Under Din of Abortion Debate, an Experience Shared Quietly
By JOHN LELAND | Published: September 18, 2005
LITTLE ROCK, Ark. - At Little Rock Family Planning Services, the
women filed in without making eye contact, a demographic that remains unrecognized.
Leah works in a clothing boutique. Alicia is in high school. Tammy pulls espresso.
Regina is a sergeant in the Army, recently home from Iraq.
Kristen Schmid for The New York Times A woman from Mississippi underwent preparation
for an abortion. She had been told that her fetus, which had serious defects,
would not live.
Far from Washington and the Supreme Court confirmation hearings of Judge John
G. Roberts Jr., here in Little Rock on an August weekend, 26 women from as
far away as Oklahoma joined the more than one million American women who will
probably have abortions this year.
Their experiences, at one of only two clinics in the state, offer a ground-level
view of abortion in 2005, a landscape altered by shifts in technology, law,
demographics and the political climate.
Brittany, 17, brought her mother for support. Linda, 39, brought her daughter.
Alexia, who wore a cross pendant, prayed all through the two-and-a-half-hour
drive from Delta State University in Mississippi. At 23, she was having her
third abortion. "My religion is against it," she said, adding that she is
a Baptist. "In a way I feel I'm doing wrong, but you can be forgiven. I blame
myself. I feel I shouldn't have sex at all."
Venetia Grunder, 21, viewed an ultrasound image of the fetus in her womb.
She was 12 weeks pregnant, though she had taken birth control pills as directed.
"I feel pretty messed up," she said after seeing the image. "It's different,
just knowing. My husband told me not to look. This changes my feelings, but
I'm sticking by it. Damn it, $650, I'm sticking by it."
More than 25 million Americans have had abortions since the Supreme Court
decided Roe v. Wade and Doe v. Bolton in 1973. Often kept secret, even from
close friends or family members, the experience cuts across all income levels,
religions, races, lifestyles, political parties and marital circumstances.
Though abortion rates have been falling since 1990, to their lowest level
since the mid-1970's, abortion remains one of the most common surgical procedures
for women in America. More than one in five pregnancies end in abortion.
In the squat, nondescript brick building here, the lofty rhetoric that has
billowed through public debate for the last 32 years gave way to the mundane
realities of the armed security guard and the metal detector, the surgical
table and the settling of the bill before the procedure - $525 to $1,800,
cash or credit card only.
While public conversation about abortion is dominated by advocates with all-or-nothing
positions - treating the fetus as a complete person, with full rights, or
as a nonentity, with none - most patients at the clinic, like most Americans,
found themselves on rockier ground, weighing religious, ethical, practical,
sentimental and financial imperatives that were often in conflict.
Regina cried on the operating table. Kori, 26, who was having her third abortion,
asked to watch the procedure on the ultrasound monitor. "I wanted to see what
it was like," she said. "It was O.K. to watch. Once you had your mind made
up to do it, you just suck it up and go with it."
The solitary protester outside , Jim Dawson, 74, stood a court-mandated distance
from the clinic with a video camera, taping women as they entered, and promising
them hellfire if they went through with it - as he has for a decade. Mr. Dawson
drives 40 miles from Vilonia, Ark., bringing cardboard signs that say "Abortion
Kills," and usually departs by midmorning. On days when the clinic is closed,
he pickets the Clinton presidential library. "I don't stop many of them,"
he said, "but a little bit goes a long way."
At the clinic, patients allowed a reporter to attend their consultations and
even operations, but most spoke only if they could use just their first names.
"It's not something I would talk about," said "M," a high school teacher who
agreed to be identified only by her middle initial. She wore a miniskirt and
T-shirt, her blond hair pulled back from her forehead. She said she had never
discussed abortion with relatives or colleagues. Only two friends knew she
"I'd lose my job," she said. "My family's reputation would be ruined. It makes
me nervous even being in the waiting room. You don't want to know who's here,
you don't want to be recognized, and you don't want to see them ever again.
Because in society's eyes, you share the same dirty secret."
Even most staff members at the clinic insisted on using only their first names
- "to protect my identity from the antichoice people," said Lori, a nurse
practitioner. Several said they had not told family members what they did
for a living, or were ostracized if they did.
"My oldest son won't let me see my grandchildren," said Sherry Steele, 57,
a surgical assistant who started working at the clinic after her daughter
had two abortions. The New York Times agreed to anonymity to encourage candor
and to get a representative sample of women. (Those who volunteer their full
names are by nature an unrepresentative minority.)
On this August weekend, the women entering the Little Rock clinic resembled
those who have abortions nationwide. They were mainly in their 20's, more
likely to be poor and African-American than the area population. Most were
already mothers, many single. They arrived as a result of failure of one sort
or another: a poor sexual decision, a broken relationship, a birth control
method that just did not work. More than half of all women who have abortions
say they used a contraceptive method in the month they conceived, according
to the Alan Guttmacher Institute, a research group that supports abortion
While abortion rates have been falling generally since 1990, the decline has
been steepest among teenagers, and rates are lowest among educated, financially
secure women. Researchers attribute the drop in teenage abortion to reduced
rates of pregnancy, as a result of better access to contraception - including
the three-month Depo-Provera injections - and abstinence.
Conversely, for poor and low-income women, rates increased during the 1990's,
possibly in response to the 1996 welfare overhaul, which reduced support systems
for women who carry their fetuses to term. At every income level studied by
the Guttmacher Institute, African-American women were more likely to terminate
their pregnancies than white women.
Leah, 26, said money was a factor in her decision to have an abortion. A former
college track athlete, she works in a clothing boutique, a job that she said
did not pay enough to support a child.
Like many women at the clinic, Leah had conflicted feelings about what she
was doing. "I always said I would never, ever have an abortion," she said.
"I probably will regret it. I'm pro-choice for cases of incest or rape, but
if it's your own fault, you should accept responsibility. And it's my own
In Arkansas, as in many states, abortion providers are required to offer women
their ultrasound images before an abortion. Because Leah was just five weeks
pregnant, her image showed a formless mass. "If I saw an actual fetal baby
on the ultrasound, I wouldn't have been able to go through with it," she said.
She said she felt selfish, "but hopefully this will set me on a straighter
The procedure took only minutes. Afterward, in a recovery area, she said she
was less shaken than she had expected. "I thought I'd be crying," she said.
"I feel goofy now, but not in a bad way. I feel relieved more than anything.
I know I'll never forget it, but I'd rather do that than have a child I can't
take care of."
Karen, 29, who arrived at the clinic 20 weeks pregnant, expressed no qualms
about ending her pregnancy. Like nearly half of all women who have abortions,
she had had one before, when she was 18. She did not look on abortion as shameful,
she said, adding, "All of your past goes into making you who you are."
She has a 9-year-old son, and she said she felt she could not start again
with a newborn child. This, too, is common. More than half of all women having
abortions have had children, a percentage that rose in the 1980's but has
not changed since 1990, according to the federal Centers for Disease Control
Karen and her boyfriend have an unstable relationship plagued by money problems,
and they lived with a relative after being evicted from their home. She did
not come in earlier in the pregnancy, she said, because she did not have the
money. In the end, because she was so far along, her abortion took two days
and cost $1,375, nearly three times what it would have cost if she had come
in at 12 weeks. "People tell you you can put your child up for adoption,"
she said. "But if your kid has medical problems, no one wants to adopt him.
And you never know."
For many women at the clinic, their desire to end their pregnancy clashed
with their religious beliefs. Tammy, a Muslim, had her first abortion a year
ago, after having three children. She is married and works in a coffee shop
in Tennessee. She became pregnant this time after erratically taking her birth
"I know it's against God," she said of her abortion. "But you have three kids,
you want to raise them good. My friends and sister-in-law say, 'You care about
money problems but don't care about what God will do.
"I believe it's wrong. I pray to God to forgive me. This will be the last
one. Never, never again."
Since 1992, when the Supreme Court recognized states' authority to restrict
abortion as long as they did not create an "undue burden," states have enacted
487 laws restricting patients or providers, in many cases calling for mandatory
counseling, waiting periods and parental consent for minors, according to
Naral Pro-Choice America. The result is a patchwork of laws and regulations
that vary from state to state, some of which may come before the United States
Supreme Court. In surveys, Americans largely support these restrictions, even
if they say abortion should be legal. This fall, the court will consider whether
New Hampshire's parental notification statute creates an undue burden because
it does not include an exception to protect the health of the woman.
Arkansas, which before Roe v. Wade had one of the nation's most liberal abortion
laws, now has one of the most restrictive, requiring state-scripted counseling
at least a day before the procedure and, since mid-August, parental consent
for minors. At 20 weeks, doctors are required to tell patients that the fetus
feels pain, though this is medically disputed.
At the clinic in Little Rock, patients and staff members said the restrictions
were more inconveniences than roadblocks. Patients nodded dutifully as the
staff members asked questions like, "Do you understand that the father of
the child must provide financial assistance if you deliver the pregnancy?"
Like the protester outside, the regulations seemed simply part of the drill.
In a pre-operation holding room, Alicia, 17, awaited an abortion for which
her parents were not asked permission. Under Arkansas law, as in 33 of the
34 states that require parental consent or notification, juveniles can bypass
their parents if they persuade a judge that they are mature enough to make
the decision themselves, or that it might be in their best interest.
Alicia, who was 17 or 18 weeks pregnant, said she did not have the abortion
earlier because she was afraid to confront her parents. When she finally told
her parents she was pregnant, she said, her mother threw a stool at her and
kicked her out of the house.
"But I can't give a baby a life it should have financially," she said. "My
boyfriend didn't want me to go through with it, but he realized he couldn't
support a baby either." Her parents ultimately gave her $1,700 for the abortion,
but she arrived from Oklahoma without their formal consent.
Getting a judicial bypass was not difficult, she said. The clinic scheduled
her appointment early in the morning, and after taking a pregnancy test, for
which she paid $200, she met with a judge briefly in his chambers. "If you
go to the judge and say, 'I'm afraid to tell my parents because they might
harm me,' that's all you need to say," said Dr. Tom Tvedten, who has been
performing abortions in Arkansas for 20 years, and now works part time at
the Little Rock clinic. "It doesn't have to be true, because how would anybody
He added, "But every time a restriction is placed on us, it increases our
costs, and that cost is passed on to the consumer."
For the clinic, the regulations add paperwork and require extra staff members,
said Dr. Jerry Edwards, the chief physician, who owns the clinic with his
wife, Ann F. Osborne, the director. Penalties can include lawsuits or criminal
"Normally, if someone's a flagrant violator of medical regulations, they get
disciplined by the profession," Dr. Edwards said. "But these guys go for the
pocketbook or put you in jail. It's much more punitive than the doctor who
commits Medicare fraud."
New licensing laws, enacted in 28 states, require providers to comply with
state codes for equipment, record-keeping, building grounds and other areas,
which small businesses can find onerous. In Arkansas, these laws - which clinics
call TRAP laws, for targeted regulation of abortion providers - do not apply
to existing clinics, but they make it expensive for anyone who wants to open
one, Dr. Edwards said. "We look at TRAP laws as a major barrier for people
who want to become providers," said Vicki Saporta, president and chief executive
of the National Abortion Federation, a trade group of providers.
Dr. Tvedten likened the regulations to "death by a thousand scratches."
In part because of the legal, financial and emotional pressures, the number
of doctors in Arkansas who perform more than occasional abortions has fallen
to three, down from six in the late 1990's. The youngest, Dr. Tvedten, is
59. This reduction mirrors a national trend. Nationally, 1,819 facilities
provided abortions in 2000, down from a high of 2,908 in 1982, according to
the Guttmacher Institute.
Dr. Edwards, 63, said he felt an obligation to stay in business. "If we retired,
I'm not sure anybody else would come to Arkansas and practice," he said. "We
can't get residents from the hospital to come over and see what an abortion
Threats against abortion clinics are on the decline, in part because of sterner
laws to protect clinics. But picketing has remained steady, at 80 percent
of clinics. Dr. Edwards and Ms. Osborne said they felt isolated from the local
medical community and the community at large. Even the patients often have
a negative view of abortion. "I very often hear, 'I don't believe in this,
but my situation is different,' " Ms. Osborne said.
Though the clinic has developed an equilibrium with its lone demonstrator,
Ms. Osborne is wary of any opposition to abortion rights. In 1994, when she
was executive director of Preterm Health Services in Brookline, Mass., an
abortion opponent named John C. Salvi III came into the clinic and started
shooting, killing the receptionist.
As laws become more restrictive, technology has gone the other way, making
abortions possible both earlier and later in pregnancy, and by pill or surgery.
Doctors can perform abortions as early as eight days after conception, and
59 percent of women having abortions do so within eight weeks, according to
2001 data from the Centers for Disease Control and Prevention.
Fewer than 1 percent have abortions after 20 weeks. A late-term procedure
called intact dilation and extraction, sometimes known as "partial-birth"
abortion, accounted for less than two-tenths of 1 percent of all abortions
in 2000 , according to the Guttmacher Institute. Fewer than one in 50 providers
Since September 2000, when the Food and Drug Administration approved the drug
Mifepristone, sometimes called RU-486, for early abortion, more than 460,000
women have chosen this option, according to the manufacturer's data. Mifepristone
is given in conjunction with a second pill, misoprostol, usually over two
or three days, and requires a follow-up exam with a doctor.
At the Little Rock clinic, few patients chose the pills rather than surgery.
"With medical termination, the discomfort is significant because they have
to go through mini-labor," Dr. Tvedten said. "There's a lot of hard cramps
and usually significant bleeding. It's cheaper, safer and less painful to
have a surgical termination."
Each technological advance has led to new legislative and legal wrangling,
which may ultimately reach the Supreme Court. On Aug. 31, the director of
the women's health office at the Food and Drug Administration resigned in
protest over delays in approving over-the-counter sales of the "morning-after"
contraceptive pill known as Plan B, which has emerged as a front in the abortion
Regina, 28, blamed a contraceptive Depo-Provera shot from an Army nurse in
Iraq for her pregnancy. In Arkansas, she receives the injection in her hip,
where it is most effective, but in Iraq she got it in the arm - she remembered
by the soreness she felt slinging her rifle. "I was in Iraq 13 months," she
said. "I guess I got a little happy when I got home."
She arrived at the clinic with a cut on her nose and bruises on her forehead
and lip, which she suffered after telling her boyfriend she was pregnant.
"He flipped out because he wasn't ready," she said. She had thought, upon
learning of the pregnancy, that she "was about to get married," she said.
She came in with two fellow sergeants, who wore their uniforms. Her boyfriend
was in jail, she said.
"I've done this once and swore I wouldn't do it again," Regina said. "Every
woman has second thoughts, especially because I'm Catholic." She went to confession
and met with her priest, she added. "The priest didn't hound me. He said,
'People make mistakes.' "
In the operating room, a team of nurses gave her injections to relieve anxiety
and pain. Dr. Edwards inserted a speculum and maneuvered a plastic suction
device around her uterus. "Don't leave," she entreated Ms. Osborne. The procedure
lasted about five minutes.
As she lay on the table, Regina wept and put an arm around Ms. Osborne, asking
how things looked "in there." "I'm not a baby, that's what's so sad," Regina
said. "Thank you, ladies, for being here for me. I'm too old to make these
She said the experience was emotional because she had expected more of the
father. She spoke to Dr. Edwards. "Thank you, sir," she said.
Ebony, 28, an operating room supervisor, rinsed the blood off the aborted
tissues for Dr. Edwards to examine. Ebony, too, had a story. When she was
15, her aunt and grandmother had made her carry her pregnancy to term. Later,
she had an abortion. As a Baptist, she still considered abortion a sin - but
so are a lot of things we all do, she said. She squeezed Regina's hand.
"No problem, sweetie," Ebony said. "We've all been there."