They seem to have such sensible, compassionate reasons to make abortion after 20 weeks of pregnancy a felony.

"[It] doesn’t prohibit all abortions ... and presents a middle ground." —former Nebraska Senator Mike Flood, sponsor of the first state-level ban

"We have a moral obligation to end dangerous late-term abortions in order to protect women and these precious babies." —Rep. Marsha Blackburn, co-sponsor of the proposed national ban

"The dignity of each and every human life is fundamental." —Sen. Marco Rubio, presidential candidate

I’d love to teach these politicians what they are really doing, especially to the dignity of human life. I’d begin the lesson in the cramped office of the New Mexico Religious Coalition for Reproductive Choice. They’d sit on a lumpy maroon chair and listen as a staffer answers the coalition’s hotline. Ring. Ring. Ring. Each call is a woman desperate not to be pregnant. The coalition is part of a national network, with affiliates in 11 states, that provides food, housing, and transportation, like a sort of abortion underground railroad. Calls come into the office all day, then bounce to a staffer’s cell phone at night.

Most of the women calling are so far along, they have been outlawed from having an abortion in their home states, says Joan Lamunyon Sanford, executive director of the New Mexico coalition. They have taken out a loan on their family’s only vehicle or pawned a mother’s engagement ring. It’s wickedly stressful because the more pregnant you are, the harder getting un-pregnant becomes — in time, money, pain, and health risk. If only in this part of the world, medical clinics that offer complete gynecological care weren’t so few and far between. Eventually, these women do every conceivable thing they can before it’s too late to get to Albuquerque, the city the anti-abortion group Operation Rescue calls "the late-term abortion capital of the world."

It didn’t used to be.

The landscape changed after the 2010 election, which resulted in Republicans controlling 59 of the country’s 99 state legislative chambers and setting about passing new restrictions on abortion. "Those new laws increased the need for later abortions," says Glenna Halvorson-Boyd, PhD, who, with her husband, Curtis Boyd, MD, directs Southwestern Women’s Options in Albuquerque, which does third-trimester abortions. "I would like to believe that was the ’law of unintended consequences’ at work, but I believe it was intended."

Some of the 289 new anti-abortion rules passed since 2010 are mendacious — Kansas and Texas require women seeking abortion be "informed" that the procedure is "linked" to breast cancer, which science says it pretty clearly is not. Some of the rules bankrupt clinics — nearly two dozen states require clinics to be tricked out like ambulatory surgical centers, maintaining millions of dollars of equipment and staff that they will likely never use. Some are grossly taxing for patients, requiring waiting periods and multiple appointments. And some of the laws present would-be-funny-if-they-weren’t-tragic conundrums for physicians — as when states require doctors who do abortions to have admitting privileges at hospitals that won’t give admitting privileges to doctors who do abortions.

The politicians passing anti-abortion laws often claim they want to make abortion safer for women. When then-Texas governor Rick Perry signed that state’s strict new abortion law in July 2013, he said it would help "improve the quality of care women receive."

In the real world, the law has forced women to delay care. The wait time for an appointment at one of Dallas’s two remaining abortion clinics ranged from between 10 and 20 days as of last September, according to research from the Texas Policy Evaluation Project. The project estimates that if all clinics not meeting surgical-center standards were to close, an average 20-day wait time would translate to about 5,700 abortions delayed to the second trimester in Texas.

Amy Hagstrom Miller, who owns Whole Woman’s Health — a network of eight facilities in five states — says the Texas law all but eliminated the option of using the abortion pill. "Before, 40 to 50 percent of our patients in Texas chose medication abortion. Now it’s down to about 2 percent," she says. Using the abortion pill used to take two appointments, but with increased state requirements, it can now take up to four.

Before the law, Miller worked with 14 doctors in Texas; after, only three were able to get admitting privileges. "Appointments for medication abortion have become nearly impossible to schedule," she says. "The law has restricted access to the safest method of abortion that can be done earliest in pregnancy," she says.

Legal abortion remains exceptionally safe, with a major complication rate in the U.S. estimated around 0.2 percent. But about the only thing activists on both sides of the issue agree on is that the procedure is less and less safe the later in pregnancy it is done. "Most of the issues are minor," says Dr. Boyd. "But laws that force women to delay the abortion create unnecessary medical risk." Bottom line: If you feel for women or fetuses or both, it’s gotten worse.

On March 2, U.S. Supreme Court began hearing oral arguments in Whole Woman’s Health v. Hellerstedt. Amy Hagstrom Miller is the lead plaintiff among a group of independent Texas abortion providers and physicians. They argue that lawmakers have gone too far with the rules that clinics must meet the standards of ambulatory surgical facilities and that doctors who provide abortions must have hospital-admitting privileges. A decision, expected in June, could reaffirm American women’s right to safe, legal abortion established in Roe v. Wade. Or it could go the other way.

Even as new restrictions push more abortions into the second trimester, lawmakers are making those procedures less accessible. One procedure done after 20 weeks, dilation and extraction, or D&X, was rebranded by opponents as "partial birth abortion" and banned back in 2003 in a law signed by George W. Bush. At press time, 11 states ban abortion after about 20 weeks past conception — and Mississippi and North Carolina ban it earlier, after about 18 weeks. (To make things extra confusing, what many lawmakers call 20 weeks of pregnancy, your doctor probably calls 22 weeks. Physicians generally date pregnancy from your last menstrual period, not from the date of conception after that.)

All but one of the 18- and 20-week bans were passed on the grounds that the fetus can feel pain by then. Scientists who studied the issue, and doctors including the American Congress of Obstetricians and Gynecologists (ACOG), have concluded that a fetus probably cannot feel pain until functional connections develop between its cortex and thalamus, around 29 to 30 weeks. Still, GOP presidential candidates, including senators Ted Cruz and Marco Rubio, have suggested they would support a national ban on abortion after 20 weeks — with no exceptions for women who are raped or victims of incest.

Today, if you need an abortion in the second trimester, the safest and most common procedure is a surgery called dilation and evacuation, or D&E. The alternative is labor induction, which can take place over several days and cause more complications.

Now D&E is under fire too. Activists have relabeled the standard of care after 13 weeks "dismemberment abortion" (it involves doctors breaking down the fetus in order to extract it). Last year, Kansas and Oklahoma became the first states to ban D&E. Courts in those states have ruled the laws unenforceable, but similar proposals are being mulled over in states including Michigan, Missouri, Nebraska, South Carolina, and West Virginia.

Sandy Pan

Julie Burkhart, founder and CEO of the Trust Women foundation and South Wind Women’s Center in Wichita, Kansas, calls her state’s D&E ban the Physician Intimidation and Criminalization Act. Says Burkhart, "I know of no studies on induction done [as early as 13 weeks] because it makes no sense medically to do a harder, more time-intensive procedure. Kansas women would be guinea pigs."

"Why would anyone wait so long?" is the question Halvorson-Boyd says people always ask her.

The vast majority of women who want to abort don’t "wait." Among those who do, the reasons include fetal anomalies discovered midway through pregnancy, danger to a woman’s health, and emotional trauma after rape or incest. But those aren’t the stories told by most of the women calling the New Mexico coalition.

"The women who call our hotline are virtually all poor and often have brutally complicated lives," Lamunyon Sanford says. So many of the women are moms. They love their children as wildly as any parent, she says. She thinks it’s sometimes that love that brings women to her door.

I spoke with several women who traveled from other states to New Mexico and had later abortions. Kasey, a 28-year-old from Texas, said, "I had been throwing up for a month, but I was still getting a light period so I didn’t suspect anything. My boyfriend and I got into a huge fight — he would drink and things got physical. I called the cops and he ran. I moved in with a friend. Finally, no period.

I went to a pregnancy center because I know they give free tests. They said I was 10 to 12 weeks along. But when I got to the real clinic in New Mexico, they said I was 21 weeks pregnant! I freaked out. It wasn’t until I got my financial-aid check that I was able to go back to New Mexico for the abortion. I took a Greyhound bus."

Allison, a 37-year-old from Oklahoma, said, "I had sex on July 4th weekend. A random guy I met at a party. In the fall, I felt nauseous, but I didn’t think much of it — I had a 20-year, fifth-a-day rum habit. After a while, I took a test and found out I was pregnant. The timing couldn’t have been worse, because soon after that, I got arrested for DUI. They piss-tested me at the probation office, but I didn’t realize they were testing me for pregnancy. When I went in front of the judge, he said I was endangering myself and my unborn baby, and even talked about prison. I had called a clinic in Oklahoma, but they had shut down. So I found the place in New Mexico. I made an appointment and missed it. I had no money, not to mention being drunk made it hard to get it together and drive almost 600 miles. I was thinking about what a screwed-up life the baby would have. Eventually, I was able to get funding and drove all night. I woke up in the clinic’s parking lot when a lady banged on the door and showed me a bunch of fetus dolls. I gave her the finger."

At the news that I’m "Amanda, the reporter" calling, a 43-year-old woman says, "Shhh, shhh," to someone wailing in the background. To me she says, "I can’t talk. I’m busy." She has seven kids.

At what point does obtaining a legal abortion become so difficult, so expensive, and so frightening that women take things into their own hands? Up to 4.1 percent of women seeking abortions in Texas have tried to do the termination on their own, a recent survey from the Texas Policy Evaluation Project estimates. In interviews with 18 women who had attempted self-abortion in Texas, more than half said they took misoprostol, "the abortion pill." They bought the pills online or in Mexico and got instructions for use from friends or Google. One woman told interviewers she took three homeopathic pills every hour for more than a week. Another said that she obtained hormonal injections. Last year, a Tennessee woman was charged with attempted murder for trying to end her pregnancy the old-fashioned way by putting a coat hanger through her cervix.

On one of those Southwest desert days that’s so hot, the world looks like it is melting, I trudge up the narrow stairs to the New Mexico Religious Coalition’s office to say good-bye to Lamunyon Sanford. I update her on the former patients I spoke with. Kasey got her own place, has a job in medical billing, and is working on a degree in social work. Allison, because of her arrest, was fitted with an ankle monitor that tracked her drinking and, a few months back, celebrated her first year of sobriety since the Bill Clinton administration. I don’t know how the mother of seven is doing.

Lamunyon Sanford and I consider for a moment the myriad of ways people suffer in this world, the mystery of how they find grace, and the fierce strength of the women who call the coalition. "So many say one thing exactly the same," she tells me. "’I just want to be a good mom.’"

Her phone rings.

Read more about how to have a safe abortion

How to Have a Safe Abortion

How to Pay for an Abortion, by State

"Why I Had a Late-Term Abortion"

6 Women Talk About Why They Had Abortions





