To fellow passengers, Hannah Brehm may have appeared to be enjoying a belated babymoon while well into her third trimester. Behind the facade, however, she and her husband were grappling with a devastating reality: their baby’s brain was not developing correctly, putting the continuation of their eagerly awaited pregnancy in jeopardy. Medical professionals cautioned that proceeding would likely mean a life of pain and suffering for their son—a risk the Minnesota couple was unwilling to take.
With heavy hearts, they chose to head to Colorado, home to the Boulder Abortion Clinic, which for years served women seeking to terminate pregnancies in the second or third trimester due to medical reasons or other situations. However, this longstanding institution discreetly shut its doors last month after more than five decades, leaving the nation with only a marginal number of clinics offering abortions past 28 weeks on a case-by-case basis.
The clinic’s 87-year-old founder, Dr. Warren Hern, expressed profound sorrow over the closure: “It became impossible to continue, but closing is one of the most painful decisions of my life,” he stated. While anti-abortion groups hailed the closure as a victory for protecting mothers and unborn children, many former patients and reproductive rights supporters feared the impact of losing such a crucial service.
Reflecting on her 2022 experience, Brehm remarked, “Chances are it’s not gonna happen to you. And I hope it doesn’t happen to someone else that you love, but it is happening.”
Federal statistics suggest only 1% of abortions occur after 21 weeks, yet experts argue this figure is likely underreported as some states, like California, abstain from submitting their abortion data to federal authorities. Reasons for late-term abortions can vary significantly as some medical anomalies or genetic disorders may not be detectable until post-20 weeks into pregnancy. Furthermore, some women might not discover their pregnancy until after the first trimester, and numerous women live in states imposing strict abortion bans.
Sarah Watkins, for example, journeyed from Georgia to the Boulder clinic in 2019 when she was nearly 25 weeks pregnant, having learned that her baby had trisomy 18, a severe condition leading to early death. Earlier genetic tests at 10 weeks had inaccurately suggested otherwise, but further ultrasounds confirmed the diagnosis later on. “You can do everything right, by the book, but you still can’t find out certain things until that ultrasound at 20 weeks and sometimes even later,” Watkins explained. Her choice was fueled by a desire to shield her child from any potential discomfort or pain.
While Watkins praised the medical care at Hern’s clinic as attentive and compassionate, she found the experience of confronting a facility fortified with bulletproof barriers and protestors to be harrowing.
Dr. Hern’s work in offering later abortions, which began in 1973, stood alone in the U.S. for many years. He initiated specialized methods, innovating tools to enhance health outcomes. Yet, the path of providing abortions late into pregnancy was fraught with risks, maintaining his dedication despite relentless death threats. In 1988, his clinic windows were shot at five times. Moreover, Hern saw five of his colleagues who performed similar services assassinated over the years, including Dr. George Tiller in Kansas in 2009.
Upon announcing the clinic’s closure in April, the anti-abortion group Susan B. Anthony Pro-Life America celebrated with a “VICTORY” proclamation on social media. Still, Hern remains steadfast in the belief that his work was worthwhile, recounting a transformative interaction with one of his earliest patients who survived a terrifying illegal abortion. “She looked up at me and said ‘Please, don’t ever stop doing this,'” Hern recounted. “So I didn’t. Until now.”
The harsh reality of financial struggles rendered the clinic’s continued operation unsustainable. The procedure’s cost, often around $10,000 and not generally covered by insurance, became burdensome for patients, compounded by dwindling private donations.
Throughout his career, Hern hoped to mentor successors to carry on his clinic, yet those plans remained unrealized. “I had to make a decision really, you know, sort of on the basis of the situation at the moment that we couldn’t continue,” he acknowledged. “It was very, very painful. I see this as my personal failure.”
As conversations unfold among providers and patients about the future, the Later Abortion Initiative by Ibis Reproductive Health indicates there are fewer than 20 clinics offering abortions after 24 weeks within the U.S., though this number is not exhaustive and does not account for hospitals and certain clinics for security reasons.
Currently, three clinics — located in New Mexico, Maryland, and Washington, D.C. — offer procedures after 28 weeks. Five more clinics across Maryland, New Jersey, New York, Oregon, and Washington state might accept patients based on medical recommendations or specific fetal and maternal circumstances.
Jane Armstrong, a therapist in Texas who aids families experiencing medical terminations, expressed concern at the absence of a figure like Hern: “I think Dr. Hern has been the torchbearer for abortion leaders in pregnancy,” she stated. “Who will pick up the mantle? We really do need a new torchbearer right now.”
The closure adds tension against the backdrop of various state-imposed abortion bans, with a dozen states enforcing bans throughout all pregnancy stages, and additional ones occurring post-six weeks. Abortion fund organizations, which assist individuals in arranging and affording procedures, face heightened demand for late-term abortions given logistics like travel and financial preparation.
“Every time a clinic closes, it does impact everybody and what kinds of care they give,” remarked Anna Rupani, executive director of Fund Texas Choice.
After Roe v. Wade was overturned in 2022, an all-trimester abortion facility opened in Maryland under the partnership of certified nurse-midwife Morgan Nuzzo and OB-GYN Dr. Diane Horvath, who specializes in complicated family planning. Despite concerns regarding reproductive rights, including legal limitations and clinic access amidst opposition, the duo is heartened by the passionate interest from healthcare providers in joining their mission. They expressed optimism that the number of clinics providing later abortions has increased since Roe’s repeal. Horvath affirmed their dedication to accessibility: “This type of care is still available,” she asserted. “It’s more rare than it was a couple weeks ago, but we want to say loud and proud that our doors are still open and there are other places still open.”