What It's Like To Provide Abortions Where Access Is Almost Nonexistent

Women in the United States have a constitutional right to get an abortion, but in some parts of the country the hurdles they face accessing that care are significant. Missouri is one of those states. Women there must wait for 72 hours from their initial consultation before they can have an abortion, with no exceptions for rape or incest. And there is only one abortion clinic left.

One state over, in Illinois, things are very different. There are relatively few restrictions on abortion (and several providers), so every day women come from Missouri seeking the care they need. A new HBO Documentary Film, Abortion: Stories Women Tell, which is coming soon to HBO, focuses on many of those women and the care providers who work near the border at the Hope Clinic for Women in Granite City, Illinois, as well as the protestors who stand outside every day. One of those women is Dr. Erin King, a 41-year-old mother, physician and the Hope Clinic’s interim executive director.

Here, in her own words, King talks about what it’s like to be an abortion care provider in this country, and to witness how Missouri’s abortion restrictions hurt women.

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I did my medical school training in St. Louis, Missouri, then moved to Chicago to do my residency in obstetrics and gynecology. I was in private practice in downtown Chicago for three years and worked part-time for Planned Parenthood. It was such a different environment. As a resident, we learned how to provide abortion care as part of our training as OB-GYNs. I performed abortions for several years, but I was never really identified as an “abortion care provider” ― you know, separate from the gynecology services I provided.

That changed immediately when we moved back to the St. Louis area, which I wasn’t intending to do, but my husband got a job here. I spend about 50 percent of my time as a general OB-GYN in downtown St. Louis where I provide routine gynecological care, and the other half providing abortion care at the Hope Clinic [in Illinois], where I’ve worked for six years. Here, it’s all very separate. If a patient comes to me in my private practice and wants to end her pregnancy for whatever reason, I have to refer her out. It’s apparent that some people here see “OB-GYN” and “abortion care provider” as very different things.

The Hope Clinic is open three, full-clinic days a week, plus several half days a week. Every day when we come and go, we walk by protestors. Today, when I came in (and we don’t have any patients scheduled) there were a couple of people talking to me. We do not engage at all. The whole point of protesting outside and yelling at people for “killing babies” is to intimidate the providers and the patients. That’s the only point of standing outside and yelling. Most people who are anti-choice are not doing that.

The thing that makes me, personally, feel horrible is when they attack my medical skills. There is a lot of talk about killing children, killing babies, and that doesn’t bother me. I happen to think that’s not a decision one individual can make for another, and everyone has their own ideas about when they think life begins ― whether it starts at conception, or a heartbeat, or at another point. What is really hard for me is when [the protestors] tell me I’m not taking care of my patients, or that I’m injuring them in some way. Or that I’m doing this work for the money. That’s so untrue, and so far from why any of us work in abortion care. Abortion care is one of the safest medical procedures you can get in the United States. To even insinuate that we are providing anything other than the highest-quality medical care... that’s the hardest thing for me to ignore.

I get asked a lot why I provide abortion care in Illinois, and not Missouri, and one of the main reasons is that [by working in a state with relatively few abortion restrictions], I’m able to treat my patients with the respect they deserve. I don’t have to put them through a certain consent process with mandated wording that may be very offensive to some women, or follow a set waiting period. I feel that women are smart and responsible and don’t need a lot of rules from the state about their bodies. Illinois has become a place that women can come get abortions with fewer burdens on them, and we can provide them with good medical care without having to do or say things that are offensive to them, or that imply they haven’t already thought really hard about their decision before they picked up the phone to make an appointment.

It can be hard work, but I’m connected to a really great network of people who do this kind of work also, locally and nationally. I also have really great friends and family who understand what I do and who really feel strongly about there being access to abortion. My husband is a gynecologist and he also provides abortions, so that’s really helpful. On the other hand, there’s no escaping it. We always joked, before we had children, that our child’s first word would be “abortion” or “vagina.”

I recently became a mother and it absolutely has changed the care I provide. Most of my patients are already mothers, so I feel like I can relate to them a little more. Being a mother is a very, very difficult, very rewarding job. It’s made me understand so much more clearly why there are times in people’s lives when they’re just not ready to be mothers. It makes even more sense to me why most women who get abortions are already mothers. They know what it entails, and they recognize that they’re just not in a place or time in their life to take it on.

[”Abortion: Stories Women Tell”] was being filmed before the Supreme Court decision came through [in Whole Woman’s Health v. Hellerstedt, in which the court ultimately struck down two Texas abortion restrictions that would have closed many more of the state’s clinics]. At one point, I was asked about the future. I said something like, “I don’t see a path where this is going to get any better.” But after the June 27th Supreme Court decision, I feel totally different. When I read the opinion, it felt to me ― and I think to a lot of people who are doing this work ― like, finally! Someone else is looking at the same evidence we’re looking at.

Now, I’d say I’m optimistic that instead of it being a debate about how people feel about abortion, it will be a debate about the medical evidence. And there is very strong evidence that abortion is safe, and access to it makes women’s gynecological care stronger. I have no dream that tomorrow all the regulations I feel pose an undue burden will go away, but I think there’s a path now.

It’s still hard though. On average, about half of the patients we see in the clinic on any day drive an hour-and-a-half to two hours to get to us. More than the half of the patients we see are from Missouri, but we also have patients from Oklahoma, from Tennessee, Kentucky, Iowa, Indiana, Kansas.

The further away people are, the longer the whole thing will take them. That sounds really obvious, but when you think about what women are sacrificing in order to access medical care, it’s significant. They have to take a day off work. They have to get gas money. They have to find someone to drive them several hours, wait several hours while they get all of their pre-operative care, their operation and then post-operative care. They have to get childcare coverage. Sometimes they need to stay overnight. It becomes much more expensive than the actual price of the procedure. It makes me so sad.

This account has been edited and condensed.