Hard choices, sweet tea: A day at a Louisiana abortion clinic

Like many Southern states, Louisiana has sharply restricted access to abortion in recent years. Our reporters spent a day in one of the state’s last remaining abortion clinics, speaking to the staff and patients, and hearing their stories. Because the state mandates a 24-hour waiting period, women must go to the clinic at least one day before they can receive an abortion. They must also speak to a counselor about their options and receive an ultrasound exam, during which the nurses are legally required to describe the fetal development in detail and turn on the sound (unless the patient specifically requests no sound).  

Kathaleen Pittman, the clinic’s director, says there are a lot of misperceptions when it comes to the women who seek abortions. For example, many are already mothers. “Their primary concern is taking care of the child or children they already have,” Ms. Pittman says. 

That’s the case with a 30-year-old single mother of two who has come to the clinic and asks to remain anonymous. “I’ve always judged people who would tell you, ‘I’m getting an abortion,’” she says. But she doesn’t think she can go through with another unplanned pregnancy.

“I had a one-night stand. And I got pregnant with my son. That was the darkest period of my life,” she says softly. “I don’t want to face that again.”

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AUDIO TRANSCRIPT

[PHONE CALL]: Hope Medical Group, this is Debbie, may I help you? OK. The state of Louisiana requires anyone considering a termination that they must come in for a doctor's session at least 24 hours before a procedure can be done. Now, do you have any idea how far along you are in the pregnancy?

SAMANTHA LAINE PERFAS: I'm Samantha Laine Perfas one of the reporters working on the Christian Science Monitor's series on abortion, "Looking past Roe." As part of the series Jessica Mendoza, Ann Hermes and I went to Shreveport, Louisiana, five hours northwest of New Orleans. The city is home to Hope Medical Group for Women, one of the last three abortion clinics in the state. Deep in the Bible Belt, Louisiana has restricted access to abortion, showing one example of what could happen if access to abortion care slowly disappears. For this story, we spent a day in the abortion clinic to simply speak to the staff and patients, hear their stories, and understand what happens behind the clinic's doors. Early that morning, we met for Fatavia Turner, a nurse who's been working at the clinic for 10 years. She had on bright pink scrubs with Hello Kitty print, which matched her disposition. She loved to tell funny stories to ease patients anxieties. Fatavia is a single mother of three teenagers and she told us that before she worked at the clinic she had very different views on abortion.

FATAVIA TURNER: You know a lot of people frown upon this place. I did. I was pro-life, actually. My cousin was working here and she asked me, did I want to work. I was like, no. And she was like it comes with benefits. And I said, well what's the job? And she's like, oh you'll be a medical assistant. She didn't say abortion clinic. So when I got here, Kathaleen was like, well, we're an abortion clinic and I was like, what? And I was like, girl, you need that money. So I was like but it's medical. I can learn something. Anything medical, I'm for, you know. And I got here and my first patient, one of my first patients, changed my mind about abortions. And she was 10. She was a 10 year old. She was raped and she had Down syndrome. And all I could see was my daughter. Got her in the room, I swear, that day I cried so hard. And it was just something about her. She touched me and I was like I mean sometimes I sit back and I think about it, and I still cry about her you know. And she was just this little innocent girl. And for me that was my first young patient, because all of them had been adults. And I was like, what the world am I getting myself into? And I was like, you have to remember: This could be your child.

LAINE PERFAS: Fatavia comes from a religious family and is religious herself. But she said that for her, she doesn't feel like providing abortion care conflicts with her faith and that allows her to connect with her patients personally.

TURNER: I tell my patients all the time. Honey, you know when they want to think about God and oh my God I hope he forgives me, I say baby, God knew what you were gonna do before you did. He knew you was going to be pregnant. He knew what your choice was gonna be and he's gonna help you with this. A lot of women when you just come in here and you just talk to these women, and you find out stuff about them, you know, it's not necessarily that they're just having an abortion. I had one woman who wanted it so bad. Wanted her baby, and she cried and cried. I couldn't do nothing but hug her. And the reason why she couldn't is because her doctor said she would die. She would die. She only had one child. And she wanted more and the doctor told her one more will kill you. Period. You can't even carry this to eight weeks. You don't know. Everybody has a different walk of life. I feel like for pro-life people are close minded. I was. And now I'm not. And it's easy to switch on a dime. You just have to have the right tools and the right person to talk to, to be honest. Or you have to live it.

LAINE PERFAS: Fatavia's experience resonates with the staff. They said that they've had protesters wind up becoming patients and those same people will go back to protesting after they've gotten an abortion. It's complicated and it doesn't always make sense. For many of the women seeking care, they're not asking themselves, is this a baby or not. They're asking themselves, what do I do?

KATHALEEN PITTMAN: This our video room. We have a little generic video we show patients. On their first visit, assuming it's the typical, come in for your consult and all that, they'll start with an ultrasound. Step two if they've never had an abortion before, video. Step three is counseling...

LAINE PERFAS: You just heard the clinic director Kathaleen Pittman. Here she is explaining how they educate first time patients. After, she continues to show us the facilities. There are multiple waiting rooms with TVs, magazines, and information about resources. Nurses will call your name and lead you down a hallway to various private rooms designated for counseling, procedures, and recovery. In many ways it runs like any dentist or doctor's office.

PITTMAN: And then we're going to sneak through here.

JESSICA MENDOZA: How long does it take?

PITTMAN: The actual procedure? OK. This is recovery. OK. We tell, if you're a first trimester patient, we tell them plan to be here three to four hours. Sometimes, we pad it a little, say in case the doctor gets caught in a delivery and can't get over here, or whatever. The procedure itself, if they're a first trimester, they walk into the procedure room, once that doctor walks in they'll be out in about five minutes. It's very quick. Then they'll have a period, stay back hear in recovery, where they receive cookies and tea. I find it very interesting the most common question I am asked, we take calls after hours, the most common call I get: What's in that tea you served us? This has been going on for years. You know sometimes the nurses send them home with a little bit because it's like, What is this? Plain old herbal tea. But for some reason it has magic properties here. So this is us.

LAINE PERFAS: Kathaleen has been doing this work since the 1980s. She says in some ways providing abortion care is more difficult now than it was 20 years ago. With the possibility of Roe v. Wade being overturned, states are legislating abortion more than ever. There are so many rules and regulations that locating a clinic is one of the least challenging aspects of getting care. Research shows that abortion patients are disproportionately poor and typically in their 20s. But besides that, it really is a cross-section of the population. Unplanned pregnancy can happen to every type of woman and does. One of the challenges to patients seeking care is Louisiana's 24 hour waiting period which requires that women must come to the clinic and be seen by a doctor at least 24 hours before the procedure. This can be difficult if you are poor, with implications for your job, traveling to the clinic if it's hours away, and finding child care if you already have children. The state also mandates that during the initial visit women receive an ultrasound to confirm the pregnancy and the state is very specific concerning what happens during the ultrasound.

PITTMAN: I'll say I'm required by the state of Louisiana to tell, to go through this with you. Because it's kind of convoluted, I'm going to paraphrase it to make it more easily understood. You have the right to see the screen as I'm doing the ultrasound. You have the right to have a copy of your ultrasound. I am required to describe in great detail the development I see as I'm doing the ultrasound. Unless you tell me you don't want me to, I'm required to turn on sound so you hear the heartbeat if it's discernable. Now the irony here is most of the time you're not hearing a heartbeat, what you're hearing is just blood coursing, pulsing through so you know, that's like, well it's not really a heartbeat but OK.

LAINE PERFAS: This point about fetal heartbeat is really interesting because it becomes a sticking point with various legislation. The term is medically inaccurate doctors say and yet it's become a political tool. Louisiana joined at least five other states in passing so-called heartbeat bills, which ban abortion after about six weeks, before many women know they are pregnant. Another requirement of the ultrasound is for staff to describe in detail the fetal development. This can also be hard to describe because two thirds of women receive abortions in the first eight weeks. At this point, development is minimal.

PITTMAN: If I'm describing a pregnancy or the embryo or fetus to a woman when she asks specific questions I have gone so far as to say OK, you're eight weeks. You know what a tadpole looks like? And they say yeah. I say okay. It's a tadpole. Things are beginning to pop out but they're not there yet and it's not really discernable. And they're like oh OK I get it.

LAINE PERFAS: The clinic carefully complies with all state laws because it doesn't want to jeopardize its ability to provide abortion care. But that doesn't mean the staff doesn't find it difficult. They say one aspect of these laws they find particularly frustrating is that the laws give the impression that women need the government's help to be fully sure of their choice. Have the patients really thought about what they're about to do? Kathaleen and other staff at the clinic point out the implication of legally requiring women to look at pamphlets, go through counseling, and see a doctor 24 hours before a procedure: that women who choose abortions are not being thoughtful about their decision and what the consequences will be. In Louisiana, the abortion debate comes deeply entwined with questions of morality and religion. Many of the clinic staff identify as Christian. They're open about their faith and the role it plays in their lives and their work. Kathaleen shares a little about her own upbringing.

PITTMAN: I come from a huge family. I originally had 15 siblings.

MENDOZA: Sorry 15?

PITTMAN: Your next question is going to be did you have the same parents. Yes we did. My mom was Catholic. My dad was, I don't know what he was originally but they both ended up Southern Baptist. Go figure. So, I mean you know we had a very strict upbringing and it was just you know, we didn't talk about you, my mom and I never had "the talk" that went with my sisters you know, my older sisters kind of took care of that, but anyways, I was divorced and had moved back home with my mom with my son. He was five at the time. And when I came to work here as a part-time counselor I was going to come back to school. So I needed a part time job so I came to work here. And I was living with her. So I had worked here for two months. She knew I was counseling women, so finally one evening I said, mother I need to tell you what exactly I'm doing. I said I am counseling women, I said, but I work at an abortion clinic. She said, you counsel women that are having abortions? I said yes ma'am. And she got very quiet and she said, women have always had abortions, baby. They always will, it's best they have a safe place to go. And she said, a lot of bad things happened back then because women were taking care of by doctors. So it's like, OK. She gets it. She totally gets it.

LAINE PERFAS: With Louisiana being so influenced by religion, there's an added layer of secrecy and shame for women who seek abortions. So I ask Kathleen, how do most of their patients respond after the procedure?

PITTMAN: The most common reaction or what we hear is relief that it's over. And as I was saying possibly, if there is remorse or guilt it's over that they don't feel bad. Why don't I feel bad about this? Well because you made the best decision for yourself. You know, this is your decision. At this moment in time this is what's best for you and your family. And another thing that is commonly not understood is most of the women we see already have families. They already have children, at least one. They know what they're missing out. They know what could be. But they also know the struggles and their primary concern is taking care of the child or children they already have.

[PHONE CALL]: OK. Sir, can I speak to just her please. What is your name? And your date of birth?

DR. JOHN DOE: I'm not pro-abortion. I'm just pro-choice. I think women deserve to be respected and deserve the opportunity to have a safe option if they choose to do so. And that's it. But I would be tickled to death if we ended up closing because all women stopped getting caught in compromised situations.

LAINE PERFAS: This is Dr. John Doe. He's been an abortion provider for 38 years. Due to safety concerns, he has always left his name out of the press. During our interview he said that providing abortions was not always something he wanted to do. He wrestled with the decision when he was a young doctor because of fears that it would consume his life. And in many ways it has. He has managed to successfully run his own private OB-GYN practice, but because he also provides abortions, he says other doctors in his community have shunned him. There are also times he has feared for his life. Abortion providers have over the years been targeted by extremists and sometimes killed. One well-known provider Dr. George Tiller was murdered in his Wichita, Kansas church one Sunday morning in 2009 while he was ushering. It's a genuine fear. And it's one of the things that makes life as an abortion provider difficult.

DR. DOE: You know, I was having otherwise personal problems in my life. My marriage, my first marriage breaking up and so on, and that was about the time they murdered the first abortion provider in Pensacola. And, my reaction was you know, that was you know, sadness that that was not me. You know I thought you know at least then maybe somebody, I would be viewed as someone would say I've done something nice. You know, and I was a martyr and so on, but it would be nice to no longer have to keep putting up with all that pain. The terrorism works you know. It does. And so once you start murdering abortion providers you know it really does terrorize the other abortion providers. But I am reminded almost every day of how difficult it is, how difficult my life has been because I work in this clinic.

LAINE PERFAS: Why would you put yourself through that, we wondered. His answer was simple. He says he believes that women should be given a safe option if they choose to get an abortion. One patient he can't forget was a 21 year old woman who had the mental capacity of a 10 year old. She had been raped by her brother and due to her disability, carrying the pregnancy to term would put her life at risk. Dr. Doe said that during the procedure, something happened that he'd never forget.

DR. DOE: And we started hearing, you know everybody in the room you know, started hearing this little voice and someone signing. It was hers, and she was singing hymns, little snatches of hymns. And there were hymns, most of them were ones that I didn't recognize from the black churches here, but we had several black employees in there, so they started singing along with her. And finally she got to one that I recognized you know, "And His Eye is on the Sparrow." You know, I don't know if you know that song, so I started singing it with her. And so to me that's, I mean me that's what God has called me to do. To save these women who have, may have suffered something horrible. Horrible horrible horrible. And to try to keep them from suffering something even worse.

LAINE PERFAS: I made my way to the so-called relaxation room. This is where women both wait for their counseling sessions in the morning and their procedures in the afternoon. The name is a bit ironic since tensions are running high. Jerry Springer is playing on the TV and strangers have nothing to do to pass the time since phones aren't allowed for privacy reasons. Small talk eventually bubbles up.

[ROOM CONVERSATION]: Ya'all are a lot nicer here than whenever I called in Dallas, there was this one lady that picked up the phone...she was rude and like it was the first call I made so I was like, I don't know if I want to call anybody else. You can call us. And I did like I was just happy because somebody else was actually nice and I was like Oh thank God because I'm an anxious wreck. This one right here. She real sweet on that phone.

LAINE PERFAS: In the room a few women opened up about why they were there. All interviewees asked to remain anonymous. The first whose voice you just heard about her experience calling the clinic is a 19 year old, a bit punk rock with the sides of her head shaved and the rest dyed blue. I'm going to refer to her as Sparrow because she said that someday she might have a daughter, when she's 40 and that's what she'd named her. Sparrow has struggled with mental health issues and feels that carrying to term would be emotionally traumatic for both her and the child. We talked for a few minutes until the doctor called her name. Later when I went out to grab a cup of coffee, I noticed her sitting there with her aunt in the waiting room before they went back for her counselling session. I continued our conversation and they filled me in on some of their family history. Sparrow has a very difficult relationship with her birth mother and she and her boyfriend are currently living with her aunt. Her grandfather and uncle are both preachers. So she and her aunt have been very careful about not revealing the pregnancy to the family. I asked her aunt how she handled the situation when she found out Sparrow was pregnant.

SPARROW'S AUNT: I said what do you want to do? And I made sure that her boyfriend was there, I wanted him to be a part of this, part of the dialogue. And I told him I said this was 100 percent your choice. I'll back you up on whatever. I'll support you with whatever. But, it's their choice. And I told her, you know you need to look at all of your open options. If you were to have a child today, right now, what kind of life would that child have? She has eating disorders. She is highly underweight. Go on back baby, I'll be there in just a second. She's attempted suicide numerous times, she, her body can't handle pregnancy. You know it's the better choice for her, personally and medically. She said I don't know how I can ever thank you for doing this for me earlier and I told her I said don't. I said you don't have to repay me for this. I said the way you repay me is that one day, somebody, a girl is going to come to you and she's going to need your help. You just got to be there for her.

LAINE PERFAS: Another woman I spoke with was sitting quietly in the corner of the relaxation room. Practically on the armrest of the couch. She's 28 and going to college for accounting. She should have graduated in May based on her timeline and plan. This was not in her plan. She has one seven year old daughter who she describes as a burst of sunshine. She starts to cry quietly as I ask about her life and why she's at the clinic. She's a little hard to hear over the TV playing in the background.

ANONYMOUS WOMAN: I'm already a single parent of one. And it is hard. I'm a college student. I have been at two year college university for three and a half years now, because of the lack of support with my first child. To be honest, I just want to make something of my life and my daughter gives me, you know, that purpose to do that. I want my daughter to be proud of her mother. I have faith that, I'll get it together soon. And I'll be able to have a family and not just be a single mother but have a family. My daughter deserves it. She deserves to have a family. You know. So.

LAINE PERFAS: The third woman I spoke with I'll just refer to as Dee. She shared that she still had not made up her mind on whether or not she was going to get an abortion. Fundamentally because of her beliefs, she felt like she shouldn't. And yet here she was in the clinic. She's 30 and works in IT in Monroe, Louisiana, about an hour and a half drive away. She's a single mother of two young children.

DEE: I'm not completely sure what I'm doing. I've never done this before I have two children already, I love them. I love babies, I love children. I'm pro-life and I've always judged people who would tell me you know, I'm getting an abortion. My decisions I made in life were not healthy for me. I made so many bad decisions and I feel like I'm repeating a cycle that I just went through. I have two children and I normally practice celibacy. I don't engage in sexual activities. And when I finally do it. Boom I'm pregnant. I had a one night stand. That's the truth. And I got pregnant with my son. That was the darkest period of my life. This situation was a repeat of 2017 which is why I don't want to face that again. I don't want to face that again. I'm afraid, I'm not going to be with... I don't know. I don't know. I don't know.

LAINE PERFAS: Dee invited us to join her for her counseling session. The physician welcomes her and the father of the pregnancy into the room and asks questions about her reproductive history. He also asked questions of her partner. They only recently started dating after meeting at work. We learned that he too has three children, aged 19, 18, and six. He is 38. The physician continues to ask questions and then they talk about her two options for getting an abortion.

ANONYMOUS PHYSICIAN: Well I'm going to talk to you about both of them, but you don't have any preconceived information as to, or way that you want to do this do you?

DEE: If I do I want it to be as simple as possible with the pill. I would prefer not to have to do the surgical procedure.

ANONYMOUS PHYSICIAN: You don't have to. The pill is called Mifoprex. It must be taken by the lady before she's eight weeks pregnant, so you qualify for that, you're five weeks pregnant.

LAINE PERFAS: The doctor explains the pill procedure has two parts. The first set of pills are taken in the clinic. Women can then leave the clinic with a prescription for the second set. They take these on their own. Many patients prefer this method so they can be in the privacy of their own home. The physician continues to explain what's expected of the patient if they opt for this procedure.

ANONYMOUS PHYSICIAN: There is a very low 3% failure rate to this pill. You must come back for a checkup so we confirm that it worked. And if you come back and are still pregnant, the clinic would do a suction on you at no charge. But you gotta come back for it, once you take that abortion pill you must terminate the pregnancy. You with me on that?

DEE: I am.

ANONYMOUS PHYSICIAN: Good that was pretty simple. You come back for a checkup we confirm that it works and everything's done. We can put you on birth control if you would like?

DEE: No, I prefer not to be on birth control.

ANONYMOUS PHYSICIAN: You're 30 years old...

DEE: I'm 30 years old, but I'm not going to be acting immaturely continuously.

ANONYMOUS PHYSICIAN: Acting immaturely? You might be acting passionately.

DEE: Passionately. Thank you for a better word.

ANONYMOUS PHYSICIAN: You gonna kick him to the curb?

DEE: Yes.

ANONYMOUS PHYSICIAN: Do you know that man?

DEE'S PARTNER: I do now.

ANONYMOUS PHYSICIAN: You better, you better figure this out!

DEE'S PARTNER: No, this is a mutual agreement.

ANONYMOUS PHYSICIAN: So y'all talked about it blah blah blah. Okay, well everybody has choices. Obviously you can terminate the pregnancy. You could keep the pregnancy or you could put it for adoption. Those are your three choices, and you've chosen to see us and we'll take good care of you.

LAINE PERFAS: Dee and her partner leave. We stay behind and ask the doctor questions about why he does this work even though he's retired from his own OB-GYN practice.

ANONYMOUS PHYSICIAN: This is a procedure that is needed. And you hate that it's needed, but you can't get into the lives of those people. They have to make what's right for them. They're here not because they want to be here but because they're in a situation in their lives, that we don't know, we don't know what's going on. We can't tell them what to do. But for them, for their families, they feel like that they need to do this at this time now. I always encourage them to be sure and get on some birth control as soon as this is over. I probably spoke to that lady about it too. Because we're trying to close the clinic down by having everybody on birth control. You know. It ain't gonna work that way.

LAINE PERFAS: By the time we finished our conversation, the counseling sessions had finished and procedures were taking place. Women are told the plan to be in the clinic for three to four hours but most of this time is spent waiting. After the surgical procedure, patients spend 20 minutes recuperating in the recovery room. They speak with the nurses, ask questions, eat cookies and drink the raspberry tea that Kathaleen mentioned when we first arrived.

[ROOM CONVERSATION]: Here's some warm raspberry tea. Sip it. It's hot, sip and blow. And help yourself to the cookies, eat all you want.

LAINE PERFAS: The recovery room is filled with patients diverse and race and age. Some are in sweatpants. Some look like they're on their way to a business meeting. Others from sports practice. On the surface you'd never know they were the type to get an abortion. Because there really isn't a type. According to the Guttmacher Institute nearly one in four women in the US will get an abortion by age 45. Now that these women have gone through the procedure the final step going home.

[ROOM CONVERSATION]: Here you go ma'am. You've been spending a lot of time here. You need to go home. Yeah, home is my favorite.

LAINE PERFAS: Thanks for listening to this story. If you like what you heard this is just one part of our series on abortion, where we look at the nuance and humanity behind the polarized political topic it is today. Throughout the series we'll be taking a close look at different aspects of the issue and the gray areas between the extremes. You can find our series at csmonitor.com/abortion.

CREDITS: The story was reported and produced by me. Samantha Laine Perfas with additional reporting by Jessica Mendoza and sound design by Noel Flatt. The story is from the Christian Science Monitor. Copyright 2019.