are advancing in several states, including Tennessee, Missouri, Iowa, Ohio, and more. Others are getting more creative with their tactics: Kansas passed a regulation requiring changes to fonts used on abortion information sheets, Arizona will require doctors who perform abortions to try and “revive” fetuses if they show signs of life, and Arkansas will force doctors to investigate abortion patients. Other states, including Florida, Texas, and Oklahoma, have likewise tried to make abortion a felony but failed.

Whether Montana will officially join the ranks of hostile states remains to be seen. But if Governor Bullock signs S.B. 282, he will undoubtedly set a dangerous and irresponsible precedent.

Source: Think Progress

In the wake of Trump’s criticism of late-term abortions, three mothers shatter the misconceptions about why women make the choice

Kate Carson in her home. She and her husband chose to have an abortion after their daughter Laurel was diagnosed with a severe abnormality known as Dandy-Walker malformation.
Kate Carson in her home. She and her husband chose to have an abortion after their daughter Laurel was diagnosed with a severe abnormality known as Dandy-Walker malformation. Photograph: Kayana Szymczak for the Guardian

Last year, Donald Trump suggested that current abortion laws allowed doctors to “rip the baby out of the womb of the mother just prior to the birth of the baby”. His statement erroneously described abortion procedures, and also triggered an uproar among the women and men who know first-hand the devastation of ending a late-term pregnancy.

Nearly 99% of abortions occur before 21 weeks, according to the Centers for Disease Control and Prevention, but when they are needed past that point, it is in response to harrowing circumstances.

“Abortions that occur at this stage in pregnancy are often the result of tragic diagnoses and are exactly the scenarios wherein patients need their doctors, and not obstructive politicians,” says Dr Jennifer Conti, clinical assistant professor at Stanford University. “Asking a woman to carry a fatally flawed pregnancy to term is, at the very least, heartbreaking. I’ve often heard women say that they chose to end such pregnancies because of unselfish reasons: they couldn’t bear the thought of putting their fetus through even more pain or suffering.”

Just this year, 400 abortion restrictions were introduced in 41 states, according to the Guttmacher Institute, a research organization that supports abortion rights. Among them, Republicans introduced the first-ever federal “heartbeat” bill earlier this year – which would ban abortions after a heartbeat is detected. Meanwhile, Congress is considering a bill that would also ban abortion at 20 weeks nationwide – which is when ultrasounds can offer the first signs of anomalies in fetal anatomy.

Here, three different women agreed to share their experiences to end misconceptions about late-term terminations, and to explain to politicians and the general public why they’re necessary in the first place.

Kate Carson, teacher, outside Boston, Massachusetts

That warm June day, the recovery room was silent. The doctor entered carrying Laurel, a bundle of just five pounds wrapped in a pink-and blue striped cotton blanket. He gently passed her to her mother, Kate. She bent forward to smell her. She touched her skin. Her daughter was warm, but not as warm as she should have been.

“I just needed to know it happened. I needed to know that I had a baby,” Kate Carson says.

At 27, Kate had her life planned out. She and her husband were going to have four kids, and she was going to be an engineering professor. Her first pregnancy went fine, and she had a healthy baby girl. But while pursuing her PhD in engineering, she suffered three miscarriages. “It was a long road,” she says, but by age 29, she was finally expecting another girl, Laurel. She was due in the summer of 2012, and both parents were elated.

Kateholds her baby Laurel’s foot and hand prints that were made by nurses at the clinic.
Kate holds her baby Laurel’s foot and hand prints that were made by nurses at the clinic. Photograph: Kayana Szymczak for the Guardian

At 19 weeks, an ultrasound revealed a shadow of concern but the finding was reversed with full confidence at a level-two ultrasound. “I’m not seeing any problems. Everything looks fine,” the specialist told the parents.

But Kate had a nagging worry. “My husband and I did not feel like everything was fine,” she says. She asked the nurse how sure the specialist was. “He would have to be so certain. They would never reverse a diagnosis without being super sure about it,” the nurse replied.

Yet her husband encouraged her to book a second level-two ultrasound, a “peace of mind ultrasound”.

Expecting only reassurance, Kate knitted a pink sweater for Laurel while chatting freely with the technician who quickly grew silent. There was a big black spot on Laurel’s brain. “This baby is different,” the technician said. She left the room and returned with a maternal fetal specialist and a specialist in training.

“That’s when they started telling me,” Kate says. The fetus had Dandy-Walker malformation, a set of abnormalities of the cerebellum.

“The problems we didn’t see last time, we are seeing today,” said the specialist. She offered Kate adoption and abortion, “if it was still a legal option”. They used to send women to Kansas for abortions, she told her, but that was before Dr Tiller was shot in the face at a Sunday church service.

Kate asked if children with Dandy-Walker malformation are ever normal. “Yes,” said the specialist.

“And that, honestly, is so hard to hear because you just want something definitive”, Kate recalls. “On the one hand, of course you want your child to be normal. On the other hand, you want to know, is your kid going to be okay, is your kid going to receive a devastating diagnosis?” But the specialist had no definitive answers and recommended an MRI to determine whether Laurel would be okay or “incompatible with life”.

Kate couldn’t get the MRI for the next 48 hours. The wait was excruciating. At home, she could find no peace and substituted knitting her baby’s sweater for sleeping. She curled up on her living room sofa and cried until her husband scooped her up each night and took her to bed.

“When you’re imagining futures beyond the miracle happy ending, it’s sinking in,” she says.

The day of the MRI finally arrived. She was 35 weeks, 0 days. By the end of it, Kate and her husband had the hardest answers they’ve ever received.

Their daughter had moderate to severe Dandy-Walker malformation. But that wasn’t the only diagnosis; Laurel also had a brain condition in which fluid builds up in the ventricles, eventually developing into hydrocephalus and possibly crushing her brain. She had a congenital disorder too, in which there was complete or partial absence of the broad band of nerve fibers joining the two hemispheres of the brain.

What this meant was Laurel was expected to never walk, talk, or swallow. That was if she survived birth.

Kate asked her doctor: “What can a baby like mine do? Sleep all the time?”

“Babies like yours are not generally comfortable enough to sleep,” the neurologist said.

“That is when it became very clear what I wanted to do,” she says. “The MRI really ruled out the possibility of good health for my baby.”

A personal letter of support from Barack Obama. Kate wrote to President Obama after her abortion experience, in an effort to educate politicians about the realities of late-term abortion.
A personal letter of support from Barack Obama. Kate wrote to Obama after her abortion experience, in an effort to educate politicians about the realities of late-term abortion. Photograph: Kayana Szymczak for the Guardian

For Kate, giving a child life and peace are the two gifts a mother can offer. “Most babies get to have life and get to have peace, but this baby, I had to choose. I could choose life, with the outside chance of peace or occasional peace, or I could choose certain peace without life. And for me, certain peace without life was the choice I wanted to make.”

On their ride home, Kate and her husband were silent as they drove in rush hour traffic across the Zakim Bridge. She was unable to say it herself, but Kate’s husband uttered the word abortion. “I think we should ask about it,” he said.

“I had been in this dark, awful prison of a place inside myself,” she says. Her husband’s words comforted her.

When they arrived home, Kate immediately called the doctor and left her a message. Her mother arrived to pick up their daughter and before leaving said she would have done the same. An hour later, the phone rang. Kate grabbed it. If they wanted the abortion, they had 30 minutes to call a clinic in Colorado before closing time or wait out the weekend. The procedure would last four days. And they would need $20,000. Massachusetts does not allow abortion after 24 weeks unless it’s necessary to save the life of the mother.

Kate and her husband live a modest life, certainly not one with $20,000 readily available. Kate’s younger brother offered his life savings of $5,000, but it was her parents who gave them the money from their retirement fund. “This is exactly why these abortions exist,” said her father.

Three days later, they were driving up to Dr Hern’s Boulder Abortion Clinic, where surveillance cameras and razor-wired fences surrounded them. She was 36 weeks pregnant.

Inside the clinic, Kate took a blood test followed by exhaustive counseling sessions, then the consent form. Dr Hern wanted to make sure she was doing this of her own free will.

By the end of the day, Kate and her husband knew it was time. Dr Hern took Kate to a room for the injection. It would slow her baby’s heart to a stop as soon as it penetrated. Sometimes, it happens quickly. For Kate, it happened over the course of a couple of hours. Just as she and her husband were planning to grab a bite of food, Laurel kicked. “I lost it,” says Kate. She retreated to her hotel room and lay there until the moving stopped. When Laurel went still, Kate’s stomach sagged low and lifeless, she says. “It was really sad and really hard.”

“I did not ever doubt I was doing the right thing for her but that did not make it easier,” she says. Kate says Laurel got the “tightest hug”. Her body was hugging her.

Next, it was time to get dilated, which was painful for Kate because she couldn’t receive an epidural. On the last day in Colorado, in early June, Kate, who was in labor for two and a half hours, delivered Laurel.

In the recovery room, Dr Hern brought Laurel to her. She smelled right, she felt warm, but not as warm as a live baby.

“She was beautiful,” Kate says.

When Kate returned home, they scattered Laurel’s ashes in the ocean. It was time for closure, but Kate worried about judgment so she didn’t tell anyone what happened for months. Then the self-doubt came.

“I feel like myself got fragmented into a million different selves. And I had my angry guard dog piece and my jealous piece, had my sad piece, I had the guilt, the religious piece. All of these pieces, and I had to figure out who I was.”

For some time, Kate wondered about the human error piece in the equation and wondered if her first doctor might have misled her on purpose. A little research later proved it was just an honest mistake. “I can live in a world where people make mistakes,” she says. “I felt like the only one in the entire world who has had such a late abortion, and it is true that we are rare, but we are not entirely alone. Just hidden.”

Kate has since given birth to another healthy daughter.

Kate Carson speaks about her experience to doctors, lawyers, and neighbors. You can also read about her experience here

Lindsey Paradiso, wedding photographer, Virginia

Lindsey and Matt Paradiso, photographed inside their home.
Lindsey and Matt Paradiso, photographed inside their home. Photograph: Justin Ide for the Guardian

The moment Lindsey, 27, found out she was pregnant, she wrapped the positive test strip in a used gold metallic gift bag and surprised her husband, Matt, with it. Two months later, they named her Omara Rose.

This was not the easiest pregnancy for Lindsey. She suffered from sciatica nerve pain and had to undergo daily injections for her blood clotting disorder. But she was over the moon about the pregnancy.

At first, it looked like a bubble floating on the ultrasound. At the routine 18-week visit in February 2016, the doctor speculated the peculiarity could be cystic lymphangioma, a group of cysts found mostly in the neck. Or it could be nothing. They immediately booked an appointment at the University of Virginia (UVA).

After seeing the ultrasound at UVA, Lindsey noticed the growth had enveloped half of Omara’s face and spread around her neck to the back of her head. When the doctor entered, they expected the worst. Again, the term lymphangioma came up. But so did cervical teratoma. Only an MRI could determine decisively, but whether it was malignant or benign, it could be fatal to the baby.

“You could just tell the energy in the room was like: you should end it, it’s not going to turn out well,” she says. The doctor told them they could terminate the pregnancy since Omara’s chances of survival were slim. Matt and Lindsey were crushed by the prospect. They wanted to fight.

Twenty days after seeing the first signs of trouble, they learned that Omara had an aggressive form of lymphangioma growing out of her neck. The diagnosis came in the form of a dense two-page MRI report. The fast-growing, inoperable tumor had grown into her brain, heart, and lungs. It had wrapped around her neck, eyes, and deep into her chest. It was so invasive, it was pushing her tongue out of her mouth.

Her chances of living to the age of viability or birth were slim. Lindsey and Matt made the heartbreaking decision to follow through with an abortion at about 24 weeks. They were just a few days away from it being an illegal termination.

A shadow box of memories of their daughter, including her hand and foot prints, sits with a teddy bear.
A shadow box of memories of their daughter, including her hand- and footprints, sits with a teddy bear. Photograph: Justin Ide for the Guardian

On 26 February 2016, Omara Rose’s heart stopped beating. Shortly after, Lindsey was admitted into the hospital for labor induction but the epidural stopped working. “I felt like my insides were being ripped apart,” she says. When the doctor administered a second epidural, Lindsey became nauseous. Her ears rang. The room spun. The doctor rushed in to administer a third epidural.

She was conflicted the whole time because while she was in pain, she didn’t want it to stop because she knew by the end of it, “your child is going to be dead”, she says. Matt held her hand the whole time.

When she finally delivered Omara Rose 40 hours later, she was so small, “I barely felt her leave me but I knew she had,” she says.

Over the next few hours, Lindsey and Matt got to hold Omara Rose, dressed in a tiny dress with a hat the size of the cup of Lindsey’s hand. Then Lindsey’s and Matt’s family came, each taking turns to say their goodbyes. “I wanted her to be alive so badly but I knew it was for the best. She went without pain,” she says.

The next day, they buried their daughter in a cemetery four hours away from where they live now.

“I don’t think people understand the gravity of how sick she was. How fatal her tumor was,” says Lindsey.

But it took some time for them to be open about it, especially Matt. Lindsey found comfort in blogging while Matt focused on completing his education at Virginia Tech.

“To hide something because you’re ashamed of it is just going to continue to perpetuate misunderstanding,” says Lindsey. People automatically assumed that the abortion had been out of convenience. On the contrary, she says: “It’s something that will stick with you forever.”

For those who believe these babies are unwanted, Matt says: “You’re not going to wait until halfway through your pregnancy to finally have an abortion.”

Prompted by Donald Trump’s statements on late-term abortions, Lindsey shared her experience more widely in a Facebook post, which was shared more than 100,000 times.

“Abortions are hard decisions made by real people,” she says. “Being open is a call for empathy.”

Lindsey Paradiso testifies against bills to limit access to safe and legal abortions. She’s also blogged about her experience here

Darla Barar, Austin, Texas, copyrighter

Darla Barar and her husband Peter. Darla was pregnant with twins - Catherine and Olivia - when they discovered that Catherine had a number of serious health issues.
Darla Barar and her husband, Peter. Darla was pregnant with twins – Catherine and Olivia – when the couple discovered that Catherine had a number of serious health issues. Photograph: Courtesy of the Barar family

On 22 June, at 3.30pm, the doctor let them see Cate one last time. She danced for them and then kicked. Her mom told her it was going to be okay. And then, guided by the ultrasound, the doctor injected a medication into Cate’s heart, stopping it. When they checked for a heartbeat 30 minutes later, the silence was deafening.

Darla, then 29, and her husband, Peter, had tried for years to get pregnant. When treatments failed, they traveled to the Czech Republic to use donated eggs. A week after the transfer, Peter got a dinner dessert with a message: “Congratulations daddy.” They were expecting twins.

Darla and Peter had named their twins Catherine “Cate” and Olivia, and by their 20-week anatomy scan they already knew their distinct personalities. Olivia was a “diva” and Cate was shy, a “cuddle bug”. “We loved them more fiercely than I ever thought possible,” Darla says.

But during a routine anatomy scan, the technician was abnormally quiet. Cate was measuring a little behind but she was always the smaller of the two, so Darla didn’t worry much. After a long wait, the OBGYN entered the room and asked Darla to sit next to her husband. “I just knew something was wrong,” Darla says.

Darla recalls hearing the doctor say he had never seen this combination of anomalies before.

Darla and Peter saw additional specialists, and all confirmed a number of issues. Cate had encephalocele, which is a neural defect that causes brain matter to leak out, slow growth, microcephaly, a very large cleft lip and possible fused digits. Her cerebellum was so underdeveloped that one doctor had trouble finding it and her brain’s midline was shifted, indicating “severe disorganization”.

To make matters worse, Olivia’s life was in danger. Cate’s amniotic sac was growing and restricting the growth of Olivia’s sac.

If she carried to full term, the restriction on Olivia’s sac would likely mean an early delivery. Darla says that every specialist they saw disclosed there was a high probability that Cate would not survive the delivery but if she did, there was no guarantee the surgeries – removing the encephalocele and placing her brain tissue back into her skull – would save her.

Darla cried and Peter prayed. “We needed a miracle and we knew as the day went on we weren’t going to get one.”

‘And then we had to grasp that we were only a family of three.’
‘And then we had to grasp that we were only a family of three.’ Photograph: Courtesy of the Barar family

Their other option was abortion, one they did not take lightly, but one that felt rushed because of Texas’s restrictive abortion laws, which bans abortions after 22 weeks. Darla and Peter had 12 days to decide. “If laws were different … we would have done more testing – one doctor mentioned an MRI, for example, to try to test the level of her brain function. But we didn’t have that, and knowing what timeline we were on, we spent a lot of sleepless nights researching, making appointments, talking to each other and our therapist, and really just spending time being the four of us,” she says.

“Finally, we just looked at each other and said it was okay. We had to do what was best for her. So we knew what we had to do to bring home one.” Darla says she was prepared to deal with it all, but “if it meant Cate was going to suffer, we just couldn’t do that to her”.

At 21 weeks and six days, Darla had an injection, and Cate’s heart stopped. “For us, it was completely humane,” she says.

In the case of an additional fetus that gets aborted in the womb, the tissue is usually reabsorbed back into the body, but that wasn’t the case this time.

“I kept telling Peter, I’m carrying our healthy baby and our dead baby. I can’t reconcile that in my brain. At the same time, it was a comfort to know that I didn’t have to say goodbye right then,” she says.

Thirteen weeks after the diagnosis, Darla delivered Cate and then gave birth to Olivia, a healthy 5lb baby. The family took turns holding Cate and later in the afternoon, the chaplain came to take her away.

“And then we had to grasp that we were only a family of three,” she says.

Darla says she couldn’t face people after the abortion. She called it a stillbirth. “I knew I was dealing with more than just grief and I couldn’t explain that to people,” she says. She was also dealing with guilt. But she never felt regret, she says. She knew she did the right thing.

Spurred on by Donald Trump’s comments about later abortions, Darla used social media to share her story and the response was overwhelming, both good and bad. The meaner comments focused on abortions as a version of birth control, or a way to rid oneself of an imperfect child.

“I can tell you, knowing how much the procedure cost, nobody is doing that for birth control,” she says. “Ask us why we’re getting it. Don’t assume that you understand our lives.”

Nonetheless, “being open has allowed me to be a better mom. I’m much more free with my emotions,” she says. Knowing that she could become a voice for women and men who needed it empowered her.

“It’s always the health of the mother but the health of the baby is never taken into consideration [in laws], and in situations like ours, it could have meant two dead babies on our hands,” she says.

Source: The Guardian