NEW YORK to SOUTH BEND, Ind. - With the New York City skyline melting into the distance, Meera Shah looked out over the pink sunset, trying to relax as she settled in for the nearly three-hour flight to Chicago.
Heavy rain splashed against the plane's windows. Some of the passengers - football fans headed to the Notre Dame game in Indiana - were talking about news of high winds in Chicago causing delays.
Shah needed to make her connection. She had patients waiting.
The New York physician was on her monthly commute to South Bend - an 800-mile trip across four states - to perform abortions. She is among about 50 doctors who travel regularly to 20 states, logging hundreds of miles, crisscrossing time zones to provide abortions in places where patients would otherwise not have access, according to Mary Frank, director of strategic initiatives at the National Abortion Federation, an association of providers. The doctors are paid by the clinics they serve.
Shah and other doctors who do such work say that their services have never been needed more - and that their commitment has never been stronger, with the nation at the most significant moment for abortion rights since Roe v. Wade made the procedure legal in 1973. Abortion opponents are optimistic that Roe will be overturned when a newly conservative Supreme Court rules next year on a Mississippi abortion ban, following arguments heard Wednesday. A Texas law that bans nearly all abortions after six weeks - the strictest in the country - is also being reviewed by the high court.
But even if Roe v. Wade is upheld, abortion rights advocates worry there will not be enough doctors to perform the procedure. That fear is part of what drives Shah.
"The commute is exhausting, of course, but I've seen firsthand how this care is so important to a patient's autonomy over their own body," said Shah, 38.
The daughter of Indian immigrants, Shah sees her work as part of her identity as a doctor and her commitment to social justice. She was back to her South Bend commute two days after her honeymoon this summer to see patients at a Whole Woman's Health Alliance clinic.
"I literally fly all this way to hand out medication abortion pills," she said. "I do what a nurse practitioner is trained to do and is already doing in some states," she said, adding that a key strategy of abortion opponents has been to place layers of restrictions on providers and clinics.
So Shah flies to South Bend about once a month and stays anywhere from 24 hours to two days. The South Bend clinic also has a rotation of doctors who drive in from nearby states, including one from Kentucky.
When abortion was first legalized, the antiabortion movement targeted women who sought the procedure, labeling them "sluts" and "murderers," said Carole Joffe, a professor in the department of obstetrics, gynecology and reproductive sciences at the University of California at San Francisco. "But this proved to be a losing strategy," Joffe said. So the movement turned to "the harassment and vilification of abortion providers instead."
"It's not just fear of antiabortion violence or harassment that inhibits abortion provision by local doctors," Joffe said, adding: "Abortion stigma plays a role. In some practices, when doctors join group practices, they are obligated to sign a statement that they will not provide abortions - even away from the group's office, in a clinic."
Pamela Merritt, executive director of the nonprofit Medical Students for Choice, said training more doctors to perform abortions will "be a key battle in the fight to maintain and increase access" to the procedure. "Fewer clinics means higher demand at all other clinics," she said. "And that means fewer openings for training, because clinics simply do not have the time."
Abortion rights activists also hope that the efforts to ban abortion will inspire a new generation of doctors who, like Shah, are committed to offering what she calls "compassionate care." Medical Students for Choice added chapters at 10 U.S. medical schools this year, with an estimated 300 additional members, Merritt said.
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Shah's flight from New York had a rough landing and was over an hour late. So she sprinted nearly a mile through sprawling O'Hare International Airport to try to make her connection. She was too late - it had already taken off.
Zigzagging through the crowds of stranded passengers, she found a virtual customer-service kiosk and was able to retrieve her luggage at baggage claim.
With so many travelers stranded, there were no rental cars available. So Shah improvised and calls an Uber - the nearly two-hour ride to South Bend would cost about the same as renting a car for 48 hours.
"Patients may have taken a day off of work or traveled hundreds of miles or set up child care," she said. "I have to make it."
She got in the car around 10 p.m. On the way, she called ahead to her hotel.
"Please don't give away my room," she pleaded. It's happened before when she's arrived late during the busy football season. "I promise - I'm on my way."
After the drive through darkness and rain, she arrived in South Bend by midnight.
The next morning, Shah was up early. Dressed in dark blue scrubs, she grabbed a frozen breakfast burrito from the hotel lobby, filled her travel mug with English-breakfast tea and headed to the clinic.
On the ride over, she saw the antiabortion billboards that dotted the skyline. She passed the campus of the University of Notre Dame, famous for football and its towering "Touchdown Jesus" mural.
Across the highway from the clinic, the Women's Care Center attempted to lure her patients away with offers of free pregnancy tests.
Escort April Lidinsky, a professor of women's and gender studies at Indiana University South Bend, held a big rainbow umbrella to block patients from the few protesters who had shown up.
She shuffled Shah in as the demonstrators held up crosses and gestured toward the pregnancy center across the street, shouting, "We love you and your baby!"
Inside, inspirational messages are painted on the walls to welcome patients: "Look at our women. They are strong, you can feel it. They are the rocks on which we really build," a quote from labor leader and civil rights activist Dolores Huerta. Exam rooms are named after female cultural icons - Diana Ross, Ella Fitzgerald, Audre Lorde. Clinic workers wear purple T-shirts with "Kicking politicians out of vaginas since 2003" on the back.
On a table in the waiting room is a book titled "You're the Only One I've Told: The Stories Behind Abortion," which was written by Shah and includes a note inside that says, "Meera Shah is your physician today."
Shah wrote the book to illustrate the range of people who get abortions and counter the stereotypes about them. She tells the stories of a rabbi who had an abortion because it was not the right time for her to become a parent, a young woman who advocated for herself before a judge in West Virginia to get an abortion without parental consent, and an Indian woman who questioned her desire to parent after she was abused growing up.
Shah, chief medical officer at Planned Parenthood Hudson Peconic in Hudson, N.Y., also wanted to show readers the next generation of providers. She wants children of her own someday and often shows off photos of her niece and nephew on her phone.
"I would do anything for them," said Shah, a family-medicine doctor specializing in sexual and reproductive health. But she said she feels just as strongly that pregnant people have the right to make decisions about their bodies.
For many young doctors like Shah, making sure access to abortions remains safe and legal is a mission, particularly in underserved communities, Joffe said.
"There's a new generation of doctors - disproportionately female, many of them people of color - who are committed to providing abortion precisely because of the assault on abortion rights," Joffe said. "They realize that the attack on abortion impacts the most vulnerable in our society. They see it as a social justice issue."
About 50 percent of abortion patients live below the federal poverty line, 25 percent just above it, Joffe said. About 60 percent also already have children.
Joffe and other abortion rights advocates fear a return to the pre-Roe era when people turned to untrained or poorly trained individuals for abortions - and in many cases died or suffered permanent injury from botched procedures performed under unsanitary conditions.
"The image of the butcher dominated the medical imagination, and helped keep abortion providers marginalized from rest of mainstream medicine . . . even though the post-Roe providers were largely ethical and skilled."
Shah's book opens with a scene in a Target in her hometown in the South. She describes bumping into a woman who looked like "Mrs. Claus or even Betty White" while in the greeting-card aisle. The woman notices Shah's black-and silver stethoscope and asks whether she was a nurse.
She tells the woman she's a doctor, and the woman asks what kind.
"At that point in my life," Shah writes, "this question was tricky for me."
Shah said she rarely disclosed that she provided abortion care, especially while in the Bible Belt. But something about the woman's questions made her finally "come out" to the shopper and tell her that, along with family medicine, she is an abortion provider.
The woman pauses for a moment. Shah holds her breath, "suddenly afraid my casual Target run was about to turn into an altercation."
Instead the woman leans in and says: "I've had an abortion. In fact, I've had two."
The woman says her first abortion was when she was young. The second was when she already had two children."
"You're the only one I've told," she whispers to Shah, touching her arm.
"Ever?" Shah asks.
"Ever," the woman says.
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In the clinic's waiting room, a soft-spoken, rail-thin 18-year-old described how she thought the people at the women's center across the street would help her get an abortion when they coaxed her over. Instead, they sent her home with information about the "bliss of motherhood" and "mental illness" that comes with abortion, along with photos of a smiling pregnant woman. Then they started calling her.
"I told them I wanted an abortion, and at first I didn't really know what they were doing," the teenager said. "Then I told them, 'It's really not your guys' decision.' "
After a few more phone calls, "they sounded all disappointed, but I couldn't really understand why," she said. "It's not their life. They won't be getting up with that baby in the middle of the night."
They texted and called so many times, she said, that she eventually blocked their number because they refused to stop.
When her name was called at the clinic, she was led to a private counseling room.
"Did you bring anyone with you today?" Shah asked.
"My grandma," said the patient, who was wearing Crocs with a rainbow charm on one and a popcorn charm on the other. "She's waiting in the car with my 6-month-old daughter. She's teething. She broke my TV."
"She's a handful," she added, smiling a little, then looking down and fiddling with her phone.
The exam room was named for poet and civil rights activist Maya Angelou. The teen looked up at an Angelou quote painted in cursive on the wall: "People will forget what you said. People will forget what you did. But people will never forget how you made them feel."
Shah began to read from a script required by Indiana law, but she added, "I don't agree with this as your doctor."
The mandated script includes medically disputed information such as, "A human fetus can feel pain at or before 20 weeks," and that abortion can cause infertility later.
"Both not true," Shah told her patient.
Shah performed an ultrasound and told the teen the gestational age of the fetus was seven weeks and four days.
She printed out the image, put it and the state-mandated information into an envelope and told her she could read it - or not.
"I'm ready for the abortion," the teen said. "Can I do it today?"
"Great question," Shah said. "State law requires that you come back in 18 hours."
"Really? Why can't I just do it today?" she asked.
Shah explained again that state law requires the waiting period.
The teen lowered her head and said quietly: "I understand. Thank you."
"I'm already in a tough domestic-violence situation," she said.
She shared cellphone photos of evidence of beatings she said were from her daughter's father when she was pregnant with her first child, leaving her with a bruised eye and head wound. She was able to get a protective order against him.
"Good," Shah said, gently touching her back.
"I just can't have another baby right now. My body isn't ready."
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In the break room, clinic staffers discussed what might happen if Roe is overturned. But they had full schedule of patients and knew they needed to take a break to eat if they were going to keep their energy up. They passed around menus from a Vietnamese restaurant. Shah rarely has time to eat, but she paid the tab for the staff.
Next on Shah's schedule was Savannah, a 29-year-old with children ages 6 and 1 at home. She rushed in when her name was called.
"I have to take my kids trick-or-treating after we talk," she said.
She explained that she was there for an abortion because she just had a baby. Her birth control failed. She is studying criminal justice with hopes of becoming a lawyer. She is a former methamphetamine addict who earned money dancing in a strip club, but she couldn't work after becoming pregnant and ended up homeless. Now, she said she had turned her life around and is trying to be a good mother to the children she already has.
"For me, for my sobriety, for me finally being able to get an education, I don't want another child right now," she said, adding she had given it a lot of thought. She was about seven weeks pregnant.
Savannah had been volunteering for Planned Parenthood, working the phones to tell callers there is nothing to be ashamed of in having an abortion and making sure they know their rights: "I've spoken to women and say, 'It's your life.' These men in government, telling you what to do, don't know your life. Have they ever been a pregnant, homeless stripper? No. At the very least they should mind their own business. That's all they have to do."
She told Shah that she thinks she's brave for doing the work she does - providing abortion services. And she was impressed that she came all the way from New York.
"Wow, that's very admirable," she told Shah. "Thank you."
"Don't worry about me," Shah said. "I'm actually honored to be able to care for you."
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