Your Body Is A Battleground

Thirty years ago this month, the Supreme Court gave women the right to abortion. That right is in peril. SELF went to Louisiana, home of the nation's tightest abortion restrictions, to see what life might be like without Roe v. Wade.

It's still dark outside when 26-year-old Ronni's alarm goes off at 5:45 on a sticky October morning in east Texas. She stumbles out of bed to the bathroom, runs a hot bath and finds her way to the kitchen to pour herself a glass of orange juice. After her bath, she pulls on a T-shirt and sweatpants and fills a plastic grocery bag with sanitary napkins. She and her mother are both quiet as they slide into the car. They're tired and anxious.

Last night, Ronni's mother went to bed early, at 8 P.M., so she would be alert for the two-and-a-half-hour drive to Shreveport, Louisiana. In the passenger seat beside her, Ronni (who asked that her name be changed to protect her safety and privacy) leans her head against the car window and watches the hulking shadows of pine trees that fringe the county road. An hour into the drive, the darkness begins to lift, and she can make out horse farms, RV parks, hand-lettered signs for fireworks and church after church, Baptist and Methodist and Pentecostal. One of them has a cemetery beside it, dozens of tiny tombstones marking imaginary graves, with a sign reading 4,000 BABIES A MONTH DIE FROM ABORTION.

She drifts in and out of sleep until they hit the interstate that crosses from Texas to Louisiana. The pine trees are gone now, replaced by billboards for riverboat casinos. DEREK W. WON $250,000 AT THE HOLLYWOOD CASINO, one reads, with a big photo of a smiling Derek W. in front of what seems to be a new SUV. As they near their exit, Ronni notices a billboard with a fresh pink infant. PRAY FOR THE UNBORN, it says.

About the same time, 20-year-old Jennifer, the administrative assistant at Hope Medical Group for Women in Shreveport, is pulling into the clinic's parking lot, the first staff member to arrive for the day. Waiting there are two armed marshals, bulky with SWAT gear: handcuffs clipped to their waists, shotguns and semiautomatic Glock .40s tucked into the depths of their padded black overalls. One of them escorts Jennifer into the clinic and checks to make sure the cameras that monitor the building's perimeter are working.

Every Saturday, the marshals come, and nearly every Saturday for the past 10 years a militant group known as God Said Ministries has been coming as well. While in some other states protesters would be required by law to stand a minimum distance away from the clinic, here 50 or 60 people led by Pastor W.N. Otwell can stand as close as a few feet away as they bellow at women going in and out. "You're shaking hands with the devil," they yell, waving angry signs at patients—some of whom are there for birth control prescriptions and pregnancy tests, not abortions. (The state requires women to have written proof of pregnancy to receive prenatal care under Medicaid; the clinic is where they get that proof.)

Ronni was warned about the demonstrators when she made her appointment for an abortion the day before—warned they would arrive when she would, a few minutes before 9 A.M. on Saturday—but she chose to keep her appointment anyway. "I want to get it over with," she says. "I'll do my best to ignore them." As her mother pulls into the parking lot, Ronni looks furtively around, then leans back in her seat. For now, no activists are in sight.

protesters may be the most dramatic obstacle that patients and employees at Hope Medical Group face, but they are not the most threatening. After the Supreme Court's Planned Parenthood v. Casey decision in 1992 granted states broader authority to regulate abortion clinics, state legislators seized on the opportunity—and nowhere more eagerly than in Louisiana, which has a powerful contingent of anti-abortion Catholics and Southern Baptists in its state legislature. In the past decade, the state has passed a series of laws designed to erode women's reproductive freedom by making abortion less accessible and harrowing for patients and cost-prohibitive for providers. So cost-prohibitive, in fact, that the most draconian of the laws, recently upheld after a five-year court battle, could drive the state's 15 remaining abortion providers out of business for good.

"Louisiana has become a proving ground for anti-choice legislation, because the anti-choice forces know they can get their bills passed here," says Priscilla Smith, director of the domestic legal program at the Center for Reproductive Law and Policy in New York City, who has challenged many of Louisiana's laws in court. In fact, a 2002 SELF analysis determined that in Louisiana the laws are more restrictive and the climate more hostile toward abortion than in any other state. For every 67,400 women of childbearing age in Louisiana, there is only one abortion provider; of 64 counties, 59 have no provider at all. The Louisiana legislature has passed a resolution declaring that the state will do everything it can, within federal law, to prevent abortions. And in 1991, the state reenacted the prohibition it had on abortion before the Supreme Court's Roe v. Wade decision, though such a ban is unconstitutional and unenforceable as long as Roe stands. "The thinking was that someday Roe v. Wade may be overturned, and if it is, we've got a law against abortion on the books, ready to implement," says Louisiana state Representative Sydnie Mae Durand, who voted for the ban.

As the nation marks the 30th anniversary of the Roe v. Wade decision on January 22, the prospect of reversal looms large. The Supreme Court's last major abortion case, a 2000 ruling that threw out a Nebraska ban on a late-term procedure, was decided by only a single vote. With three justices older than 70 and an anti-abortion president likely to be charged with nominating new justices, activists on both sides of the debate say there is a good chance of a shift in that fragile balance.

A reversal "would mean there would no longer be a U.S. constitutional right to an abortion, and abortion laws would be fought out on a state-by-state basis," says Denise Burke of San Antonio, staff litigation counsel of Americans United for Life in Chicago. "A few states where there is strong pro-life sentiment, such as Louisiana and South Dakota, might ban it outright. In a number of states, it would probably remain legal, as it is now. And the vast majority would probably impose more restrictions." In other words, in the future abortion might be experienced in much of the nation as it is in Louisiana today.

Shreveport is clearly not the most welcoming place for a woman who wants to end a pregnancy, but it's Ronni's best option. The Hope clinic is one of the few abortion providers in a 200-mile radius, serving women from small towns in Louisiana, southern Arkansas and east Texas, where Ronni lives in a middle-class logging town. Because Ronni doesn't own a car, her mother had to drive her to the clinic—twice, in fact, in 48 hours, thanks to a provision, benignly dubbed the informed-consent law, passed by the Louisiana legislature in 1995. This law requires women to undergo an in-person consultation with a physician at least 24 hours before an abortion. Thirty-one other states have passed abortion-specific informed-consent laws, including 15 that enforce a 24-hour waiting period, according to the National Abortion and Reproductive Rights Action League in Washington, D.C. But most give patients the option of receiving the information by mail or doing the consultation by phone. For Ronni and her mother, the informed-consent law translates into 10 hours on the road: one trip for the consultation, another for the abortion itself.

It means missed wages as well. Both women work weekdays, so they had to skip work on Friday. That meant Ronni's mom lost a sick day, and Ronni sacrificed an entire day's pay; she earns $7 an hour as an executive assistant and has no paid vacation, sick leave or health insurance. Mother and daughter considered staying overnight in a hotel so they wouldn't have to make the trip twice, but rates are high in this city of riverboat casinos: A room at the Holiday Inn downtown runs about $75, more than Ronni earns in a day. "The trip to the clinic for the consultation was a hassle, and I didn't learn anything new," she says. "Do you think I'd drive all that way if I hadn't already decided that I had to have that abortion?"

Despite the obvious hardship, the fact that Ronni was able to save enough money to pay for her abortion, and that her mother was willing to be her chauffeur and confidante, actually puts her among the more fortunate women in her situation. Because Medicaid does not cover most abortions in Louisiana, the burden of travel expenses, child care and lost wages, combined with the $350 to $575 cost of the surgery itself, puts the option out of reach for many women. "We'll never hear about the women who are most affected by this law," says Robin Rothrock, administrator of the Hope clinic. "They're the ones who hang up and never call back for an appointment when you tell them they'll have to make the trip twice."

not that the decision to have an abortion was simple for Ronni. She is a devout Methodist who attends church every Sunday and Bible study every Wednesday. She has strong moral convictions against abortion. "It's wrong," she says, shaking her head, unable to articulate exactly why. "It's just wrong." Yet Ronni is also the single mother of a 5-year-old son she is struggling to support. She is firm that she absolutely cannot take on the financial responsibility of another child, and when her gynecologist in Texas broke the news that Ronni was pregnant with twins, it only confirmed her initial decision.

The father—a boyfriend who quickly became an ex—could not help pay for the abortion, because, Ronni says sarcastically, "he doesn't feel like getting a job just now." Nor could Ronni afford to miss days of work because of illness, as she did the last time she was pregnant. Last year, when she left her job selling cell phones, she had to pack her furniture into storage and move in with her parents. But her stepfather didn't have the temperament to handle her son—"he's got a lot of energy, my little boy," Ronni says, grinning suddenly—so she had to send him to live with her grandmother in Louisiana, three and a half hours away.

"It hurts me, thinking about all the things I'm missing," she says. "I want to be the one to put him on the bus in the morning. I want to see the drawings he made at school at the end of the day." She finally landed her assistant job in September and has since taken a part-time retail job evenings and weekends, too. She puts about two thirds of her paychecks into the bank and hopes to rent an apartment where she can live with her son in the next few months.

Like Ronni, plenty of women grapple with guilt over the issue of abortion; for these women, informed-consent laws pose more than a logistical burden. Physicians' consultations follow a script prepared by the state that seems skewed to make women uncomfortable with their decision; the script covers, among other things, "medical risks and alternatives to abortion" as well as "probable anatomical and physiological characteristics of the unborn child at the time the abortion is to be performed." The provider is then required to give patients a booklet published by the state titled Abortion: Making a Decision, which features enlarged color photos of a fetus at two-week gestational increments.

Peg Kenny, executive secretary of Louisiana Right to Life, the group that lobbied state legislators to adopt the informed-consent law, insists that its purpose was not to dissuade women from their choice but to educate them. "If you go in for any kind of surgery, you talk to your doctor first, and then you have time to think about whether or not you want to proceed with it," Kenny says. Putting space between a consultation and a surgery may be common, but abortion is the only medical procedure in Louisiana for which specific information must be given in a specific manner by specific people at a defined time.

While the state script can prescribe words, however, it can't prescribe attitude. Dr. M., a semiretired physician who does most of the consultations at Hope (and who requested anonymity), does his best to put patients at ease. He has a warm, folksy manner. Ronni listens and nods as Dr. M. explains the surgery, using his fist to stand in for the cervix and his finger or a pencil for the curette. She nods some more as he opens the booklet to page 4 and marks the color photo of a 12-week-old fetus, magnified so the eyes and arms and legs are visible.

"This is about where you are in your pregnancy," he says, handing her the literature so she can review it on her own. Beside the 3-inch-by-3-inch photo, the booklet explains that Ronni's fetuses "can swallow, the kidneys make urine, and blood [has begun] to form in the bone marrow." A few pages later, the booklet discusses Ronni's medical risks, including pelvic infection, blood clots, bleeding, perforation of the uterine wall and the potential long-term risk for breast cancer. (As SELF reported in its August 2002 issue, officials at the National Cancer Institute, World Health Organization and American Cancer Society have discounted any link between abortion and breast cancer.)

But Ronni doesn't read those words. "I didn't want to study that book," she admits. "I knew it wouldn't change my mind." Dr. M. mentions the possibility of adoption and the obligation of the father to pay child support, and points out that the risk of complications during childbirth can be 10 to 15 times higher than the risk of complications during an abortion—his personal addendum to the lecture. Ronni doesn't blink. It all seems to have passed right through her, like a commercial you hear coming from the den when you're busy in the kitchen. Nothing Dr. M. says makes her rethink her decision. "I feel the same way I felt when I came in," she says. "I don't like the idea of abortion, but it's hard enough to take care of one child. Add two more to that? I just can't do it."

Twenty-four hours later, ronni is back at the clinic. By the time a nurse leads her into the operating room and helps her into a reclining chair, she is hazy with Valium, which the clinic gives patients to help them relax. The nurse holds her hand, and Ronni holds the nurse's—grips it, actually—as Dr. B. (who also asked to remain anonymous out of fear of retribution) numbs her cervix with a local anesthetic. During the abortion itself, Ronni holds a nitrous oxide mask over her face and is urged to take slow, deep breaths. The sounds of waterfalls and birdsong play softly from a stereo beside the chair. The vacuum aspiration method Dr. B. uses takes only about 45 seconds, and the whole procedure lasts seven and a half minutes. But afterward, sipping herbal tea in the recovery room, Ronni says it felt like much longer. "I thought about my son the whole time, and that helped get me through it—the way he jumps on me as soon as he sees me, and that big smile of his."

Louisiana law allows a woman who regrets her abortion to sue her doctor for an unlimited sum—up to 10 years after the procedure.

Throughout the 21 years that Dr. B. has worked at Hope Medical Group, he has put both his life and his livelihood on the line. In the early '90s, nearly all the doctors who shared the office suite where he ran his private practice cleared out, fearful of offending their patients. Dr. B. is also acutely aware of the dangers of his profession; in 1982, the owner of a Hope clinic affiliate in Granite City, Illinois, and his wife were kidnapped for eight days, blindfolded during much of the ordeal. Dr. B.'s wife has received menacing phone calls that terrify her.

The thing most likely to drive him out of business, however, is not a criminal threat but a legal one—specifically, Louisiana's civil liability law, which the legislature passed in 1997 but which was tied up in court until last November. This provision, unique in the nation, allows a woman to sue the physician who performed her abortion for an unlimited sum of money—not just for her own injuries, but for damages to the "unborn child"—up to 10 years after the procedure. Not only does that mean a woman who regrets her abortion would have the potential to bankrupt a clinic, but a big judgment in her favor could scare every abortion provider in the state into closing down. And that outcome would surely motivate anti-abortion lawmakers in other states to push similar bills.

Hope clinic's Rothrock and other abortion providers enlisted the Center for Reproductive Law and Policy to challenge the law twice. They lost both times. The Louisiana Supreme Court rejected their last appeal in early November. The upshot of that decision: Abortion providers will have to wait until a patient sues them before they can challenge the constitutionality of the law again.

In large part because of the liability law's being upheld, one of the Hope clinic's physicians has already announced he will have to stop providing abortions; the law threatens to send his already high insurance rates through the roof. But Dr. B. will continue. "My whole life could be ruined, but this law is not going to stop me," he says. "Because I have to ask myself: If I don't do it, who will?"

In a state where many women have religious convictions against abortion, it's not hard to imagine one of Dr. B.'s patients having second thoughts (as has Norma McCorvey, aka Jane Roe, now an outspoken activist against abortion). Many of the patients in the waiting room at the Hope clinic seem to have grave reservations about what they are doing. In theory. A woman with a heart defect whose pregnancy threatened her life was racked with guilt two days after her abortion. "But I know I did what I had to," she said. A bubbly 23-year-old named Jessica made a three-hour round-trip drive alone, both times, because she didn't want a soul to know what she was doing—especially not her Southern Baptist boyfriend.

It's a delicate balancing act, reconciling morality and necessity, as Ronni knows all too well. As she's getting ready to leave the clinic at half past noon, groggy but relieved, she learns that the militant group never did show up. But there are other protesters out front: a group from a local Catholic church, pregnant women with baby carriages and a priest thrusting a wooden crucifix toward the clinic, all of them praying for the souls of the women inside. Ronni seems unfazed by the news.

"I have no problem with people praying for me," she says. In fact, she said a prayer or two herself while lying on the operating table. What bothers her is when people condemn her for things they don't understand. "I don't want a bunch of politicians or crazy men in camouflage telling me what to do. You know why? Because they haven't lived my reality." She tucks her painkiller prescriptions into a makeup bag, puts it in her purse and strides outside into the early afternoon sun. Then she slides into the car beside her mother to begin the long drive home, past the casino billboards and the RV parks and the church cemetery where dozens of tiny tombstones mark imaginary graves.

Kimberley Sevcik is a contributing editor for Marie Claire and has written for Elle, Ms. and Salon.