Women's reproductive freedom on the ropes

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It remains legal for women in America to terminate some dangerous and unwanted pregnancies, but in many states it is hard and getting harder.

If enough Republicans are elected on Nov. 6, it could become nearly or virtually impossible for a woman to end her own pregnancy, according to activists who support reproductive freedom. The GOP platform endorses overturning Roe v Wade, the Supreme Court decision that legalized choice. Republican presidential candidate Mitt Romney would have the opportunity to appoint one or two new justices to the court if he wins, meaning the High Court would likely overturn that ruling in the future.

Just this year, 17 states set new limits on choice; 24 did last year, according to the Guttmacher Institute, a pro-choice nonprofit whose numbers are widely respected. In several states with the most restrictive laws, the number of abortions has fallen slightly, pleasing the conservatives who oppose reproductive freedom. They say the laws are working.

Some of the states with the toughest laws are spread across a big middle swath of the country, stretching from Canada to the Gulf of Mexico.

In South Dakota, which has just one abortion clinic, lawmakers want to extend the required waiting period from two days to three for women seeking to end a pregnancy. Next door in North Dakota, there’s only one clinic. The same is true in Mississippi, where a new law threatens that lone clinic’s existence. In several states, doctors now must warn women about so-called “risks” from abortion, even though they are scientifically unsupported.

There are hurdles even in states like Illinois, where abortion laws are more lenient and clinics relatively plentiful.

Women seeking help in terminating their pregnancies at a Granite City, Ill., clinic can expect to find their photographs to turn up on a right-wing, anti-choice activist’s website. And before her abortion in June, a Chicago woman says her own gynecologist refused to offer any advice, fearing that just mentioning abortion could endanger her job at a Catholic hospital.

“The level and scope of activity on abortion and family planning is completely unparalleled to anything we have seen before,” said Elizabeth Nash, Guttmacher’s states issues manager.

“The way people are attacking abortion is distressing because they are getting much more creative in the way they’re chipping away” at it, said Dr. Renee Mestad, an OB-GYN who provides reproductive health services in upstate New York. Access to abortion isn’t much of a problem there. But it was where she used to work in Missouri.

“The ideal thing would be that no one gets pregnant unless they’re ready –that all pregnancies are desired pregnancies, but that’s not what happens,” Mestad said.

While surveys have consistently shown most Americans support keeping abortion legal in certain circumstances, many people’s views are nuanced. A Gallup poll last month found nearly as many voters consider themselves “pro-life” as those who say they are “pro-choice.”

And a new Gallup poll released  found that nearly 40 percent of female registered voters surveyed in 12 swing states consider choice the most important election issue for women – even outranking jobs.

President Barack Obama supports access to abortion. GOP challenger Mitt Romney says Roe vs. Wade, the Supreme Court’s nearly 40-year-old decision legalizing abortion, should be overturned, which would allow states to ban choice.

Anti-abortion attorney Teresa Collett, a law professor at the University of St. Thomas in Minneapolis, says her ideal would be “to live in a country where abortion is not even really thinkable.” She’d like to see Roe vs. Wade overturned, but even if it is, she said, the debate won’t end because it would be up to states to ban abortion.

Some seem to be moving in that direction.

- More than 30 new abortion laws have been enacted this year, a record topped only by the unprecedented 92 laws last year.

- 41 states ban abortion after a certain stage of pregnancy, generally around 20 weeks, unless the mother’s life or health is in danger. In many of those states, the bans are based on an unsupported premise that fetuses can feel pain at that stage of development.

– Pre-abortion counseling is required in 35 states; 26 require waiting periods after counseling, and in 13 states, the counseling must caution women against terminating their pregnancies by providing them with information that is not based on legitimate science.

Texas has the most prescriptive counseling laws – requiring, among other things, that doctors tell women abortion is linked with breast cancer. A group of scientists convened by the National Cancer Institute in 2003 concluded abortion did not raise the risk of breast cancer.

A Texas law passed last year requires women to get an ultrasound and their doctors to describe the fetus. Texas abortions have dropped every year since 2008.

While records from several states with laws restricting women’s reproductive choices show fewer abortions in recent years, it’s uncertain whether the decline is real. Not all states track the number of abortions per 1,000 women of reproductive age. And pregnancies are also in many states, a development some experts link to a weak economy.

The most recent national abortion statistics are from 2008, and the trend shows the number and rate of abortions have generally leveled off after a long period of decline.

In South Dakota, a new law facing a legal challenge would impose a three-day waiting period. During that time, a woman would have to visit a crisis pregnancy center discouraging abortion. Utah is the only other state with a waiting period that long, but it doesn’t require such specific counseling.

In July, a federal appeals court in South Dakota upheld a 2005 law requiring doctors to warn that abortions increase risks for suicide. Scientific research disputes this.

Dr. Carol Ball, at the state’s lone abortion clinic, in Sioux Falls, says information she’s required to tell patients is “of questionable validity” and designed to make them feel shame and guilt.

“They’re throwing hurdles in front of us to see when we stop jumping in front of them. If I stop, it means they win and women of South Dakota lose, and I’m not willing to let that happen,” Ball said.

Across the state to the west in Rapid City, Dr. Marvin Buehner cares for women with high-risk pregnancies and does a few abortions each year when pregnancy endangers the patient’s life.

He’s required to describe each fetal stage and explain that abortion ends the life of a separate human being – even to women whose fetuses have deadly abnormalities and won’t survive.

“It’s just incredible,” Buehner said.

One of his patients is a 31-year-old woman who gave birth Oct. 14 to a stillborn baby with a rare, inherited and ultimately fatal condition called achondrogenesis, which causes severe deformities. She had two previous babies with the same condition. One was also stillborn, the other died an hour after birth.

She had considered abortion when tests showed this baby, too, was doomed, but couldn’t afford the cost. It would have involved traveling nearly six hours to the Sioux Falls clinic. And because her life wasn’t at risk, Medicaid in her state wouldn’t pay for it, even though it was clear her baby would be born dead or die shortly after birth.

In Illinois, laws are relatively lenient. The Hope Clinic in Granite City in Southern Illinois caters to women from neighboring states like Missouri and Kentucky where it’s harder to get an abortion.

Tamara Threlkeld, the clinic’s executive director, said despite increasingly difficult access, Hope Clinic has not seen any increase in patients with later-term pregnancies seeking abortions.

Though you’d expect to see that trend, “they’re able to find us” early on, she said.

Most abortions occur in the first 12 weeks when the embryo is about the size of a lima bean. Major organs have begun developing, but the embryo at this stage looks nothing like the photographs of mangled fetuses that abortion foes promote. Those pictures generally represent late-term abortions, those after five months, which account for less than 2 percent of abortions.

Some Hope Clinic patients come from Kentucky, where the number of abortions has steadily dropped from almost 4,400 in 2007 to roughly 3,900 in 2010.

Kentucky’s only two abortion clinics are in Louisville and Lexington, an hour apart and several hours from some of the state’s most impoverished counties. Kentucky requires a 24-hour waiting period, and five of the seven surrounding states also have waiting periods. Public funding of abortions in Kentucky is limited to cases of rape, incest or when pregnancy endangers a woman’s life.

Mississippi has similar restrictions and only one abortion clinic, in Jackson, threatened with closure because of a new law requiring providers to have local hospital admitting privileges. State Health Department data show Mississippi abortions have steadily dropped, from nearly 3,000 in 2007 to about 2,200 in 2011. Meanwhile, the number of Mississippi residents seeking abortions out of state grew from fewer than 2,000 a decade ago to at least 3,000 in more recent years, according to data from the state Department of Health.    

“Never have times been this restrictive,” said Dr. Willie Parker, a Washington, D.C.-based physician who since June has traveled periodically to Mississippi to provide abortions.

Parker said he’s often struck by the hardship many women face, and told of a 33-year-old mother of four who lost a child to cancer two years ago. She was unemployed and still grieving when she learned she was pregnant again. The woman traveled three hours to the Jackson clinic to get required counseling in June. Then she had to return the next week for the abortion.

“She told me she couldn’t afford to have another child financially or emotionally,” Parker said.

He said he doesn’t know whether she was using birth control; he doesn’t usually ask.

“All I need is to make sure that they’re certain” about abortion. Most “have already been thinking about this decision for weeks on end,” he said.