Inside a drab blue cinderblock building in this Downstate industrial town, the rhetoric about late-term abortion meets reality.
The reality for the 27-year-old preacher’s daughter was that she needed $870 to pay for the abortion she had come to get at the Hope Clinic for Women, and she had brought only $635. Lisa (not her real name) was 21 weeks’ pregnant. She didn’t have much time or anywhere else to go.
The privately owned Hope Clinic, located 15 minutes from St. Louis and across the street from a Catholic hospital, is one of the few clinics in the Midwest that will do abortions for women who are up to 24 weeks’ pregnant. It attracts patients from as many as 10 surrounding states.
Medical secretary Jamie DeRuntz gently pressed Lisa about money. Sometimes, she asks women about their tax refunds. She finds out if they have jewelry or VCRs to pawn.
Did Lisa have any credit cards or extra cash? DeRuntz asked. Anything else, just enough good-faith money to set up a payment plan?
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“I have $75 stash money I could bring tomorrow,” Lisa offered. “Would that help?”
DeRuntz left to find out. Lisa confessed that the money is what she puts aside for her 7-year-old son’s allowance.
“I’m borrowing from him” she said. “I have to put it back. Otherwise, I’ll feel guilty.”
The morning that Lisa arrived, there were nine other women at the Hope Clinic who were more than 14 weeks’ pregnant.
In 1996, 6,848 abortions were performed there, including 1,233 on women who were 14 to 24 weeks’ pregnant.
Last week, both the U.S. House and the Illinois Senate passed measures to ban a controversial technique its opponents call “partial birth abortion” that is performed late in pregnancy.
Nationally, only 10 percent of abortions are done after 12 weeks’ gestation. The method under debate–“intact dilation and extraction”–is the least common procedure, and the Hope Clinic doesn’t use it.
Yet the controversy has spotlighted the fact that there are a significant number of healthy women who abort healthy fetuses during the second trimester of pregnancy.
What has been lost in the discussion about numbers and politics, however, are the stories of the women who get these abortions.
The reasons they get abortions aren’t much different from the reasons women get abortions earlier in their pregnancies.
The reasons they wait are as varied as their lives. Often they don’t know they are pregnant. When they do, they can’t get someone to watch their children. They can’t get off work. They can’t raise the money.
Lisa’s story is this: She was using birth control pills when she got pregnant. She didn’t know that taking antibiotics would interfere with the pill’s effectiveness, she said. She dismissed her abnormally light periods until February, when they stopped altogether and she got a pregnancy test.
Then, she and her fiance spent another six weeks talking about what to do and trying to scrape together the money for an abortion.
They plan to marry in August. She has her son; her fiance is responsible for two children of his own and pays child support for a third. He works in a plant in the small Downstate city where they live. She is not working.
They didn’t have enough money for a baby right now, the couple finally decided. They already had a family.
Currently, a woman may terminate her pregnancy for any reason until the fetus is viable, or able to survive outside the womb.
After that point, which occurs around 24 weeks, abortions are permitted only if the woman’s health or life is at risk.
There is little question, though, that people generally become more uncomfortable with the idea of abortion the later in pregnancy it occurs, even when it is legal.
In a California poll released this month, 62 percent of the respondents said they supported a woman’s right to an abortion in the first trimester.
Only 26 percent thought abortion should be allowed in the second trimester.
At the heart of that discomfort is the recognition of the narrowing margin between fetus and baby. Premature infants now survive at earlier ages. At 20 weeks, fetuses kick. They have fingernails and suck their thumbs.
In Illinois, a woman who wants to terminate her pregnancy during the second trimester will most likely be referred to either the Hope Clinic or Family Planning Associates in Chicago.
The Hope Clinic began doing abortions in 1974, and it has been a target of anti-abortion groups ever since.
In 1982, its owner and his wife were kidnapped at gunpoint. The same year, the clinic was firebombed. Bomb threats are so common that the staff keeps a checklist under the front-desk phone of what to do.
From outside, the clinic appears to be under siege. The image of an oversize baby looms from the side wall of one hospital parking garage, beaming above a banner that lists the phone numbers of anti-abortion pregnancy clinics.
The lot behind the clinic is occupied by a trailer where an anti-abortion group provides pregnancy tests and counseling. There are two arrows on its sign. The one pointing to the trailer reads “life.” The other, pointing to the Hope Clinic, says “death.”
At the Pregnancy Aid Center trailer, director Mary Jane Hoenig, a retired pediatric nurse, stands ready to urge women to reconsider and to offer help. The late-term abortions dismay her.
“But there’s nothing I can do. It’s legal,” she said. “I just feel we are there to talk to the girls.”
Inside the Hope Clinic, behind windows now covered with siding, the atmosphere is surprisingly warm. The walls are painted in pastel pink and mint green.
The women who work here speak of their jobs with enthusiasm and candidness. They believe what they do helps give women new chances in life. DeRuntz keeps the high school graduation photo of one patient who sent it to her in thanks.
“She’s going to college,” she said proudly. “She’s going to make something of herself.”
When asked about second-trimester abortions, most women give a number of reasons for delays. According to one study by the Alan Guttmacher Institute in New York, almost half the women who got abortions after 15 weeks’ gestation said they waited because they had trouble affording the procedure, finding a provider or making other arrangements.
At the Chicago Abortion Fund, which helps women pay for second-trimester abortions, Executive Director Toni Bond says most callers want an early abortion but just aren’t able to get together the money in time.
“They try and save what they can once they’ve spent the money on rent and feeding the children, the basic life necessities, but it’s still not enough,” she said. “They have to wait to come up with additional money, and by the time they look up, they’re in the second trimester.”
Then the costs go up significantly, and the women sometimes find it even harder to catch up. At the Hope Clinic, an abortion costs $305 at seven weeks. At 24 weeks, it’s $1,500.
Medicaid, which pays for medical care for the poor, is not an option. Under a law sponsored by Rep. Henry Hyde (R-Ill.), federal funds may not be used for abortion except to save a woman’s life or in the case of rape or incest.
Although states can use their own funds for Medicaid abortions, Illinois does not.
Some abortion-rights advocates say laws that limit abortion funding and access, like the Hyde amendment and parental notification laws, push some women into the second trimester. That argument is disputed by anti-abortion groups.
The most common reason women cite, however, for delaying abortion was that they didn’t know earlier that they were pregnant.
Although that explanation sounds suspect, it can happen when women have irregular or no periods, doctors say. Some women, particularly teenagers, may be ignorant about the workings of their bodies. Or denial may be so powerful that women attribute pregnancy symptoms to stress or overeating.
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Once the clinic’s financial director allowed Lisa to set up a payment plan for her abortion, she squeezed into a room with five other women to learn what the procedure involved.
There were 23 women scheduled to get second-trimester abortions that day. Only 10 showed up.
One was already past the clinic’s 24-week deadline. Another had to reschedule because she had only $600 toward the $1,200 abortion.
Of the six women in the group information session, three were white, two were black and one was Hispanic. Overall, about 65 percent of the clinic’s patients are white, and 51 percent have children.
The women sat slumping or straight, nervous or solemn. One woman wearing a sweat suit and sneakers had her arms wrapped around her purse.
The oldest of 16 children, she helps her parents financially support her younger brothers and sisters. She already feels like a parent, she said.
She got pregnant despite taking the pill, she said. She kept getting what seemed to be menstrual periods. After she found out at 16 weeks that she was pregnant, it took her five weeks to raise the money. That morning, her sister had sent her a check by Federal Express to the clinic.
Another young woman kept tugging on her long brown ponytail. When the counselor told the group that second-trimester abortion is as safe as childbirth, she joked, “It ain’t going to feel that bad, is it?”
The counselor, Nathalie Pettus, described the abortion procedure, step by step. First, she said, absorbent fibers would be inserted into the woman’s cervix to gradually dilate it overnight.
If a woman was 20 or more weeks pregnant, she would also receive an injection of digoxin, a heart medication, into her amniotic fluid. The shot stops the fetus’ heart.
The next morning, the fetus would be removed using forceps and suction. Usually, said Allison Hile, the clinic’s director of public information and education, the fetus does not remain intact.
Because of the risk of miscarriage once the cervix begins dilating, anyone who lives more than 45 minutes away from the clinic is asked to spend the night at an area motel.
This procedure, known as dilation and evacuation (D&E), is one of several methods of performing second-trimester abortions.
Others include dismembering the fetus before removing it from the uterus and the D&X, which involves extracting all of the fetus into the birth canal except its head, forcing a sharp intrument into the base of the skull and using suction to remove its brain so it can pass through.
The abortion bill passed last week by the state Senate would ban all abortion procedures that allow the fetus to enter the birth canal while alive. Thus, it would likely not affect abortions that included the digoxin injection but might raise questions about other procedures, even if they aren’t D&X abortions. Abortion-rights groups say they plan legal challenges if the law passes the House and is signed by the governor.
“It’s worded very broadly,” said Colleen Connell, head of the Reproductive Rights Project of the American Civil Liberties Union of Illinois.
After meeting one on one with a counselor, which the clinic requires of all its patients, one young woman from Arkansas changed her mind.
The 17-year-old wanted the baby but had come here at her mother’s insistence, she told the counselor.
“She said she had become very attached to the baby emotionally. She had been talking to it, patting her stomach. She became teary,” said the clinic’s director of counseling, Anne Baker, who talked to her.
Baker told the young woman it was better to disappoint her mother than to do something she might regret the rest of her life. She talked to the girl and her great-aunt, who had accompanied her, about preparing for the baby’s birth. The teenager and her great-aunt wept together, then left.
A counselor at the clinic for 20 years, Baker has found that second-trimester patients often distance themselves from emotional attachment, even if they have felt the fetus move. They rarely ask what it looks like.
“They kind of know, so they don’t want to know details,” Baker said. “It’s kind of like, `I know what I need to do; I don’t want to make it any harder on myself.’ “
Hile said, “The issue for these women is not whether or not it has a beating heart, but will I have enough money for my other children?”
In her counseling session, Lisa talked about her two previous abortions. About four years ago, she was raped, she said, and got pregnant.
Later, she had a fallopian tube removed because of a cyst and thought she could not get pregnant. But she did.
Her family did not know she was there to get an abortion, but she said her father, the minister, supports abortion rights in some circumstances.
Just before she left, she asked a question. She had seen news coverage about the controversial D&X procedure. “The pictures they’ve been showing on the TV, will it be that?”
The counselor said no, her abortion would be by a different method.
At 6 a.m. the next morning, Lisa warmed up her car and woke up her fiance. He works the night shift and had just gotten home an hour earlier.
But because she would be groggy afterward, he would have to drive her home. She had already sent her son to stay with her mother.
By 8 a.m., she sat in a puffy pink recliner, an intravenous tube hooked up in preparation for the various drugs that would relax her, relieve pain and help prevent hemorrhaging. Fifteen minutes later, the procedure was finished.
Afterward, she was walked back to the recliner and offered pretzels and Sprite. Her eyelids drooped a little because the drugs left her woozy, but she remained calm and resolute.
She had prayed when she made her decision and hoped faith would carry her through now.
“Being a preacher’s daughter,” she said, “it will be something I’ll just have to accept because it’s over and done.”