With Roe v. Wade set to fall, this doctor’s clinic and others like it may emerge as America’s safe havens for abortion
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Hey there, time traveller!
This article was published 03/05/2022 (217 days ago), so information in it may no longer be current.
BOULDER, Colo.—Inside this small medical recovery room, little has changed over the decades, even as a political war has raged about its very existence.
While protesters shouted outside, its two neat beds were made up daily with colourful blankets. While politicians fought for years about whether this place should be legal, stacks of papers piled up, and plastic uterine figures gathered on side tables. When someone tried to put a bullet through the clinic’s front door, this room was still here, featuring a doctor’s nature photography on the walls.
Thousands of women and girls looking for a safe way to end their pregnancies have passed through the doors of Dr. Warren Hern’s clinics for the past 50 years, 47 of them at his current office space in Boulder. They’ve come from all 50 U.S. states and every permanently inhabited continent. They’ve come at times when a later-term procedure was illegal where they lived, and when Hern was one of few doctors with enough experience to handle their complicated cases.
They’ve always come when the right to an abortion was guaranteed in the United States by Roe v. Wade. Now, with that right seemingly set to be taken away, it’s places such as this one that will keep fighting for women’s access to abortion care, filling gaps where they can.
Just outside, the sun beams down and the Rocky Mountains of Colorado tower overhead. This is one of the longest-standing abortion clinics in the first U.S. state to legalize some abortions.
“This was actually my first waiting room when I first opened up,” says Hern, gesturing around at the space that is now one of multiple recovery rooms and comprises just one small corner of a labyrinthine, multi-level medical building.
“The women that come in, they’re desperate. And they move heaven and earth to come from all over the country.”
Now, they are coming to Hern as the sun appears to be setting on those rights across the U.S. A leaked draft of a U.S. Supreme Court decision suggests America’s top court intends to overturn the landmark Roe decision, thereby taking away its guarantee for women across the country to seek abortions legally. Texas and Mississippi have been leading the way as U.S. states place more restrictions on the right of women and girls to have abortions. A dozen states have been preparing to enact legislation restricting abortion as soon as the Supreme Court decides to overturn Roe — a decision that is now all but certain to come next month.
The tall, bespectacled 83-year-old doctor pauses and inhales before saying something he’s repeated in journals, speeches, articles and interviews for decades. It’s the fact that drove him to perform abortions in the first place, and to view safe abortions performed by doctors as a crucial medical advance.
“Women will get abortions no matter whether they’re legal or not. Whether they’re safe or not,” he said. “And you know, women died by the thousands in the United States before Roe versus Wade. Thousands.”
“I had decided (in 1973) that performing abortions was the most important thing I could do in medicine.”
As calls flood in from women in states currently restricting abortion, Hern guesses he’s twice as busy as he was last year.
It’s the first sign that, for abortion providers in the U.S. who are determined to uphold this right, everything is about to change. As much as legal regimes may permit access to abortions, it’s providers who see to it that women can actually get them. If and when Roe falls, the scaffolding of abortion rights that had been held up by the highest court of the land may be delegated to a patchwork of providers in states that have their own legal abortion regimes — a heavy burden in a fight that is already costly.
But in at least one important way, Hern says, nothing has changed since he set up his first clinic in 1973.
“We just answer the phone,” he said. “And take care of the patients.”
Six years before Roe v. Wade, and later the Casey decision, guaranteed a woman’s right to a first-trimester abortion “without undue burden” imposed by the state, a Democratic state lawmaker introduced a bill to legalize abortion in cases of rape, incest or fetal defects in a Republican-majority state legislature. The bill was signed into law by a Republican governor.
A bipartisan coalition made Colorado the first state to significantly ease restrictions on abortion in the U.S.
It might seem counterintuitive that Colorado was the first state to legalize abortion, in cases of incest and rape. It’s a traditionally red state that has only more recently leaned blue, driven by population growth of liberal cities such as Denver and Boulder.
But conservatism in Colorado is of a different tradition than what you find in nearby southern states such as Texas, Kansas and Oklahoma. There’s a strong presence of conservative values, and one city, Colorado Springs, has the nickname “Evangelical Vatican” for being a centre of Christian conservatives. But another force has an even stronger hold on this western, former gold rush state: a sense of fierce independence bordering libertarianism. Colorado consistently ranks among the states with the highest proportion of independent registered voters, compared to registered Democrats and Republicans.
Keeping the government out of people’s personal decisions was one of the reasons Dick Lamm, who became governor after sponsoring the bill to legalize abortion in 1967, put it forward. And it’s the reason Republican Gov. John Love signed the bill, his son Dan Love told Time magazine in 2017 (Lamm died in 2021, and Love died in 2002). Neither was punished by voters, with Love being re-elected governor, and Lamm going on to become the longest-serving governor of the state in later years.
The state’s early decision to legalize abortion, which was followed by 12 other states prior to Roe, says something about the libertarian tradition in Colorado, but it also shows that there was a time when abortion was not the partisan flagship issue it is now (Hern calls it the “hammer and tongs to power for the Republican party”), with Republicans almost always opposing legal abortion and Democrats in favour. Both parties, but especially Republicans, have leveraged the emotional weight of the issue to court single-issue votes — a key part of election strategies for former presidents Nixon, Reagan, George H.W. Bush, George W. Bush and Trump.
Instead, there was a time when abortion was considered at the nexus of ethics and public health, with people from all parties weighing when and how the technology should be appropriately used, and with opponents and supporters from both parties.
Hern viewed legal abortion as an obvious advance in the health of women in 1972, when he returned to Colorado after working as a doctor abroad, and opened the first non-profit abortion clinic in the state the following year. At the time, he didn’t know how controversial and how central to American politics abortion would become. But public health still drives his thinking on abortion today.
In fact, when Hern thinks about why he does what he does, when he could have retired many years ago, he says, he remembers one of the patients he saw within his first two years of practising as an abortion doctor.
“One day in the middle of 1974, sometime, there was a young woman with red hair who was in her early 30s, who was there to have her abortion and we had a two-day procedure,” he said. “So I was coming to do a physical exam on this patient and she was just trembling. She was she was terrified. And I said: ‘What’s wrong? Tell me what you’re feeling.’ ”
“She said: ‘It’s just so different.’ She said: ‘It’s clean, the lights are on, the windows are open. You’re a doctor.’ And it turned out she’d had an illegal abortion years before, which was the most terrifying, humiliating experience of her life. And she just said she thought she was going to die.”
“She looked at me, said, ‘Don’t ever stop doing this.’ ”
Providers such as Hern, who perform abortions as a matter of public health and safety, and hold the politicization of the practice by Republicans in open disdain, are keeping abortion available in the U.S. today, in states that support — or at least do not intend to ban — the procedure as rights begin to crumble in other states.
These safe havens for abortion care — of which Colorado has already become one — are becoming more important as the right to get an abortion erodes across the U.S. In Texas, a law came into effect in September that places the greatest restriction on abortion care seen in the U.S. in decades. It leaves any woman seeking an abortion, or any person who helps her get one, six weeks into pregnancy, liable to a lawsuit, setting up what is, in practicality, a bounty system using common law rather than criminal law.
Meanwhile, a Mississippi law restricting abortion after 15 weeks of pregnancy is in front of the Supreme Court, with a decision to come in June. If the Supreme Court upholds Mississippi’s ban, 12 states have “trigger” laws in place that would immediately ban or restrict abortion upon the decision being put in place.
To Dr. Kristina Tocce, the medical director of Planned Parenthood Rocky Mountain region, it’s an “overwhelming reality.”
Recalling her days as a medical trainee in New York, she spoke about her OB/GYN mentor, who taught her not only how to perform an abortion, but what was at stake when abortions are not available. He had worked as an OB/GYN prior to the legalization of abortion in New York.
“His stories were of taking care of young, healthy individuals that had serious adverse outcomes due to unsafe and illegal abortion care died,” she said. “He said: ‘(I focused my entire career on abortion) because I knew after my experience being in this city hospital in New York, pre-legalization of abortion that I would save more lives and impact more patients in a positive way by providing abortion than any other aspect of medicine that I could pursue.’ ”
Those reasons, which mirror Hern’s with near-surgical precision, belong to an older generation of doctors, Tocce said. It’s impossible for most doctors and people in the modern-day United States to completely understand what’s at stake when abortion is illegal — the illness and death that inevitably ensues. For most of them, they simply haven’t lived through a reality like pre-Roe America.
But they will learn now, Tocce said, because a post-Roe America is on the horizon.
“I can hear those words over and over again in my head and see this path that we’re heading on as the country now. And those words just resonate with me even stronger now, 20 years later, than they did as a naive student,” she said.
Tocce is already seeing the beginnings of this change at Planned Parenthood in Colorado. Since Texas implemented its anti-abortion restrictions, their clinics have seen a 1,000 per cent increase in patients from that state travelling to clinics in Colorado. Tocce says counselling patients on when to book flights and what to do if they feel sick on a 13-hour drive home have become a regular feature of her practice.
The change on the horizon for abortion care in the U.S., with half the states in the union likely to restrict abortion access in the months and years ahead, means a new era is coming, the likes of which younger generations have never experienced. It means that no matter what safe havens such as Colorado do, they will not be able to provide care for every woman seeking an abortion in an abortion-restricted state.
It means backlogs that will cause people who could have had an abortion by taking a pill to need a surgery, and some to wait so long that they have no other choice but to carry pregnancies to term. It very likely means some will seek illegal, unsafe abortions.
For providers such as Tocce who are doing everything they can, it presents a mix of emotions.
“I think every single person that works in abortion care right now is so honoured to serve our patients and proud of the care we provide. We’re just really thankful that our doors are open and we can take care of patients. I have a little sticker that says, Welcome to Colorado, where you can access safe, legal abortion,” she said.
She feels a huge weight on her shoulders, knowing she will never be able to do enough.
“I think all abortion providers and individuals involved in abortion care feel that right now, I think everybody feels that,” Tocce said. “I just continue to be overwhelmed by what is happening because it doesn’t make any sense to me, medical sense. Patients are harmed when they can’t access abortion care.”
“It’s just perplexing to me that we seem to not have learned from history.”
The work that Tocce and Hern do comes with significant costs and risks, borne of the emotional and political weight abortion has come to represent in this country. Hern says he knew the issue of abortion was controversial when he first opened his clinic, but he didn’t expect the death threats that began immediately, or the bullets that shot toward his clinic, breaking windows, in 1988. He didn’t expect an anti-abortion protester to throw a brick through his window, or tail his car in his hometown.
Dr. George Tiller, a former Kansas abortion doctor who was shot and killed in 2009, was Hern’s friend and colleague. Closer to home, three people were killed by a gunman who opened fire at a Colorado Springs Planned Parenthood in 2015.
“I felt very vulnerable to getting assassinated, and I thought that’s what would happen. I thought I would get killed,” Hern said.
Today, Hern’s clinic is under tight security. The windows are bulletproof glass, and no one is allowed to enter it with electronics of any kind. Every person going in has to show identification. And he still provides care to women who can’t access care elsewhere — filling gaps left by the system elsewhere.
Having worked as an abortion doctor for so many years, Hern now specializes in providing care to the riskiest cases, including late-term abortions for women who discovered fatal problems late into a pregnancy that they wanted, or young girls. His specialty in late-term abortions has made Hern a particular target of anti-abortion groups who have labelled him a murderer for the work he does.
When Hern opened the Boulder Abortion Clinic here in 1975, on the two-year anniversary of the landmark Roe v. Wade decision coming into effect, he was one of 10 doctors leasing space in this building, and kept the clinic’s name and purpose quiet.
Now, 47 years later, he owns the whole thing. A doctor 50 years younger than Hern works with him and is a candidate to become eventually the main physician seeing patients in Hern’s practice. When that happens, it may be a very different world for abortion care, marked by truly limited access and women doing everything they can to get to sites such as the Boulder Abortion Clinic.
“People say, why do I do abortions? I say, because it matters. It matters for the health of the woman. It matters for the health of her family. It matters for the health of society,” he said. “And now, it matters for freedom.”
Alex McKeen is a Vancouver-based reporter for the Star. Follow her on Twitter: @alex_mckeen