Editor’s note: The following is an excerpt from the new book “Life-Altering: Abortion Stories from the Midwest” by Tribune reporter Angie Leventis Lourgos, published earlier this year by the University of Missouri Press. Here, Lourgos describes the situation at Hope Clinic for Women in Granite City, an Illinois community not far from the Missouri state line. Lourgos has been a Tribune staffer since 2009. The excerpt has been lightly edited for style and length.
The couple donned sunglasses and baseball caps before entering Hope Clinic for Women on a spring weekday in 2019, to shield their identities from a throng of protesters outside. Fearing for their safety, they also rented a car so their own license plate couldn’t be traced.
The young woman’s 21-week pregnancy was clearly visible to the small cluster of anti-abortion activists in front of the southern Illinois clinic. One of the strangers said the woman must be able to feel her baby moving and suggested adoption. Another mentioned to the woman’s partner that Father’s Day was approaching.
Inside the clinic, the man and woman described their initial elation at the prospect of parenthood, eagerly preparing for their firstborn, whom they affectionately called Little One. They announced the pregnancy on social media with a photo of baby shoes. Then a 20-week ultrasound revealed the inconceivable: Large portions of the brain and skull were missing, a rare birth defect called anencephaly.
Their obstetrician in Missouri said the fetus wouldn’t survive outside the womb.
“There was no top to the head, there was no top to the brain,” said the man in the baseball cap, his sunglasses now clipped to his shirt and no longer concealing his eyes, which welled with tears. “The options were to either carry this child who had a death sentence. Or to terminate the pregnancy.”
But they faced many barriers to the procedure in Missouri, including a three-day waiting period. The state of more than 6 million residents had only one abortion clinic — and the fate of that provider remained in limbo when the couple received the devastating diagnosis.
The pregnant patient’s physician referred her to Hope Clinic, which performs abortions at up to 24 weeks’ gestation. The couple were confused and dismayed: They couldn’t understand why they couldn’t terminate the pregnancy in the same state where they received prenatal care. Although they lived nearby in southern Illinois, the young woman was treated throughout her pregnancy by doctors and nurses in Missouri and planned to deliver at a hospital there. In her time of grief, she said, it was difficult to understand why she had to find a new medical provider to terminate the pregnancy as they faced the worst possible outcome.
“I was in shock,” said the young woman, who asked to remain anonymous to protect the couple’s privacy.
Missouri lawmakers had just approved multiple abortion restrictions, including an eight-week gestational limit, a measure that would be blocked temporarily by the courts.
“It’s time to make Missouri the most Pro-Life state in the country!” Gov. Mike Parson tweeted a month prior to the couple’s appointment.
At the time, Missouri was one of a half-dozen states with only one abortion clinic: Kentucky, Mississippi, West Virginia, North Dakota and South Dakota were also down to a lone clinic providing abortions statewide.
Then, in May 2019, Missouri health officials refused to renew the license of Missouri’s last remaining clinic, a Planned Parenthood clinic in St. Louis, a move that threatened to leave the state without a single dedicated abortion provider. The Missouri Department of Health and Senior Services in a statement alleged there were “failed surgical abortions” in which patients remained pregnant, as well as other health and safety problems at the clinic.
The president and CEO of Planned Parenthood Federation of America accused Missouri officials of having “illegally weaponized the licensing process.” A judge issued a temporary restraining order allowing the abortion provider to stay open as the case moved through the legal process. But the clinic’s unresolved future still affected abortion access: Since the state had a three-day waiting period, many patients were afraid to book appointments there in case the clinic couldn’t survive until their procedure date.
By 2020, a state government administrator determined the state health department had been wrong to not renew the Planned Parenthood clinic’s license, and the facility was allowed to continue operating. But the clinic’s victory was short-lived: Roughly two years later, the U.S. Supreme Court overturned Roe v. Wade and Missouri banned terminating a pregnancy in almost all circumstances, so the clinic had to cease providing abortions.
Missouri had 12 abortion facilities in 1992, but by 2014, the state was down to three providers, according to an American Civil Liberties Union report tracking clinic closures over several decades in six states. The decline was largely due to regulations in numerous states requiring that abortion providers have hospital admitting privileges and that clinics meet the same standards as surgical centers. These types of mandates are often referred to as “targeted restrictions on abortion providers,” or TRAP laws, by reproductive rights advocates, who argue the rules are medically unnecessary and designed to limit access to the procedure.
“The TRAP requirements are difficult — in some cases impossible — to meet,” the report said. “Many hospitals simply won’t provide admitting privileges to doctors who perform abortions due to anti-abortion bias and stigma. Others require doctors to admit a certain number of patients at the hospital each year, but because abortion is such a safe procedure, abortion providers can’t meet that threshold. Ambulatory surgical centers are far more complex and expensive than what is necessary to provide a safe abortion, and no other comparable medical procedure is subject to such requirements.”
The report found that more than two dozen states had these types of regulations on the books, though some measures were blocked by courts. In 2016, the U.S. Supreme Court struck down those regulations in Texas, and, shortly after, a federal district court enjoined the laws in Missouri as well. But Missouri legislators swiftly approved new regulations that were strikingly similar to the old ones, and they survived legal challenges. In 2018, the state was back down to one provider.
“And with so few clinics in Missouri, a trip to the clinic could be 300 miles away,” the ACLU report said. “That, in turn, requires additional time off of work and possibly extra childcare costs, given that the majority of women who have abortions are already mothers.”
The same day the couple came to Hope Clinic, about a half dozen protesters gathered in the public right of way outside the Planned Parenthood clinic in St. Louis, just past the property’s black fencing. Many were praying for the facility to shut down.
One man walked up and down the sidewalk, fingering the small wooden beads of a rosary. He spoke of how children are the world’s most precious gift and that gift must be preserved.
“I am praying for all those who need God’s mercy,” said Richard Tourville, who described himself as a devout Catholic. “I believe it’s a terrible tragedy. … I just hope this finally comes to an end.”
… Because the couple’s pregnancy was so far along, the abortion was a two-day procedure for the young woman at Hope Clinic. The first day her cervix was dilated. The following morning, she had a surgical abortion.
Afterward, she sobbed in a hospital bed, her limbs shaking beneath the blanket, a side effect of the medication. “It’s over,” she said. “The baby won’t ever have to suffer.”
In a private recovery room, the man in the baseball cap kissed her forehead and touched her left hand. The physician who performed the abortion held her right hand, telling her the procedure went well.
“We did the right thing,” her partner said, weeping and repeatedly thanking the doctor.
“I feel like I did the best thing for the baby,” the patient said, wiping her eyes. “And it won’t ever hurt. It won’t lay in a NICU or my arms and pass away.”
As drivers cross into Illinois from Missouri on Interstate 55, a billboard greets them with the message: “Welcome to Illinois, where you can have a safe, legal abortion.” It was erected a few months before the couple’s appointment by Hope Clinic.
The prospect of Missouri losing its last abortion clinic was daunting to the staff at Hope Clinic, which performed more than 3,700 abortions in 2018. Roughly 55% of patients that year came from Missouri, though the two-story brown brick medical facility also drew women from many other states in the Midwest and upper South, as well as other countries.
The clinic had already seen a 30% increase in patients since 2017 and had doubled the number of staff physicians in that time from two to four, said the clinic’s deputy director, Alison Dreith, who had previously served as the executive director of NARAL Pro Choice Missouri.
In the previous week or so, the abortion provider had hired several extra counselors and nurses as well as its first lawyer, Dreith said. More volunteers were also undergoing training, but it’s difficult to plan for a potential influx of patients given the shifting legal and political landscape locally as well as across the country. While the St. Louis clinic was still seeing patients amid the battle over its license, more women from Missouri had been seeking appointments at Hope Clinic because of the uncertainty.
“Patients also know that there’s a 72-hour waiting period, and the clinic’s licensing issue is in the court,” Dreith said. “So they’re worried that clinic could close by the time they have their procedure or go in for their 72-hour consent.”
… Faced with increasing hurdles in Missouri, Planned Parenthood of the St. Louis Region and Southwest Missouri in late 2019 opened an 18,000-square-foot health center in Fairview Heights, Illinois, near St. Louis and Hope Clinic. The location on the east side of the Mississippi River meant no extra regulations for the abortion provider and no mandatory waiting period for patients.
As the couple at Hope Clinic prepared to terminate their pregnancy, the national abortion debate roiled in headlines and on television newscasts. Multiple states had just passed some of the strictest abortion laws in the nation, with the intention of challenging Roe v. Wade. In 2019, more than 50 abortion restrictions were enacted, and two dozen abortion bans were passed, primarily in Midwestern and Southern parts of the nation.
“It’s really unfortunate they’re lumping all abortions into one category,” said the young woman at Hope Clinic. “And that’s not to say that I should get special treatment or be exempt, because everyone has a choice to do what is best for their body and baby, and no one else can make those decisions.”
Four other women were resting on recliners in the Hope Clinic’s main recovery room that day, either waiting to have a surgical abortion or recuperating after the procedure. That morning, three patients were from Illinois, one came from Missouri and another traveled from Tennessee.
“Everyone is here for a reason,” she said, motioning to the other patients.
While abortion was still legal in every state at the time, clinic staff said looming abortion regulations in some parts of the country were stoking confusion and fear.
“The phones have definitely been ringing off the hook these days,” said Aryn Hanebrink, the clinic’s medical secretary. “A lot of people are scared, honestly. I’ve had girls call me and they’re crying, because they’re so thankful that we can still help them here.”
In the clinic’s changing room, three white binders labeled “Patient Journal” contain hundreds of handwritten notes chronicling the thoughts and emotions of women before or after their abortions.
“I am happy with my choice to make a better life for me and my family,” one patient wrote, encircling the sentence in a heart.
“You cannot be judged by anyone who has breath in their lungs,” another wrote. “They are not God, because he forgives. Dear Lord, I love you and have faith in you. I know you love me too and I know I will be forgiven.”
“It’s a choice — not a child,” a third patient wrote.
In careful cursive, the patient from southern Illinois penned her parting words before leaving the clinic.
“Loving someone doesn’t always mean you fight for them,” she wrote. “Sometimes loving someone just means letting them go.”
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