One Tuesday morning in April,Alicia Moreno and the rest of the staff at Boulder abortion clinic learned that the clinic’s owner, Dr Warren Hern, was closing the clinic on Friday. One of the fewabortionclinics in the US that performed abortions past the second trimester would, after 50 years, shutter its doors.
They sprang into action. Suddenly, the dozen patients who had been scheduled for abortions that week had to go somewhere else.
Using secure lines, Moreno and other staffers called abortion clinics across the country to see who could take the patients. Because Boulder abortion clinic typically helped patients schedule flights and hotels, they had to reschedule all those logistics –while ensuring that nothing cost too much, since more than 90% of the clinic’s patients relied on outside funding to help pay for their abortions.
“It was hardest on the patients that were already scheduled,” Moreno said. “They’re already in a really shitty circumstance, and we’re just like: ‘Haha, just kidding. You’re not coming toColoradonow. You’re going to DC in four days.’”
Abortions that take place later on in pregnancy are rare: In 2022, the year the US supreme court overturned Roe v Wade,about 1% took place at or after 21 weeks of pregnancy,according to the latest data from the CDC. But later abortions may be on the rise. Before Roe fell, about 8% of abortion patients living in states that today ban the procedure ended their pregnancies in the second trimester, according to not-yet-published research by a team involvingDiana Greene Foster, the principal investigator behindthe seminal Turnaway Study, which followed women denied abortions. After Roe fell, leading more than a dozen states to ban abortion,that rose to 17%.
While data suggests the post-Roe demand for later abortions is on the rise, the supply has not kept pace. Now that Boulder abortion clinic is gone, later abortions will be even harder to obtain.
These procedures can make even people who support abortion rights uneasy. The US abortion wars are always volatile, but later abortion remain a uniquely explosive third rail. While 70% of Americans believe abortion should be legal in the first trimester of pregnancy – when a fetus tends toresemble a feathery sea creature– just22% think it should be legal by the third, when a fetus looks much more like a baby.
“The way that I conceptualize it is that, yes, if I didn’t intervene, often, this pregnancy would continue,” said Dr Diane Horvath, medical director of Partners inAbortionCare, a Maryland clinic that performs abortions up until 34 weeks of pregnancy. Every week, her clinic sees between six and eightpatients who are at least 26 weeks along. “This is a potential life that I am taking part in ending, and I am completely comfortable with that, because the life of the pregnant person and their needs are always more important to me.”
Only nine states even permit abortions after viability, the benchmark at which a fetus can survive outside the womb and which typically occurs around 24 weeks of pregnancy.Just 17 clinicsin the US provide abortions after that point. Only three routinely do abortions past 28 weeks; others do so on a case-by-case basis.
Thelittle research that existson people who get later abortionshas found it tends to happen to people who have discovered some late-breaking news – such as receiving a diagnosis about a fetal anomaly, many of which cannot be confirmed until later in pregnancy, or realizing that they are pregnant later than normal. Young people and individuals who used contraception when they had sex are especially likely to miss early signs of pregnancy, Greene Foster said.
“There’s a really gross lack of understanding of what people go through and why they might make this decision to terminate a pregnancy later in pregnancy,” said Dr Jennefer Russo, the chief medical officer of DuPont Clinic, a Washington DC-based abortion clinic thatoffers the procedure until 32 weeks of pregnancy. “I’ve had patients whose partners have died during their pregnancy. There’s lots of different decisions that people could make in response to that event. But even just at the basic level of finances, if you don’t have the financial and emotional support of a partner, in this world being a single parent is really difficult.”
There’s little room, however, for this kind of complexity in US politics. In the months leading up to the 2024 election, campaigners behind ballot measures to codify abortion rightsdrew the line at viability– and most of these measurespassed. Meanwhile, Democrats rushed to capitalize on voters’ outrage over Roe’s downfall – but still acted like later abortions don’t happen. When Donald Trumpinsinuated in a debatethat Kamala Harris supported abortions in “the seventh month, the eighth month, the ninth month” of pregnancy, Harris fired back: “That’s not true.”
On the other side of the political spectrum, Republicans have taken to equating later abortion with infanticide. “President Trump has told me that he wants to end late-term abortions,” Robert F Kennedy Jr, secretary of the Department of Health and Human Services,told senators during his confirmation hearingsearlier this year. “I serve at the pleasure of the president. I’m gonna implement his policies.” (“Late-term abortion” is a medically inaccurate phrase, as “late term” refers to pregnancies that continue past their due date.)
Horvath believes that more doctors and clinicians are now willing to perform later abortions; indeed, the overturning of Roe led to asurge in demandforabortion training. However, advocates say it is too difficult to get later-abortion clinics off the ground.
“People just don’t have the resources to do it. We had to start a GoFundMe to begin this clinic. We solicited grants. We put in our own money to do this,” Horvath said.
Back in 2022, DuPont Clinic announced plans to open up another clinic in Beverly Hills, California. The wealthy city is deep-blue, but the announcement wasgreeted by a ferocious uproar. Anti-abortion protests erupted, and DuPont’s landlord ultimately cancelled the clinic’s lease.
California’s attorney general, Democrat Rob Bonta, accused Beverly Hills of violating state laws that protect Californians’ right to abortion. A lawsuit filed by Bonta’s office alleged that city officials had improperly delayed DuPont’s building permits as well as launched an “intense pressure campaign” against the clinic’s landlord, such as by claiming that the clinic would be so overwhelmed by violent protests and bomb threats that the city could not protect the public.
Beverly Hills settled with Bonta’s office and agreed to train their employees in abortion law. However, city officials maintain that they did nothing wrong and did not try to block the clinic from opening.
Russo is sympathetic to fears around harassment and violence. In 1988, somebody fired multiple shots into Boulder abortion clinic’s waiting room; in recent years, the front of the clinic was blocked from the street by a thick wall, while staffers protected patients’ privacy by using code words, referring to patients by numbers and placing phones in Faraday bags. In 2009, Dr George Tiller, perhaps the most famous later-abortion provider in the US, was shot to death in his Wichita, Kansas church by an anti-abortion activist.
“I’m worried about violence myself,” Russo said. But, she added: “If we all just decide that the Maga movement is violent, and we say we’re scared of them, and then we don’t stand up for civil rights or the rule of law, then they win.”
The events leading up to Boulder abortion clinic’s closure are in dispute. Hern has said that the business had become unsustainable for several reasons, including patients’ inability to affordlater abortions.
“It’s a difficult situation, and I decided that I didn’t want to continue with this,” Hern said. “I have other things that I need to do.”
Moreno, the chief operations officer at Boulder abortion clinic, said that plans for Hern to retire had longbeen in the works, but recently sped up as clinic staffers and physicians grew increasingly concerned about the 86-year-oldHern’s age and his ability to treat patients. Hern’s decision to close the clinic came as a surprise to her.
Now, Moreno and other former staffers at Boulder abortion clinic are planning on setting up a new later-abortionclinic. There are two main obstacles,she said:they need to find real estate.Also, the Trump administration has made donors skittish.
“That’s a barrier that everybody in this space is up against,” Moreno said. Given Trump’s animosity to later abortions,“they want to be able to donate their money safely, where they won’t be audited, that their business licenses for their personal businesses won’t be held because of their donations”.
Still, Moreno hopes to open up the clinic within 60 to 90 days, as the national abortion rights group the Brigid Alliance is helping fundraise. The need feels too great to wait too long.
“The clinics that provide this kind of care were already overloaded,” Moreno said. Now that Boulder abortion clinic is gone, “they’re absorbing as much as they can”.