One of the last abortions in Louisiana? Diary of a woman from a clinic under threat of closure

The US supreme court will hear oral arguments this week in a high-stakes case that threatens the constitutional right to an abortion.

The Louisiana law under review, known as June Medical Services v Russo, would require doctors who perform abortions to be able to admit patients at a nearby hospital – a law abortion rights groups characterize as a bureaucratic hurdle designed limit abortion access.

The supreme court struck down a nearly identical Texas law in 2016 in Whole Woman’s Health v Hellerstedt. But since then, Donald Trump has appointed two justices to the court and cemented a solid conservative majority on the bench.

This will be the new court’s first major abortion case. If upheld, the law could lead to the closure of Louisiana’s last three abortion clinics. And in such a ruling, the court could signal its appetite to unwind Roe v Wade, the 1973 landmark decision that guaranteed constitutional abortion rights in America.

Tiffany Pennywell may be one of the last women to have an an elective abortion in Louisiana. This is her story.

Monday, 23 December

Pennywell stood in the restroom of a Target retail store, staring at a pregnancy test, waiting. She was already a week late. It was 9am on a mild morning in Shreveport, Louisiana, two days before Christmas. She’d stopped in on her way to work.

It didn’t take long for the line to show up – it wasn’t even faint.

“I guess I gotta roll with the punches with this one,” she remembers thinking. She bought prenatal vitamins and went to her retail job at a jewellers.

Pennywell was already a mother of three; two boys and a girl aged 11, seven and five years old. Each had been complicated pregnancies, requiring cesarean sections that left a build-up of scar tissue. After the second, the scar had trouble healing. The doctor advised her that her third child should probably be her last.

She’d wanted a hysterectomy but the hospital, a Catholic institution in this conservative state in the deep south, wouldn’t perform one. The intrauterine device, or IUD, she’d had implanted instead caused her so much pain it had to be removed.

Her last option had been to take the birth control pill, but it caused her cramps and dizziness. So, she and her partner had simply tried to be cautious. It had worked until now.

Tuesday, 24 December

Pennywell and her partner were in the bedroom wrapping presents on Christmas Eve. They stayed up all night talking.

Pennywell had told her partner, the father of her two youngest children, about the pregnancy the day she found out, and he was upset. They’d been doing well as a couple, becoming more financially stable. But, he had said: “It’s your body and your decision.”

Pennywell believes it is a woman’s choice whether to carry a pregnancy, but a part of her still clung to the teaching of the conservative Christianity she was raised in, in the Church of Christ. She’d left to find her own spiritual path in her early twenties, but it remained in the back of her mind: abortion is taking away a life.

Still, Pennywell was afraid for her health, and frightened that the birth could even kill her. She worried that her kids could lose their mum.

“There was a lot of crying on my part because I was torn,” she said. “It’s not something I ever really saw myself doing or being able to do.”

After hours of talking, she recalls having “a moment of stillness”, and felt it just made the most sense.

“I had been in denial, kind of sweeping it under the rug that if we just go ahead and go through with the pregnancy, things would be okay, we’d go day by day,” she says. “But in the back of my mind, I knew I was scared. And I had to face that. The guilt was keeping me from facing that fear and I had to push that aside.”

It felt as if a weight lifted off her shoulders. She knew she was doing the right thing.

By that morning, hours before they had to get the kids up for presents, they came to a decision. Pennywell would have an abortion.

Wednesday, 25 December

She told her mom on Christmas Day, after the presents. Pennywell didn’t want her imagining a grandchild that would not come. She explained the medical reasons.

“Are you sure?” her mom asked.

“For my safety, it’s something I need to do,” Pennywell told her.

Her mother was sad, torn between her beliefs about abortion – she remained in the Church of Christ – and her daughter’s safety. Eventually she’d support her daughter’s decision. She didn’t want to face the chance of losing her only child.

Friday, 27 December

Pennywell had her first appointment that Friday morning at Hope Medical Group for Women, the only abortion clinic in north Louisiana and one that serves women from across neighboring states. She was born and raised in this town, and she knew about Hope – knew who to call, where to go. She was surprised, relieved, that there weren’t any protesters outside that day.

The clinic hardly looked like a lightning rod of controversy: a low, windowless brick building with a parking lot and small sign. Traffic whizzed by on a busy two-lane road. She pulled the first door open and waited to be buzzed through the second. No phones or bags were allowed inside; “Do not feed (or speak to) the protesters” one sign read.

She entered a small waiting room and checked-in at the reception counter. Daytime soap operas and game shows played on two TVs. A large carafe of coffee sat on a table.

This room is packed most days. Pennywell filled out pages of paperwork and read some brochures – one on feelings after an abortion, like anxiety or fear; one about the pain that can be involved in the procedure, which later she’d wish she’d picked up.

She browsed the magazines and books. The time seemed to pass without notice. She was nervous.

There are just three abortion clinics left in Louisiana, which together provide between 8,000 and 10,000 abortions annually.

In 2014, the state passed a law requiring abortion doctors to have admitting privileges at nearby hospitals, essentially the ability to admit patients in the event of an emergency. Only one doctor in Louisiana has such privileges – the others have been denied.

If the law being debated in the supreme court is upheld, the clinics in Baton Rouge and New Orleans would close immediately, and Hope would likely follow. That lone doctor with admitting privileges works at Hope, but the clinic would have a hard time staying open without its second physician.

When the supreme court hears Louisiana’s case on March 4th, Hope will be the lead plaintiff. It’s not a stretch to say that what happens to this clinic could shape the future of abortion access across the country.

Louisiana has already passed some of America’s harshest abortion restrictions, and by far the most of any state since abortion was declared a constitutional right by the US supreme court in 1973. A recent poll found that almost a quarter of the state’s population believe abortion should be entirely illegal.

But it’s not alone in its antipathy to abortion rights. More than half of US states are deemed hostile to abortion, according to the reproductive rights research group the Guttmacher Institute. Many of those states would be likely to pass a similar law if Louisiana’s were upheld, leading to more clinic closures.

States could also amp up the passage of other restrictive laws, buoyed by the hope that they, too, would be upheld by the court. The decision could also signal this court’s willingness – sooner or later – to overturn Roe v. Wade.

Pennywell had hurried to get her own abortion out of fear that the laws could soon change. “How long are these places still going to be here?” she’d wondered. “If I wait too much longer, am I going to find out, oh, you should have been here a week earlier before you know this law passed or this happened?”

If the clinics close, a lot of women will be disadvantaged, she thought. Some will have to go out of state, if they can afford it.

“It causes more hurdles,” she said. “You’re already going through so much emotionally, mentally and spiritually that it’s too hard to have to go that one more step or 10 more steps.”

At the clinic, Pennywell first had to undergo an ultrasound, as mandated by the state. Staff told her she was five-and-a-half weeks pregnant, and that made everything more real.

Pennywell didn’t look at the ultrasound image for fear of becoming too attached. She still felt on edge. She knew the pregnancy could harm her, but a part of her still wanted this baby.

She spoke to a counselor, as all patients at the clinic do, about the reasons for needing the abortion. The counselor listened. Pennywell felt she understood. They talked about birth control and decided she should have a medication abortion, rather than the surgical procedure. She talked with a physician, too, who agreed.

She made the abortion appointment and left – women in Louisiana must wait a state-mandated 24 hours before undergoing abortions, another anti-abortion law in force. The laws were the reason Pennywell couldn’t simply go to her obstetrician for an abortion, and the reason the state dropped from 11 clinics in 2001 to its current three.

Saturday, 4 January

Pennywell had originally made the appointment for January 2nd, but she couldn’t get her shift covered at work, so she pushed it to Saturday, January 4th.

That morning, her partner met her in the clinic parking lot and gave her a hug. “He said that it would be OK, and to call him as soon as it was over,” she recalls.

The clinic’s waiting rooms were packed – Saturday is its busiest day of the week – and there was more paperwork to fill out. Federal law bans abortion coverage under government healthcare in the US, and Louisiana bars most insurance from covering it. Pennywell qualified for financial assistance offered through the clinic, putting the cost at about $400. She put it on her credit card.

On her first visit, she had spotted a copy of Michelle Obama’s Becoming, and she grabbed it and read while she waited.

The Centre for Reproductive Rights, a legal group fighting for Hope at the supreme court, has described the looming supreme court case as a direct attack on court precedent. A nearly identical law in Texas shut half of that state’s 40 clinics, before it was struck down by the supreme court in 2016.

“The facts, the law, and the constitution have not changed” in the intervening years, the center’s president, Nancy Northup, has noted. But what has changed is the make-up of the court. Trump has placed two new conservative justices on the court, both considered hostile to abortion rights.

Kathaleen Pittman, the clinic’s administrator, has worked at Hope since 1992. She’s been distressed at the wealth of misinformation and the high number of phone calls lately from potential patients asking if abortion is even legal in Louisiana, questions fueled by the state’s six-week “hearbeat” abortion ban passed last year. The law has not taken effect and is also being challenged in separate legal proceedings.

The staff here are used to lawsuits – the clinic has been the plaintiff in cases over anti-abortion laws since 1992 – but this will be its first appearance the supreme court. “I think this time feels different for all of us,” said Merritt Rebouche, 27, the clinic’s director of patient advocacy.

“Surely the credibility of the supreme court means something to somebody,” Pittman said. But she was frightened. “I think women all over the state should be very afraid at this point in time.”

Even so, most of the clinic’s patients have not heard about the supreme court case before they enter its doors, her staff said. Rebouche and others try their best to educate women, but a legal battle in Washington DC can feel far removed from the immediacy of a personal crisis. Many women tell staff that they never thought they’d need an abortion, and swear they’ll never be back.

The staff called Pennywell to a back room. She undressed from the waist down for a vaginal ultrasound – even that was painful, due to her scar tissue.

She took the first set of pills. Staff had told her the abortion medication can make people nauseous, and they’d given her a prescription for nausea medication as well as one for the second abortion pills. They warned her to avoid two pharmacies in the area that don’t like giving out abortion medication.

She left the clinic, and her partner took her home.

Sunday, 5 January

She took the second pills 24 hours later, and the pregnancy passed that day. It felt like severe cramping, like the first time she had contractions. She didn’t know it was going to be that painful. She called the clinic, just to be sure, and they told her that each person’s pain is different.

She wore pads for the next couple of days, a long period of bleeding, sometimes so heavy that she went to her doctor and discovered she’d become anemic.

“The pain would be worse in the morning. I had a hard time getting out the door, getting the kids to school,” she said.

“The whole time I’m thinking there is no one who just casually goes through this, this decision to have this pain,” she said. “There’s nothing casual about getting an abortion.”

Monday, 30 January

A few weeks later, she returned to the clinic for a check-up – the first time she’d seen protesters outside: Two women in their sixties passed out anti-abortion pamphlets.

The appointment went well. Pennywell took a pregnancy test, and the line was very faint. Staff gave her another one to take a few days later, but she was positive it was just left-over hormones.

She felt at peace.

The last month had been “a mourning phase” with a gamut of emotions: sadness, anger, depression. The pregnancy was something that could have grown up to be a person and sibling, and she allowed herself to grieve that.

“Some people see things as black and white, but abortion is not,” she said.

And the people and politicians trying to close down these clinics?

“I think it’s selfish of them,” she said. “That’s a lot of pain I would have gone through. They aren’t paying for the doctor bills, they aren’t going to be paying for anything that happens afterwards. They’re not going to be there for my family if something happens to me.”

Abortion is a common experience – about one in four US women will have one – but most patients don’t talk about them publicly. Pennywell had wanted to tell her story so that she could “be there for other women”. She wanted her daughter to grow up with the chance to make the same choice for herself.

“I just hope that at some point politicians will realize that women’s bodies are not something to politicize, that they’re human,” she said.

“They have a soul. Women have a mind, a conscience, and they know what’s right for their bodies. And no one should be telling them what to do with it.”