The trouble is, both Keenan and Michelman are soldiers; their primary job is to defend abortion rights. Even clinic workers weren’t always comfortable talking about moral complexity. “In the beginning,” recalls Johnston, “we were so afraid of Roe being overturned we didn’t want to do anything to jeopardize legal abortions. So things like the reality of abortion—all those posters showing bloody fetal tissue—we freaked out at it, and if people used to ask ‘Am I going to regret this?’ or ‘Is God going to punish me?’ the questions would stop some of us cold.” But sustained exposure to the worries of women making this decision, day after day, year after year, has a way of changing things, and in the past decade, some of the most emotionally honest pro-choice materials—workbooks, DVDs, websites—and conversation have come from people who’ve been at patients’ sides.
Particularly the academic literature. In “The Things We Cannot Say,” published last year in Women’s Studies Quarterly, Jeannie Ludlow describes the experience of seeing repeat-abortion patients—“I love you guys, but I hope I never see you again!” says one as she leaves the clinic—and dares the pro-choice movement to own up to the fact that it’s these women, much more so than rape and incest victims, whom they’re defending: average, fallible people who on occasion screw up their birth control. And then there was Harris, who wrote about performing an abortion on a woman who was 23 weeks along and then immediately running to deliver a premature baby … of 23 to 24 weeks. “I thought to myself how bizarre it was that I could have legally dismembered this fetus-now-newborn if it were inside its mother’s uterus,” she writes, “but that the same kind of violence against it now would be illegal, and unspeakable.” Later she notes, “Currently, the violence and, frankly, the gruesomeness of abortion is owned only by those who would like to see abortion (at any time in pregnancy) disappear.”
The girl, a high-school sophomore from a small rural town, is curled up in a ball in her seat, her giant sweatshirt pulled down low over her gym shorts. Her mother, trim and erect and clearly stunned, can barely squeak out her question: “It’s too late for her to have an abortion now, right?”
“Well,” says Keyes, looking at the daughter, “you can’t have one at this clinic. There’s one hospital in Pittsburgh where they do it, but it’s often hard to get an appointment.” She looks at the patient’s folder. Her sonogram says she’s 21-weeks pregnant, which means the fetus—or baby—is nearly a foot long. “Oh. You live in West Virginia. Why does life have to be so complicated?” She closes it. “There are a few other places you can go, if you still decide that an abortion is what’s appropriate for you. One would be D.C. There’s also Cleveland. New York. And Philadelphia.”
As a political matter, it has always been safest to discuss second-trimester abortions in the context of a looming tragedy: women whose lives are endangered by the pregnancy, women who discover terrible fetal anomalies. But they’re not the only women who get them. Some are extremely poor and only scrape together the money for the procedure when it’s nearly too late. Some are drug addicts or mentally unstable. And some, like this patient, are 15 years old. Adolescents have an amazing capacity for denial. And when girls are this young, their periods are so irregular and their birth-control literacy is so poor they often have no idea they’re pregnant until the baby starts to kick.
Keyes turns to the daughter. “Is there anything you want to ask me?”
The girl is catatonic. Then: “Are they positive? I went to the thing in July”—by which she means her local health department, in order to get birth-control pills—“and when I had a pregnancy test, I wasn’t pregnant.”
Keyes stands up to get a pregnancy calculator wheel. “When in July?”
“Okay. Fourth of July, we’ll call it.” She spins the wheel and turns it upside-down to show the girl. “If you got pregnant on the Fourth of July, that puts you at 21 weeks. So you were pregnant either right when you went for your pills, or right before, or right after. Which means it didn’t show up.”
The girl is impassive. Her mother is holding her head in her hand. “So if we can’t do it at the hospital here, the closest place to us would be where? Cleveland?”
Keyes consults some literature and determines that it is. One clinic goes to 22 weeks, the other to 24. “Here’s one thing I’d advise,” she says. “Make the appointment, because that way, at least you’re on the books. People don’t do this procedure every day, and it takes three days.”