Sonia Loureiro never expected to need an abortion. A married, 34-year-old mother of four, Loureiro had relied for years on a copper intrauterine device, or IUD, a hormone-free method of birth control that allowed her to avoid some of the side effects of the pill. Busy working and caring for her kids—Loureiro works from her home in Raleigh, North Carolina, as a human resources coordinator—she wasn’t paying much attention in late 2015 when her state passed some of the most restrictive abortion laws in the country, and she had never thought much about where she stood in the abortion debate.
But in January, Loureiro found out she was pregnant. “I’m one of those Google people,” she says, explaining how she discovered some of the risks and complications of her pregnancy through online searches. An IUD like the one that Loureiro used prevents pregnancy by affecting sperm’s ability to fertilize the egg and has a better than 99 percent success rate; it’s supposed to last between 5 and 10 years. The risk of miscarriage, premature delivery, and placental abruption would be greatly heightened by leaving the IUD in place.
Soon after she discovered the pregnancy, at around six weeks’ gestation, she was experiencing a sharp pain in her left side and bleeding heavily. She saw an obstetrician, who asked her right away if she wanted an abortion; Loureiro was taken aback and said she didn’t know. The doctor confirmed that leaving the IUD in place was risky; surgically removing the device would end the pregnancy. Loureiro agreed to allow the doctor to attempt removing the IUD manually, using forceps, but the attempt failed.
Loureiro made a follow-up appointment with the obstetrician, in case she decided to continue the pregnancy, but also asked for a referral to a clinic that could attempt to surgically remove the IUD and also provide an abortion. That night, she talked over the decision with her husband. They agreed the risks of miscarriage and preterm labor, plus the threat to her own health, were too great. They had four other children to think about, and Loureiro’s pain and bleeding were getting worse. Loureiro talked to her mother and girlfriends, who all said they would do the same thing: opt for surgical removal and an abortion, the safest option for Loureiro.
The next day was a Tuesday. Loureiro called the Duke Ryan Clinic expecting to make an appointment on Tuesday or Wednesday. She learned that she would have to wait 72 hours before having the procedure—one feature of a new law, The Women’s and Children’s Protection Act of 2015, passed by North Carolina’s Republican-controlled legislature just the month before, in December. “I did not know about that law,” she said. “I was upset about it—I couldn’t imagine waiting three more days in so much pain.”
She described her symptoms to the clinic’s scheduling nurse, a woman she described as “super nice,” but there was nothing the nurse could do. She read Loureiro a script mandated by the state, including a list of supports and resources available to Loureiro if she decided to continue her pregnancy. She might be eligible for medical assistance benefits, the nurse read from the list. The father was liable for the child’s support. She had other alternatives to abortion, including keeping the baby or placing it for adoption. Though Loureiro understood the nurse had no say in the script, the experience of listening was alienating. “It was very one-sided, almost like they want you to feel guilty,” she said. “It was not a good feeling.”
Meanwhile, weather forecasters called for snow later in the week, generally a disruptive event in central North Carolina: Schools close over flurries here, and predictions of when and how much can consume local news for days. By Thursday morning, the day before her abortion was scheduled, shoppers were emptying grocery shelves and the roads were striped with brine. While arranging payment over the phone with the clinic’s billing department, Loureiro overheard the scheduling nurse’s voice. “Tell her we’ll be closed for inclement weather,” she recalls the nurse saying. Loureiro had to reschedule for the following Tuesday, turning an increasingly painful and worried 72 hours into seven days of agony.
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I’m sometimes surprised by how little I have to wait for things. If I’m sick, I can usually arrange an appointment with my doctor for the same day; outside of office hours, I can call a 24-hour nurse line and have my call returned in 20 minutes or less. At the grocery store near my house, cashiers open new registers rather than let waiting customers get bored enough to pick up a magazine. If I had a permit—I don’t—I could buy a gun, or several guns, with no waiting period at all. The experience of not-waiting is thrown into relief by periods of waiting—I don’t think about the convenience or speed that attends my life’s big and small tasks until something stands in their way. Waiting then becomes more than an inconvenience; it feels like a punishment.
In North Carolina, as in many other states around the country, waiting is just one of the obstacles women face when seeking abortions. Thirty-eight states require counseling before abortions, and 28 require a waiting period before the abortion can be performed. The wait is most often 24 hours, but six states—Louisiana, Missouri, North Carolina, Oklahoma, South Dakota, and Utah—require 72 hours. Because clinics often provide services only three or four days a week, and can be geographically out of easy reach for many women, it’s easy to see how waiting periods can be extended beyond what’s legally required. South Dakota even stipulates that weekends and holidays aren’t counted in those three days of waiting.
In addition to the longer waiting period, North Carolina women and their doctors became subject to another new restriction: Whenever an abortion is performed after 16 weeks, the doctor must now submit what the law describes as an “ultrasound image of the unborn child” to the state’s Department of Health and Human Services. The law makes no mention of the woman’s uterus also pictured, and does not require doctors to inform patients that their health records will be collected and stored by the government.
Other states, such as Texas, Ohio, and Mississippi, have shorter waiting periods but require patients to attend in-person consultations before the wait begins. If a patient discovers her pregnancy on a Monday, travels to the clinic for her consultation on a Friday, and the clinic doesn’t offer appointments until the following Thursday, she has waited far longer than the state-mandated time. Any additional delay caused by a weather event or other factors could mean the difference between an abortion performed locally and one that would require travel, additional expense, and higher risks. Some women might be forced to continue unwanted pregnancies.
The impact of this waiting—on women’s health and their constitutional right of access to abortion—is at the heart of Whole Women’s Health v. Hellerstedt, the first major abortion case argued before the Supreme Court in nine years. The case asked the currently eight-member court to decide whether Texas has to prove that abortion restrictions designed to protect women’s health and safety must actually accomplish their stated goals. Restrictions in Texas’ HB2 law—which requires physicians to obtain admitting privileges at local hospitals and requires clinics to have the same resources as ambulatory surgical centers—will close more than three-fourths of the state’s remaining abortion clinics. Though the law’s stated intention is the protection of women’s health, it isn’t hard to see how the result will be the opposite. Texas’s clinics are already overburdened; in some facilities, patients wait an average of three weeks for an initial appointment, and researchers predict that the number of second-trimester abortions could nearly double if HB2 is fully enforced. For some women, especially poor women from rural parts of the state, shrinking the number of Texas’s available clinics from 40 to nine or 10 will make safe and legal abortions essentially unavailable.
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“The only thing I could do,” Sonia Loureiro says, “was lay and wait.” With snow steadily falling outside, and her cramps and bleeding getting worse, she tried to find a comfortable resting position in bed while her husband took care of their children. Mom’s having back pain, they told the kids home from school on a Friday because of the storm.
On Saturday, the pain was worse. Loureiro reeled between dizziness and feeling “like an elephant was sitting on my chest,” she recalls. She thought she might be miscarrying and also having a panic attack, so she went to the emergency room with her mother.
They waited seven hours before being seen. When Loureiro was finally called in to an examining bay, she described her situation and fears—that this was an unsustainable pregnancy, that her body, confused by the presence of both the IUD and the embryo, was trying to end the pregnancy on its own. The doctor wheeled in what looked to Loureiro like an “old, old ultrasound machine” and performed an exam, which was inconclusive. How many maxi pads was she using? the doctor asked. Could she sit up? Unless she was doubled over in pain or soaking two pads an hour, there was little the ER doctors could do for her. She’d have to wait to be seen at the clinic on Tuesday, they told her. Loureiro and her mother left, driving home on ice-covered roads.
Aside from the births of her children, Loureiro had never been admitted to a hospital, and she is reluctant to complain or criticize the people who cared for her. The Ryan Clinic nurse had given Loureiro her personal cellphone number and stayed in touch before the clinic closed, she told me; everyone at the clinic was “exceptional.” Even the IUD had worked great, she says, until it didn’t. But the unexpected waiting period, followed by the long, fruitless emergency room visit, gave her a new perspective on the divide between doctors and patients, at least where abortion is concerned.
“Medical professionals have their hands tied,” she says. “I think they’re afraid. They’re very limited in what they can do.”
I asked Dr. Matthew Zerden, an OB-GYN who provides care for Planned Parenthood South Atlantic, about Loureiro’s experience. While he couldn’t comment on the specifics of her treatment, he acknowledged that North Carolina’s laws have impacted the relationship between patients and their doctors. “Some physicians may be fearful of how they can practice or the implications of their care, and it may result in patients not receiving the care they deserve,” Zerden says.
Zerden has worked with Planned Parenthood in North Carolina since 2011, and in that time has seen a troubling increase in regulations with no basis in medicine. One of these is the script that must be read to patients who call or come in to schedule an abortion; reading the script to distraught patients terminating wanted-but-nonviable pregnancies, for example, can take up to 30 minutes because the patient is crying. “Sometimes, I’m waiting for them to compose themselves,” Zerden says. “I’m apologizing. They’re apologizing. It’s one of my least favorite positions to be in in medicine.”
Another regulation affecting doctors and patients is the ultrasound provision, which Zerden says is “a solution to a problem that, as far as I know, didn’t exist.” Zerden and other Planned Parenthood South Atlantic doctors inform their patients about the law and reassure them that names and identifying information are removed from the images—a safeguard negotiated by Planned Parenthood South Atlantic, which opposed the new law, to protect patient confidentiality. Still, he says, “it undermines the confidence patients have in their doctors, and undermines the doctor-patient relationship.”
But delays in care—like the one Loureiro faced—appear to have the most obvious negative impact. The clinics where Zerden practices were also affected by winter storms this year, and he notes that the combined impact of unpredictable weather delays and the 72-hour waiting period directly affected the timing and type of care some patients received.
“The end result are procedures that occur at a more advanced gestational age, which has health implications for the patient,” he says. “Or some women switch from their desired method of abortion, medication, to surgical because of the delay.”
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Sonia Loureiro finally had her abortion at around seven weeks, the Tuesday after the snowstorm. Two weeks after the procedure, her bleeding had subsided completely and she was feeling much better. The experience had changed her, from someone who didn’t identify as pro-life or pro-choice, to someone who wanted to tell a painful personal story so others would know what they might one day face, too. “It’s scary and absurd,” she said. “I can’t think of any reason why they’d need to do this, unless they want to prevent women from having a choice. Do you know why?”
Her question was sincere. She really wanted to know why the Women and Children’s Protection Act was passed, and what purpose its authors believed it might serve, if not to protect women with children—women like her—from unnecessary pain and suffering.