Seventeen-year-old Katie* and her grandmother Maria got their very first glimpse of the Big Apple last month. But what brought them here from Boston wasn't a Sox-Yankees game or The Lion King or even more-than-ever patriotism.
Katie needed an abortion. Fast.
She wasn't the only one. Latisha, 30, arrived on the same day from Philadelphia and rode the subway to the same clinic where Katie and Maria sat in the waiting room. "There were all these people getting off the train. I'd never had so many people bumping up against me in my life," Latisha says of her first rush hour in midtown. "Then this lady comes out of nowhere, grabbing my arm and screaming, 'You don't have to do this! I'll be your baby's godmother,' and I'm like, 'Miss, can you get off my arm?' "
Katie and Latisha are among the thousands of out-of-towners annually who find their way here for an abortion. Already a beacon for reproductive rights, New York this month will become the first city to require abortion training for OB residents in public hospitals, thanks to a mandate from Mayor Michael Bloomberg. It's also one of the few places free of parental consent laws and mandatory waiting periods. With competition among dozens of providers keeping costs down, getting an appointment in NYC is often faster and cheaper than getting one closer to home.
The phenomenon of women traveling to far-away clinics actually has a name: "abortion tourism." But usually the flow is from countries where abortion is illegal, or close to it. Best known are the estimated 7000 Irish women who journey to England every year for the procedure.
Yet with 86 percent of all U.S. counties lacking even a single provider, American women have more in common with their Irish sisters than we'd like to think. For many in the Northeast who need a second-trimester abortion, New York City is the only choice. In nearby Philadelphia, Boston, Rochester, and Buffalo, clinics that offer the procedure are scarce and getting scarcer, with full schedules and high fees, and almost none will end a pregnancy past 20 weeks.
Drawn by the promise of reasonable access, women with no other option keep coming to New York. In 2000, according to the city's Department of Health, nearly 1700 traveled here for a second-trimester terminationmore than six per working day. It's a procedure that often requires two or three days, because the cervix is first dilated with sterile sticks of seaweed, called laminaria, which expand over the course of many hours, and varying stages of pain and discomfort. That means patients need a place to lay their head, whether or not they're able to pay for one. Those poor and determined enough come prepared to crash on a subway train, a park bench, or the backseat of a car, like Lisa, a college student from Maine who recently drove down with two close friends and three sleeping bags.
Luckily, she didn't have to camp on the streets. Instead, she found the Haven Coalition, a grassroots group of about 20 women who are willing to house abortion patients for free. Last month, Haven celebrated its first anniversary of offering couches and meals to virtual strangers. In the past year, volunteers have hosted 39 patients, most under age 21, some from as far away as Newfoundland, many whose trip to New York was their first one ever.
Among them was Katie, the Massachusetts teen, who was nearly 20 weeks along before her grandmother, a warm woman with a funky purple dye job, suspected something and coaxed her to the doctor for a regular checkup. The procedure would have been doable in Boston but was delayed by the parental-consent requirement. Even though Maria is Katie's legal guardian and was more than willing to give consent, the clinic demanded an official state ID, which Katiea city kid with no need for a driver's licensedid not have. Getting one took exactly two weeks, pushing the pregnancy past the clinic's limit.
After several phone calls to providers all over New England, someone finally told Maria she'd have to make the trip to New York. "Talk to a woman named Catherine," Maria remembers the voice on the phone saying. "She'll help find you a place to stay."
The late Flo Kennedy once quipped that if men could get pregnant, abortion would be a sacrament. In that alt universe, Catherine M., the founder of Haven, might very well be the patron saint of abortion access. Her name, which has been concealed here to protect her safety, is almost legend among providers and activists. Malika A. Lévy of the Greater Philadelphia Women's Medical Fund says that if a client is past 21 weeks, "we know we're sending her to New York. It's really a pleasure and relief to be able to say, 'Don't worry, we've got a group of women there who can house you and help you get around.' "
As the hot line director at the National Abortion Federation in the late '90s, Catherine could raise $1000 for a needy woman within a day. "I still can," boasts the 25-year-old, and sometimes she does, even though that's not really her job anymore.
Working the phones in Washington, Catherine heard every story imaginable. She took calls from women who were bleeding regularly and fitting into their size-six jeans but were in fact 22-weeks pregnant; teens who'd been too paralyzed by fear and shame to tell their parents; women who had been to "crisis pregnancy centers"funded by "Choose Life" license-plate sales and anti-choice groupsand lied to about how far along they were; women who wrongly believed they had a 50 percent chance of dying from an abortion; aunts and grandmothers of girls who had been sexually assaulted. Sometimes Catherine would even get a call from a woman who had just been told at her mid-pregnancy sonogram that the fetus was anencephalica defect in which part or all of the brain is missingand that her OB either didn't know how or didn't want to perform an abortion for her. "There are so many reasons why women need second-trimester abortions," says Catherine.
For Latisha, finding out she was 21-weeks pregnant was a total shock. She had just started school again after 12 years of working two jobs to support her two sons, now 10 and 12, and was on Depo-Provera, an injected contraceptive. But within days of her first class she landed in the emergency room with a chest infection, where a doctor came bouncing in with the news. "I was like, 'What? That's impossible. I'm not showing. I've got no symptoms. And I've been getting my period every month.' " She stared straight at the doctor and held up her arm. "You must have mixed up the charts. Here, look at my wristband."
But Latisha was indeed pregnant, and not once did anyone at the hospital mention the word abortion. She was worried the contraceptive could lead to a serious birth defect. "The doctor told me that I could come back for amnio at six or seven months and they could tell me if there was something wrong with the baby," she says. "Right. But by then, what could I do about it? I wasn't going to take that chance." The minute she got home she opened the yellow pages and began calling every clinic listed. "I'd call and they'd say, 'We don't go over 20.' 'We don't go over 18.' 'We don't go over 16.' " Finally, on the fourth call, a woman directed her to call the Choice hot line, which in turn directed her to NYC. "I told the clinic I could maybe pay for one night at a hotel, but not two. Then I talked to Catherine, and she told me she had some people I could stay with. The best part about everything was Catherine," says Latisha.
Even with help from Haven, Latisha ended up dipping into her savings account to get through the ordeal. Close to 90 percent of U.S. abortions happen in the first trimester, at a fee of approximately $350. But a second-trimester procedure costs four times as much, and the women who are more than 12 weeks along are often those of least means. Nearly one out of three are between 15 and 19 years old, and many are on Medicaid, which in most states doesn't cover an abortion.
"Sometimes they don't know they're pregnant for a couple months, and then they're dicking around with Medicaid," Catherine explains one evening over a cup of coffee. Then they're hit with fees of $1500 to $2000, not including travel expenses and missed work. "As they're trying to raise funds, the pregnancy is getting further and further along, the price is going up and up, and the likelihood of finding a provider is dwindling," she says, talking faster and faster, shifting her long hair from one shoulder to the other. "It's like they're chasing the fee."
A recent study published by the Alan Guttmacher Institute confirms the effect of money on reproductive choices. In a survey of women whose Medicaid wouldn't cover an abortion, up to a third of those asked said they continued the pregnancy against their wishes. Leslie Rottenberg, senior director of social services at Planned Parenthood, has seen this happen again and again. "A lot of these women give up," she says. "It takes a lot of work to find the right person to call."
Other women, like Katie, are pushed into their second trimester by parental-consent laws or mandatory waiting periods. Thirty-two states now require parental consent or notification, and 26 mandate state-directed counseling and/or a waiting period of up to 24 hours. In Mississippi, second-trimester abortions increased 17 percent after the state implemented a one-day waiting period.
State-ordered delays are not just patronizing. As Catherine points out, 24 hours of waiting can turn into a week, and "a week can mean $800," not to mention a more physically taxing procedure. At the hot line, Catherine noticed that she was sending a lot of the most desperate women to New York, where a second-trimester abortion can run relatively low at around $1000. But when they asked her, "Where am I going to stay?" she didn't have an answer.
After more than a year at the hot line, Catherine left for a counseling job at a clinic on Manhattan's West Side. One day she got a call from a colleague across town who had a patient desperate to get an abortion but in need of a place to stay; could she possibly sleep on Catherine's couch? She could. "After that, I was hooked," says Catherine. She began asking other counselors and friends if they would take people in, and hooked up with two women from the Brooklyn Pro-Choice Network who'd been hosting for years. In June 2001, she made Haven official by gingerly recruiting volunteers and offering her services to three of the city's largest clinics. She has since registered with the National Network of Abortion Funds.
Without really intending to, Catherine re-created a network that existed pre-Roe v. Wade, when abortion was legal in New York State and almost nowhere else. Back then, some 350,000 women with unwanted pregnancies flocked to the city. "There was a whole East Coast 'underground railroad,' " writes Robin Morgan, a noted feminist and former Ms. editor, in an e-mail interview. Volunteers made referrals, raised money, and baby-sat for people who couldn't get child care. The corps deliberately remained informal and unnamed, "a leftover from the days when we were already all doing the same thing illegally."
Catherine believes her generation may be breaking down class and race barriers in a way the second-wavers did not, but she admits Haven needs diversifying. "Almost all of our volunteers are white, and almost all the patients are black or Hispanic," she says.
Still, expanding the operation in general is a tricky endeavor. Up until now Catherine has only recruited by word of mouth, meeting with each prospective volunteer for a couple of hours to gauge their emotional maturity and commitment to abortion rights. Over dinner she scans for any hint of discomfort in their eyes, any wavering in their voices. She says one woman ended up confessing, "To tell you the truth, I hate the idea of abortion. But I'm trying to test my boundaries."
Catherine also checks in with every patient after they've been hosted. "My greatest fear is that someone will sneak by," she says. "It's such a sensitive time for these women. There is enormous potential for damage."
The other obstacle in recruiting is that when it comes down to it, very few women are willing to open their homes for such direct activism. "This is practical feminism rather than theoretical feminism," says Catherine. "Maybe it takes a little bit of madness, a little insanity to say, 'Let's go back to my house and cook dinner together.' We're taught to set boundaries."
Jennifer Baumgardner, co-author of the 2000 book Manifesta and a Haven member, says it's real work to move beyond principles and politics. "What actually needs to be done is harder and more direct than saying, oh, let's make sure Bush doesn't appoint a right-wing Supreme Court justice," she argues. "There are so many things that are more critical that have to do with access, and hosting is one of them. Paying for people's abortions is another."
That's actually another cause that young New York women have taken up. Around the same time that Catherine founded Haven, a few Barnard and Columbia grads started the New York Abortion Access Fund, an independent source of financial assistance that mostly aids nonresidents who can't get Medicaid. In just one year they've helped 50 women.
The numbers involved aren't vast, but the effect on individuals is huge. Baumgardner herself has hosted three times. Once she took home an Orthodox Jewish woman from upstate who couldn't eat off her dishes. "She got on a bus in the middle of the night. She told me very matter-of-factly that her boyfriend would kill her if he knew what she was doing," she says. Another time it was a teenager who was all alone. Though Baumgardner says hosting engages her on a deeper level, she admits the intimacy can be grueling. "It's not only awkward for me, it's awkward for the person I'm hostingI try to give them respect and privacy, but it's pretty hard because I live in a studio, so they're sleeping 10 feet away from me," she says. "It's ironic to me that a right that's based on the right to privacy is now practiced in so many unprivate ways."
Still, the women who've been hosted bubble over with gratitude. "I'd never been through an experience like that before," says Latisha, "where people had treated me so nice, you know, strangers helping each other. Catherine's little group made me feel so comfortable." Maria was also moved: "I told Catherine, any time she knows someone who needs shelter in Boston to call me."
In September, though, this little group will need a new leader. Catherine is moving back to her native Canada to begin the ultimate act of practical feminism: She is going to medical school so she can add her young face to the graying population of abortion providers. This decision feels as natural to her as the French she still speaks with her family. And perhaps it is also a way of making good on the help she received a decade ago, when she needed an abortion at the age of 14. "I came to this work feeling like my life had been saved by this procedure," she says, "and I've made my life my thank you."
* Names of patients and family have been changed to protect their privacy.
DIAL 'H' FOR HELP
Women who need help from Haven should ask for a referral from the clinic of their choice. Women who'd like to volunteer should write to firstname.lastname@example.org.
If you are in New York City and need an abortion, call the Women's Healthline at 230-1111 (in both the 212 and 718 area codes). You can also look in the yellow pages under "Abortion Providers." (Ignore "Abortion Alternatives," which lists anti-choice "Crisis Pregnancy Centers.")
If you are a New York State resident without health insurance, Medicaid funding is available. The folks at Planned Parenthood will get you going on the spot; they provide services up to the 20th week of a pregnancy. Call them at 212-965-7000. After 20 weeks, call the Women's Healthline at the number above.
If you live outside of New York and need help finding a provider and/or funding, call the National Abortion Federation hot line at 1-800-772-9100. This group helped 40,000 women last year.
To donate to the New York Abortion Access Fund, send checks to: NYAAF, FDR Station, Box 7569, New York, NY 10150-7569 or go to www.nnaf.org/nyaaf. J.B.
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