Inside an abortion clinic: Private choices in public debate

Shortly after the doctor terminated her pregnancy in the 21st week, a clear-eyed young woman sat down to do something rare in this country: talk about her abortion.

"I feel relieved," she said, wearing a surgical gown with a fluffy blanket wrapped around her shoulders. She's petite and pretty, with three school-aged children at home and a college exam coming up that will bring her a step closing to a nursing degree. "I felt relieved before and after, knowing I have this option."

Down the hall at the Whole Woman's Health clinic in downtown Minneapolis, calls ring into its national call center switchboard from women around the country trying to book an appointment at one of their clinics.

They call from Texas, where two of Whole Woman's five clinics have been shuttered — along with half the other clinics in the state — by restrictive new state laws. They call from South Dakota, where there's a mandatory three-day waiting period at the state's only clinic. They call from Minnesota, which has as many abortion clinics as Wisconsin and the Dakotas combined and where a third of abortions are taxpayer funded.

"It feels like two different Americas that depend upon your ZIP code," said Amy Hagstrom Miller, the native Minnesotan who founded Whole Woman's Health in 2003 and who now operates clinics in Texas, Minnesota, Maryland and New Mexico. "So many of the women who call us [from Texas] have no idea if abortion is even still legal."

An estimated one of every three American women will have an abortion by age 45. The young woman at the Minneapolis clinic contacted three clinics before settling on Whole Woman's Health, where walls are painted a soft purple and covered with reassuring, uplifting messages: "I have no fear. I only have love — Stevie Nicks."

The clinic, which performs about one-third of the state's abortions, opened its doors to a reporter and a photographer in the hope of demystifying a procedure that remains an emotional and political minefield, more than four decades after the Supreme Court handed down its landmark 1973 decision in Roe vs. Wade.

"I think it's just really important for people to know that they're not in it alone," said clinic marketing manager Stephanie Shea.

But this young woman came to the clinic alone, after telling only a few trusted people about her decision. She declined sedatives so she could drive herself home to her children.

Abortion is an intensely personal issue caught up in a highly public debate. In Texas, thousands of abortion supporters stormed the Legislature in 2013 to protest its crackdown on clinics. Whole Woman's Health is now a plaintiff in two lawsuits trying to dial back the restrictions that are wending their way up the court hierarchy. Last year, 15 states enacted 26 abortion restrictions, adding to the 205 laws that passed between 2011 and 2013, according to the Guttmacher Institute, which researches reproductive health issues.

In St. Paul Thursday, thousands of abortion opponents will return to the Capitol for their annual call for similar restrictions in Minnesota, if not an outright ban.

"It's their contribution to making sure the unborn aren't forgotten," said Scott Fischbach, executive director of Minnesota Citizens Concerned for Life, which organizes the annual demonstration. "Their presence tells the rest of Minnesota, 'This issue will not go away until it changes.' "

This year, Fischbach expects to see bills calling for licensing and inspection of abortion clinics, a ban on so-called "dismemberment abortions," and an end to state funding for abortions — Minnesota is one of 15 states that offers Medicaid coverage to low-income women for medically necessary abortions. If any of the bills pass, they would likely run into Gov. Mark Dayton's veto pen.

"The Legislature passed seven different pro-life measures and every single one of them was vetoed by Mark Dayton," said Fischbach, who takes some consolation in the the closure of two Minnesota clinics in recent years — Regions Hospital stopped offering elective abortions in 2011 and Whole Woman's Health consolidated two downtown clinics into one location in 2012. Under previous administrations, he noted, Minnesota has passed restrictions, including a 24-hour waiting period, parental notification for minors and state-directed counseling that includes information designed to discourage women from going through with an abortion.

Legislative restrictions make it harder for women to book an appointment, but they don't stop abortions, said Sarah Stoesz, president of Planned Parenthood Minnesota, the state's largest abortion provider.

"Women will have abortions when they need them, whether it's legal or illegal, whether they are harassed outside the clinics or not harassed outside the clinics," she said.

But even with those restrictions, Minnesota stands in stark contrast to neighboring states like Wisconsin, where the U.S. Supreme Court struck down abortion restrictions last year that would have forced half of the state's four clinics to close, or North Dakota, where a court battle is being waged to restore a ban on abortions that would go into effect as soon as a fetal heartbeat is detectable — as early as six weeks.

"Minnesota, currently, is a real beacon of sanity and hope for women in the Upper Midwest," Stoesz said.

There were 9,903 abortions performed in Minnesota in 2013 — continuing a steady decline that is mirrored by national numbers. Nearly 900 of those abortions were performed on women who traveled to Minnesota from neighboring states.

When the women can't travel, doctors like Carol Ball come to them instead.

Once a month, she drives 200 miles to spend several days in Sioux Falls. The last South Dakota-based doctor willing to perform abortions retired, and she is among the tag-team of doctors who commute to staff the state's lone abortion clinic. Why does Ball do it?

"I had one physician in South Dakota, who is supportive of abortion services, tell me that it would be 'career suicide' for any South Dakota physician to perform abortions," Ball said. "In order for the women of South Dakota to have this service that they need and want, then other people need to go in."

There's a 24-hour wait for an abortion in Minnesota; in South Dakota, it's 72 hours. Patients there must meet, face to face, with the doctor who will perform the abortion, then return three weekdays later — weekends and holidays don't count — for the procedure. Very few end up reconsidering their decision during the waiting period, Ball said.

"I have not found it to be an actual deterrent. It just makes it harder," she said. "Women in South Dakota are very aware of how difficult their state is making it."

On the cold sidewalks outside the Whole Woman's Health clinic, Debra Braun paces with a stack of pamphlets, trying to gauge which women entering the multistory medical office building at 7:30 in the morning might be getting an abortion. She beckons encouragingly to a young woman waiting for the elevator, inviting her to come outside and talk. The woman boards the elevator.

"Our goal is to help women choose life for their child," said Braun, the education director for Pro-Life Action Ministries of Minnesota. "It's very rewarding when a woman changes her mind and saves her baby."

Clinic staff like Shea say most women make up their minds before they place their first call to the clinic and long before they walk through the door. But Braun's group estimates it has talked and pamphleted 3,000 women out of an abortion over the years. The thought of 3,000 babies keeps Braun coming back, twice a week, bundled in a warm coat and woolen gloves. She's one of an estimated 150 local volunteers who rotate "sidewalk counseling" duty outside the Twin Cities' four abortion clinics.

The young woman in the clinic visited twice to prepare for her procedures. Both times, she was met by protesters offering literature, begging her to reconsider. They were very polite about it, she said.

She turned down the literature on the first visit. On the morning of the procedure, she accepted a pamphlet and brought it inside. She hopes abortion opponents keep an equally open mind when they hear stories like hers.

The abortion took about 10 minutes. Afterward, staff bundled her into a blanket and let her relax in a recovery room with a heating pad and a mug of herbal tea until the cramps subsided. Gentle Peruvian flute music floated down from overhead speakers.

"You don't have to be alone — that would be the main thing I'd like people to know," she said. "It can be a scary thing."

On a table nearby, sat a pamphlet with a message for patients like her: "For some women abortion is a clear, certain decision. For others it can be really hard. For most women it is somewhere in between."

Jennifer Brooks • 612-673-4008