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In Missouri, Legislators Fail to Protect Women’s Basic Rights, Undermining Justice for All

8:11 am in Uncategorized by RH Reality Check

Written by Pamela Merritt for RHRealityCheck.org. This diary is cross-posted; commenters wishing to engage directly with the author should do so at the original post.

On July 14, 2011, Missouri Governor Jay Nixon allowed two identical abortion restriction bills to become law. In a bizarre move toward the end of the 2011 legislative session, Missouri legislators passed two versions of the same restriction bill, one originally filed in the Senate and the other in the House. The passage of identical abortion restriction bills was likely fueled by more than one legislator wanting to take credit.

Often erroneously reported as banning abortions after 20 weeks gestation, HB213 & SB65 can more accurately be described as eliminating certain health exceptions that protected women facing serious pregnancy-related complications. The legislation changes the factors physicians must consider before performing a post-viability abortion and creates criminal penalties for physicians not following the new regulations. Governor Nixon, a Democrat who successfully ran as a pro-choice candidate in 2008, did not sign the abortion restriction bills into law nor did he veto the legislation.  The identical abortion restriction bills automatically became law once the July 14, 2011 veto deadline passed.

Reproductive justice advocates had hoped that Governor Nixon would veto the abortion restriction bills. In the weeks leading up to the 2011 veto deadline, the St. Louis Post-Dispatch published an editorial that called on the Governor to do just that and send a message to state legislators that it is time to get serious and cease treating women’s health like a political football. The Post-Dispatch editorial points out that Missouri’s annual legislative pander to anti-choice special interest groups in lieu of focusing on prevention is both fiscally irresponsible and hypocritical; unintended pregnancies cost tax payers billions, while reducing the number of unintended pregnancies would also reduce the number of abortions. But as the hours ticked by Thursday July 14th it became clear that the Governor was not going to capitalize on this leadership opportunity to send a message through his veto.

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Why Did She Wait So Long? Later Abortions and the Implications of the New Nebraska Ban

6:59 am in Uncategorized by RH Reality Check

Written by Susan Yanow and Kimberly Bullard for RHRealityCheck.org – News, commentary and community for reproductive health and justice.

*The stories in this article are true summaries of women who presented for services at the ParkMed Physicians clinic in New York during 2009.  Details have been changed to protect the anonymity of the women.

At 17, Rachel* was a high school senior when her steady boyfriend forced her to have sex. Rachel’s period was not regular, and like her family, Rachel had always considered herself pro-life. When she finally realized that she was pregnant and thought about her strong desire to go to college and her life goals, she realized that for her, abortion was the right decision.

Rachel called the nearest clinic and was informed that her state had a parental consent law, requiring her to get the consent of a parent or a judge because she was under 18. For the next three weeks Rachel feared telling anyone, especially family, but after much deliberation and anxiety she finally told her mother. While her mother was initially angry, within a few days she agreed to help Rachel get an abortion. They called the nearest clinic and got the first available appointment, one week away.  At the appointment, Rachel and her mother were shocked when the ultrasound showed that Rachel was already five months (20 weeks) pregnant. The clinic did not offer abortions past 14 weeks. They referred her to a clinic five hours away, but because of limited physician availability that facility had no appointments for three weeks. They also learned that the clinic could not accept the health insurance that Rachel’s family had. Since Rachel’s procedure would take two days to perform, they would also need to make arrangements to stay in a hotel. Rachel and her mother spent the next three weeks borrowing $2,500 to pay for the travel, hotel, and abortion. On the day that Rachel finally had her abortion, she was 2 days shy of 24 weeks pregnant.

Rachel’s story is more common than many might think. “Pro-choice” or “pro-life,” most people do not realize that although only one percent of abortions occur at 21 weeks or later, this one percent represents about 11,000** women in the United States who get later abortions every year.[1],[2] Many of these women must raise $2,000 to $4,000 to get the abortion they need. These women are disproportionately young and poor, and many already have a job. Some struggle to cover the cost of birth control pills, in addition to food and the next month’s rent. Pulling together the money for an abortion takes time and sacrifice. 

This is compounded by the fact that the nearest abortion provider is often in another state. In addition to various state regulations that restrict access to abortion care, such as waiting periods and parental consent laws, only a few facilities nationwide provide abortions late in the second trimester. Since these abortions usually require two or more days to complete and are not widely available, women who must travel to these providers have to make extensive arrangements for travel, childcare, and accommodations. These all add to the cost for the woman, and as she scrambles to put all the pieces together, the cost of her abortion continues to rise. At 10 weeks the average abortion costs $450.  Each additional week may add $100 or more.  Studies have found that many women who obtain later abortions tried to have the abortion sooner but could not overcome these financial, geographic, and political barriers. [3][4]

For Rachel, being unfamiliar with the symptoms of being pregnant, having irregular periods, her ambivalence about abortion coming from growing up in a “pro-life” family, and being in denial about the fact that her boyfriend had raped her all contributed to late recognition of her pregnancy.  Restrictive policies, a delayed referral, and needing to travel to find a provider who could help her pushed her to present much later for the abortion she needed.

Diana* already had special-needs three year-old twins when she found herself pregnant a second time.  She brought up the idea of abortion with her abusive, alcoholic husband who angrily rejected the idea, despite their current financial and emotional strain.  He demanded she deliver a son for him, a “normal one,” not some “freak show” like before, and punched and kicked her when she argued.

During Diana’s 20th week of pregnancy, after weeks of fear and contemplation, she secretly borrowed money for an abortion from her sister.  Before bed that night, she hid clothing and her purse in the bathtub, planning to slip away with the twins in the pre-dawn hours.  When her husband caught her attempting to leave, he beat her ferociously. Three weeks later, her bruises still present, Diana found another opportunity to leave, this time leaving the twins with her sister. She feared for their safety and her own, but was resolute in her decision to terminate her pregnancy.

She took a bus to New York City, now 23 weeks pregnant, but the abortion was more expensive than planned. A friend offered to contribute, and together they spent another few days raising the additional $300. Diana was lucky; in spite of the delays and obstacles, she found help raising the money and was able to get to New York City where there are abortion providers who could take care of her.

Diana’s story, like Rachel’s, is a typical example of “the perfect storm”- the intersection of life situation, funding and regulatory barriers, scrambling to find a provider and needing to travel – all circumstances that may lead a woman to seek an abortion later in her pregnancy. However, most Americans are unaware of how women find themselves in the center of this storm. According to a 2010 Gallup poll, 45 percent of Americans consider themselves to be pro-choice. Nevertheless, only one quarter of Americans support women’s right to end an unwanted pregnancy in the second trimester.[5] Many Americans become uncomfortable with later abortion because they focus on the developmental level of the fetus rather than on the rights of the pregnant woman, overlooking the myriad reasons that women need later abortions. Without the full picture of women like Rachel and Diana, it is easy to assume that women who obtained later abortions had total control over when to come for abortion care and simply chose to delay. These women are often misjudged as careless and immoral and of not taking responsibility for presenting earlier for abortion care.

The reality is that women need later abortions for many of the same reasons women need any other abortion. A woman or girl is not yet ready to start a family; she’s about to start college; she’s just lost her job; she was raped; she needs to look after her existing children.  Later abortions, like earlier abortions, happen because birth control fails, because the choice of when and how to be sexual is not always a woman’s choice, because obtaining health insurance is slow or out of reach, or because the decision to fully commit to the children that she already has is a moral decision that women take seriously. For some women, a diagnosis of fetal anomaly comes late in pregnancy, for some it comes earlier.  For others, partners leave, houses disappear in hurricanes or floods and their new situation means they no longer feel they can parent a new child. Women who seek early and later abortions alike do not make a decision about a pregnancy in isolation; each woman’s decision is impacted by her location, health, socioeconomic status, race, nationality, religious beliefs and family circumstances.

In April 2010, the Nebraska legislature banned abortions after 20 weeks of pregnancy for all reasons except for the life and physical health of the mother. This law will go into effect on October 15.  What little public discussion there has been about this new law has centered on the constitutionality of the ban or the scientific credibility of the reasons for the ban.  Scarce attention is being paid to the women whose abortions will be prohibited if the ban is allowed to go into effect.

The stories of the women who need later abortions must be placed at the center of the debate.  The Rachels and Dianas of Nebraska have lost access to the abortions that they need. While we may not all agree with the decisions these women make, we can develop empathy and understanding for their situations, along with the awareness that these women are struggling to do the best they can with time against them.  Support for women seeking later abortions needs to start with each of us.

*The stories in this article are true summaries of women who presented for services at the ParkMed Physicians clinic in New York during 2009.  Details have been changed to protect the anonymity of the women.

**Estimated from CDC data containing all states but CA, LA, and NH, plus Guttmacher State Profile data for CA, LA, and NH.


[1] Centers for Disease Control and Prevention. Abortion Surveillance–United States, 2006. Surveillance Summaries, 27 November 2009. MMWR 2009;58(No.SS-8).

[2] Guttmacher Institute. State Center. Accessed 30 July 2010. At: http://www.guttmacher.org/statecenter/sfaa.html

[3] Finer LB, Frohwirth LF, Dauphinee LA, Singh S, Moore AM. Timing of steps and reasons for delays in obtaining abortions in the United States. Contraception. 2006 Oct;74(4):334-44.

[4] Drey EA, Foster DG, Jackson RA, Lee SJ, Cardenas LH, Darney PD. Risk factors associated with presenting for abortion in the second trimester. Obstet Gynecol. 2006 Jan;107(1):128-35.

[5] Gallup Poll News Service. Abortion. Accessed 21 July 2010. At: http://www.gallup.com/poll/1576/abortion.aspx#1

ReproJustice Roadtrip: A Couple Facing Late Abortion Finds Red-state Obstacles in a Blue State

7:09 am in Uncategorized by RH Reality Check

Written by Khadine Bennett for RHRealityCheck.org – News, commentary and community for reproductive health and justice.

RH Reality Check is partnering with the American Civil Liberties Union to publish stories from a reproductive justice roadtrip through Illinois.

One of the reasons  we decided to embark on this road trip for reproductive health and access was that we wanted to provide individuals in Illinois with the opportunity to share, in their own words, examples of barriers they face when attempting to access reproductive health care and information. Today’s post will feature Amy S, a lifelong Illinois resident who currently lives in the Chicago suburbs. Amy’s experience when faced with the difficult decision to terminate a wanted pregnancy echoes that of two other women (one from central Illinois and the other from northwestern Illinois) who have reached out to us while on the road. We would like to thank Amy for her willingness to share her experience with all of you.

Amy S. – In Her Own Words:

In 2006, I was expecting my second child.  My husband and I are college sweethearts and will be married 14 years this year.  Our son Aidan was four at the time.  My pregnancy was uneventful.  I did all the screening tests and everything had come back great.  I went in for an ultrasound at 20 weeks gestation and the doctors told me to come back in four weeks, because they couldn’t see everything they wanted to see, but what they did see looked good.

When I went back in four weeks, the baby had turned and they had a clearer view.  They discovered that my son had a catastrophic brain malformation, holoprosencephaly.  Moreover it was the worst type, alobar.  My child would surely die.  When the doctor delivered the news, it did not register.  I did not get it until he told me "many would terminate the pregnancy for this."  Worse, my pregnancy dated 23 weeks and six days.  In terms of practitioners in Illinois, I had essentially no time to make up my mind.  Yet, I had to be sure.  I needed to know, irrational as it sounds, that the ultrasound machine was not broken.

I had an amniocentesis on the spot, went to see an MD who is a genetic counselor, and was able to get in for a prenatal MRI on my baby’s brain at Evanston Hospital.  My genetic counselor was at Lutheran General, and I live in Kane County, so I was all over the place.  The MRI confirmed the diagnosis.  The genetics counselor confirmed the prognosis.  If the baby was carried to term, he would essentially be a vegetable.  He would never sit, eat, or recognize his parents.  He would have seizures, not be able to regulate his temperature or blood sugar, and likely be in great, great pain.  And I thought, no way.  Not my child.  I would not let him suffer and die because I couldn’t muster the courage to do what I had to do for him to pass away in a more humane way.

What I had to do shocked and astounded me.  In a "blue" state, I never imagined that I would be told my OBs could not induce labor at my local hospital.  So the perinatologist, the geneticist and my OB all tried to pull in favors and call contacts to help me.  UIC, Rush, U of C, Evanston, Northwestern, Lutheran General, and my local hospital, Delnor, all said no.  I was too far along at 25 weeks.  At least at Lutheran General, it got before the ethics committee, but they said no because I was not "their" patient.  Where did that leave me?  Dr. Tiller’s clinic in Wichita, Kansas.  Dr. Tiller who was killed last year.

The fee had to be paid in cash, up front.  All told, including travel, it cost us $6000.  Blue Cross denied my claim as out of network.  I appealed and they denied it again.  It was a weeklong process.  I lied to my four-year-old that Christmas Eve was actually Christmas so we could have presents; we had to fly out Christmas Day.

I did not have Dr. Tiller but one of his colleagues.   The doctor was amazing, flying out from their home city one week a month to help out.  We crossed picket lines to go to the clinic each day.  My son began to have seizures in utero, I could tell by the wild and rhythmic movements.  I was scared silly; I did not want to deliver in a clinic.  It was my only choice.  We took pictures of my son and had him baptized.  He was tiny but looked like my other son.

The day after delivery, I was on my way back to Chicago.  I felt sure I was going to die on the plane.  I came home and tried to soldier on.  But, it was too much.  I began having panic attacks and was terrified that something would happen to my four-year-old.  I had what in the old days they would have called a "nervous breakdown" with no psychiatric history.  I was diagnosed with postpartum anxiety, panic disorder, PTSD from what I had to go through to end the pregnancy, OCD and depression.

Long story short, I worked hard to get past that.  I miss my baby terribly to this day.  I got better and went on to have a daughter last year.  My kids are six years apart.  People remark that it’s a big age difference.  I usually don’t tell them that the gaping hole did have another baby there.

My older son has owned this experience all along.  He never lets us forget about Owen.  For a long time he included him in drawings of the family.  He reminds people that he has a baby brother too, he’s just in heaven, and he’ll get to meet him one day.

We have most of Owen’s ashes but spread some at my father-in-law’s grave.  I like to think that they are together.

The entire experience moved me to go back to school for nursing.  I am now halfway through and hope to have my RN by this time next year.  I’m not sure if I want to help moms through labor and delivery, knowing the outcome is not always good and being able to comfort those moms, or through psych, working with people dealing with grief and loss as I have.  But I will not let this experience go without turning it into good, helping people.  I work in a psych hospital now, and I dedicate every day to my son, and hope he’s proud of me.

What Everyone Needs to Know About Second Trimester Abortions

6:45 am in Uncategorized by RH Reality Check

Written by Steph Harold for RHRealityCheck.org – News, commentary and community for reproductive health and justice.

Most of us don’t think we’ll ever have an abortion, until we become one of the one in four women in the US who has an unwanted pregnancy.  And if we think about it at all, we assume we’d get an abortion pretty early in the pregnancy.  While 90 percent of abortions do happen before 12 weeks, some women seek abortions later in their pregnancies.

Most women do not try to have later abortions. In fact, in a study done by Finer et al, nearly three fifths (58 percent) of women in the survey reported that they would have preferred to have had the abortion earlier than they did. In another study done by Drey et al, 29 percent or one third of women who ended up having abortions during their second trimester were in their first trimester when they made the first call to an abortion clinic. If this is the case, what causes women to have second trimester abortions?

First, let’s learn a bit about second trimester abortions. Drey’s study outlines the following basic information:

  • One out of every ten abortions performed in the United States happens during the second trimester
  • Second trimester abortions carry an increased risk of complications and are more expensive to obtain then first trimester abortions
  • The American public tends to favor restrictions on later termination

These restrictions vary state by state. In some states, like California and New York, Medicaid can cover the cost of an abortion. In others, such as Pennsylvania, Medicaid funds are forbidden from covering the procedure unless the woman is a survivor of rape, incest, or has a medical condition that threatens her life. And in other states still, Medicaid and private insurance are banned from covering abortion no matter the situation. This means that if a woman doesn’t live in a progressive state and if she doesn’t have health insurance that covers an abortion, she will have to spend time raising money towards the cost of her procedure. Depending on how long this takes, the cost of the procedure could go up weekly (as it often does in the second trimester). In the world of abortion funding, this is called “chasing the fee” and is kind of a Dante-esque hell. The longer she waits to have the abortion and the more time it takes her to raise the money, the more the abortion will cost, causing her to have to raise more money and further delay the procedure.

There are other types of anti-choice legislation that can affect a woman’s access to abortion services.  She often has to jump through hoops to be able to make an appointment for the procedure. This could be anything from a 24-hour waiting period from the time she makes the appointment to the time of the procedure, getting parental consent, spousal consent, a mandatory counseling session, signed doctor’s notes, or sessions before a committee or before the police. Many women barely have time to schedule a full-day clinic visit, not to mention dozens of hours spent making sure she abides by these laws. This means taking hours or days off of work, arranging childcare, and arranging travel, not to mention other logistics.

Who are these women who have later abortions, and why do they have them? According to Drey’s study, women who have later abortions tend to be young and of low-income status. Specifically, Dryer found that women under 18 took longer to identify pregnancy symptoms and poor women had to delay their abortion because they had to make arrangements, such as raising money, getting childcare, or transportation to the clinic.

Finer found very similar causes of delay. Second trimester abortion patients, according to his study, were significantly more likely to say that it took them a long time to make arrangements to have the abortion. This is because there are many abortion providers who only provide abortions to 12 or 14 weeks, and the number of providers decreases further later in pregnancy. Many states have NO abortion providers after 14 or 16 weeks. In addition, second-trimester patients were significantly more likely to indicate that they were delayed because they needed time to raise money for the procedure and because it took time to talk to their parents.

Other women have abortions in their second trimester because they need more time to make their decision. According to Finer, 60 percent of women stated that someone helped them come to their decision to have an abortion. What these women may not know is that once they go into their second trimester, the cost of an abortion usually increases every week. It is not clear that women with later pregnancies know the consequences of delaying their decision.

The Finer study also finds that:

“poor women took a significantly longer time from thei first attempt to obtain the abortion to actually having it. When compared to white and Hispanic women, black women reported significantly longer time periods.”

Why might this be the case? Poor women, who are often women of color, may have to take more time to raise the money towards the costs of the procedure. The more time they take to raise the money, the further they are in the pregnancy, and the further they are in the pregnancy, the higher the cost of the procedure. Again, this is an example of “chasing the fee.”

Another important part of the Finer study found that women with two or more children took more time to access abortion services. Why? They have to arrange childcare and have childcare-related expense. Higher-income women and women 30 years old and over reported less time between deciding to have an abortion and going through with the procedure. Why? Because these women are more likely to have access to resources (money, transportation, lodging) that erase or ease the boundaries faced by poor women.

Finer also observed that if a woman goes to one clinic and is turned away because she is too far along in the pregnancy to have an abortion there, it may take her twice as long, on average, between initially attempting to make an appointment and having the abortion. This makes sense, as she would likely have to gather more money, take more days off work, arrange for transportation, childcare, and possibly even lodging to go to a different clinic, one that may not even be in her state.

Perhaps a woman lives in a state where there is only one abortion provider. She then has to arrange travel and lodging at this destination, along with coming up with the cost of the procedure. A woman’s ability to take the time off required to get to the clinic, whether this means arranging for transportation, renting a car, flying out of state, arranging childcare, taking time off, arranging lodging, you get the picture. If a woman can’t afford a $350 first trimester procedure at a nearby provider and takes too much time raising that money, she then has to deal with the rising cost of the procedure AND travel and accommodations costs.

In boils down to a few things. Women have second trimester abortions because they need to, not because they want to. Why? Because their insurance doesn’t cover abortion, because they needed time to raise money for the cost of an abortion, because they needed to arrange travel/childcare/time off of work in order to spend a full day at the clinic, because they needed time to make the decision with confidence, because they needed to make time to travel out of state to access an abortion provider.

The Finer study concludes by stating that their findings:

“suggest that gestational age at abortion in the US could be further reduced if financial barriers faced by disadvantaged groups were removed and if women, especially young women, were educated about how to recognize pregnancy.”

The links between sex education and pregnancy are clear. The better women are able to identify pregnancy symptoms, the faster they will take a pregnancy test. The earlier they are in the pregnancy, the more time they have to make a decision about whether or not to carry to term without worrying about a significant rise in the cost of the procedure. A first trimester abortion is a safer and less expensive abortion. We must work to eradicate the barriers women face in abortion services. This means:

  • Ensuring that all teens have access to comprehensive sex education
  • Requiring that ALL state Medicaid to cover abortion services
  • Making sure that medical schools to include abortion care training in their curriculum so women have more providers to choose from

Lobbying for protections against anti-choice terrorists who endanger abortion doctors and their patients through clinic violence and threats

We are the women who will need abortions, and we need to learn as much as we can about our bodies and about abortion services so that we can get the abortions we need as early as possible in an unwanted pregnancy.  And we need to organize, to make sure that abortions are available as late as we need them.