What Is It Like to Be an Abortion Provider in an Anti-Choice State?

What Is It Like to Be an Abortion Provider in an Anti-Choice State?

What Is It Like to Be an Abortion Provider in an Anti-Choice State?

In Utah, Dr. Leah Torres has to contend with a slew of medically unsound regulations to care for her patients. And that’s before the death threats.


Leah Torres wakes up early in a modest townhome between the two looming mountain ranges that border Salt Lake City. She makes coffee with the precision you’d expect of a doctor, though for breakfast she might eat a bowl of Trix. She sits down on the couch to watch the Today show. Then she checks Twitter to see if anyone has called her a murderer overnight.

Later, at the hospital where she works, Torres will talk with teenagers about birth control, and with women about their mammograms. She’ll examine patients with high-risk pregnancies; implant IUDs; take pap smears; perform surgery. She sees patients who are uninsured, and when they can’t afford the medicines she wants to prescribe, she figures out another treatment plan. What she doesn’t do at the hospital is perform abortions. Only two clinics in Utah have found their way through the maze of restrictive laws that govern abortion care in the state—and so, to do that part of her work, Torres spends a Saturday each month at one of them, helping people end their pregnancies.

One afternoon in April, Torres came striding out of the hospital’s sliding-glass doors in her white coat, furious. After initially giving The Nation permission to film in her office, hospital administrators had revoked it the night before, at first citing patient privacy and finally admitting to Torres that they didn’t want publicity about her work as an abortion provider and reproductive-rights advocate. Torres was apologetic—and angry. She is not one for hushing up.

Although she works in a conservative state and in a political climate marked by overt hostility toward abortion providers, the 36-year-old obstetrician-gynecologist maintains an unusually public profile. On Twitter, Torres responds to anti-choice trolls with facts and links to medical research. On her blog, she answers readers’ questions, which are mostly about birth control. She writes op-eds and participates in public-policy debates. She became even more active this past spring, when Utah’s Republican-controlled legislature passed a novel law requiring doctors to give anesthesia to fetuses for abortions taking place at 20 weeks or later—though there is no scientific evidence that fetuses can feel pain so early.

We met Torres in mid-April, three weeks before the law was set to take effect. She was placing near-daily calls to the state attorney general’s office in an attempt to figure out how to comply, since there is no standard medical practice for giving painkillers to fetuses. No one, including the accountant who sponsored the legislation in the State Senate, could tell her what the law actually required. Would it be OK to give the woman an extra dose of Advil? Or would Torres have to knock her out completely with a general anesthetic, making what is generally a safe procedure more costly and dangerous?

Doctors who provide abortions have reasons to keep quiet about their work, as the fatal shooting at a Planned Parenthood clinic in Colorado last year confirmed. Anti-abortion activists have made the demonization, harassment, and even murder of abortion providers a central part of their strategy since the early 1990s. “We’ve found the weak link is the doctor,” said Randall Terry, the founder of the extremist group Operation Rescue, at a rally in 1993, just days before a provider named David Gunn was killed in Pensacola, Florida. “We’re going to expose them,” Terry promised. “We’re going to humiliate them.”

As a result of such threats, Torres does take precautions. She has her mail delivered to a post-office box; she doesn’t talk about her family or personal life online; she doesn’t even put pro-choice bumper stickers on her car. Still, she’s come to the conclusion that the only way to counter the vilification is to say more about her work, not less.

“There’s a lot of shame and stigma surrounding abortions,” Torres said. “That shame and stigma comes from silence from one side, and vociferousness from another side. You’ve got: ‘You’re a baby killer. Abortion is murder!’ That’s my motivation: revoking the power that the shame and stigma has over abortion. [It] drives all of these bad laws, drives the violence…. I’m trying to reduce that violence, the shame and negativity. Because abortion is health care.”

* * *

Torres grew up in northern Michigan. She was an adopted child, a fact that she said has little bearing on her work now. “The anti-choice argument about adoption always being an option is a false statement. Adoption is an alternative to parenting, not to pregnancy,” Torres noted. “I’m glad that my birth mother had the option and decided to risk life to give birth to me—but if she’d decided to have an abortion, I wouldn’t know, and it’d be a moot point.”

By high school, Torres knew she wanted to study medicine. She majored in Spanish in college but also took courses in women’s studies, which spurred her interest in women’s health. She decided to make abortion part of her practice in medical school, after meeting members of a group called Medical Students for Choice who were “just super-fun” and offered her a sense of community. Despite that resolve, Torres had to fight for adequate training. Her residency program in Philadelphia covered the mechanics of dilation and curettage (or D&C), which is used for some miscarriages as well as abortion procedures, but it left her without an understanding of the differences in caring for those two types of patients. On her own initiative, she shadowed an independent doctor who occasionally used the hospital’s operating room for abortions. Still, she felt ill-equipped to handle second-trimester procedures.

Torres’s experience is not unusual. Since the Supreme Court legalized abortion in 1973 with its ruling in Roe v. Wade, abortion care has shifted out of hospitals, where most medical education takes place, to private clinics, in part because the mainstream medical community has shied away from the stigma associated with the procedure. Many states ban public-university hospitals from providing abortion care at all, which means that students and residents at those institutions can gain practical experience with abortion only if they seek it out elsewhere, on their own time. A survey published in 2005 by the American Journal of Obstetrics and Gynecology found that less than a third of US medical schools offered even a lecture specifically about abortion during their residencies, while nearly a quarter provided no formal abortion education at all. At the schools that did provide clinical experience or a reproductive-health elective, participation was low. Considering these gaps in education, as well as the daily harassment directed toward abortion providers, it’s not surprising that by 2011, there were 40.7 percent fewer doctors performing the procedure than in 1982.

Beginning in the early 1990s, a number of programs and groups were founded to ensure that, despite weaknesses in the official curricula, there would be a new generation of highly qualified physicians trained to provide contraceptive and abortion care. Medical Students for Choice is one; another is a two-year program called the Fellowship in Family Planning, which is what brought Torres to Salt Lake City. She arrived in 2012, part of the “new vanguard” of doctors described by Emily Bazelon in The New York Times in 2010. These young doctors had lived most—if not all—of their lives in a post-Roe world, and yet they were beginning their careers just as Republican-controlled state legislatures were launching a stealth campaign to undermine the legal right to abortion.

When Torres arrived in Utah, she was shocked by the number of rules she had to navigate in order to provide abortions. There are at least eight regulations she considers medically unnecessary, even dangerous. One requires patients to wait three days between an initial consultation and their abortion. Another requires her to “counsel” patients that abortion is associated with negative long-term mental-health effects, though a 2008 review of scientific research by the American Psychological Association found “no credible evidence” for that claim. Another requires her to have admitting privileges at a hospital within 30 miles. A fourth mandates that all abortions, even those induced by a pill, take place in a room equipped for surgery—though by enacting a law prohibiting state funds from being used for abortion care, the state has also made sure that room cannot be in a hospital. (Most hospitals receive some public funding.) Then there’s the law that requires minors to get parental consent for an abortion, though they’re not required to have parental consent to become parents themselves. Another law makes some of Torres’s personal information public simply because she provides abortions. Finally, there’s the new fetal-pain law.

In fact, Utah is hardly exceptional in erecting barriers for people seeking abortions and the doctors who treat them. Since 2010, when Republicans swept to power in a number of states, legislators have enacted nearly 300 bills that restrict access to abortion. Some of these laws, like the one imposing mandatory waiting periods, place an extra burden on women in the form of time and money. Others, like the requirement that abortions take place in mini-surgical centers, single out abortion for special regulations that don’t apply to other medical procedures, even those with higher rates of complications. Although these laws are often described by their backers as health and safety measures, their actual effect is to make it prohibitively expensive for clinics to operate. Many states now have only a handful of doctors who provide abortions, and women in rural areas, in particular, may live hundreds of miles from a clinic. In effect, the constitutional right to abortion has become contingent on geography and money.

Torres expected to stay in Utah only for the two years of her fellowship. “That’s been my life track: go, get the job done, move on, experience new places,” she said. But instead of being discouraged by the hostile political climate, Torres found it galvanizing. She estimates that there are less than a dozen doctors providing abortions in all of Utah, and—largely because of the requirement that they do so in surgical centers—there are only two facilities in the entire state where they can practice. Some patients drive over 500 miles to reach them. Because she went into medicine to help people—especially those who wouldn’t otherwise have access to health care—staying in Utah felt like filling a crucial void.

“The population in Utah that’s impacted most by these laws are those who have less money, who are lower in socioeconomic status,” Torres explained as we sat in her kitchen, drinking tea. On the wall, written on a whiteboard, was a quote from the 19th-century American doctor Thomas Mütter: “The world is no place of rest.”

* * *

Last November, on the day after Thanksgiving, Robert Lewis Dear Jr. walked into a Planned Parenthood clinic in Colorado Springs and murdered three people. Although these were the first abortion-related killings since 2009, they weren’t entirely unanticipated. In the preceding months, abortion-rights advocates had noticed what Vicki Saporta of the National Abortion Federation called an “alarming” escalation of threats, harassment, and vandalism directed at clinics and doctors. The uptick began soon after anti-choice activists who’d posed as representatives of a fake biomedical company began releasing undercover videos purporting to show Planned Parenthood officials haggling over the price of fetal tissue. (None of the many investigations into Planned Parenthood have turned up any evidence of wrongdoing.)

The shooting shook Torres, but it didn’t cause her to rethink her advocacy work. Salt Lake City is fairly liberal, and elsewhere in Utah, Torres said, Mormon culture elicits a more polite form of anti-abortion activism than in other red states. That makes her feel safer. But it also means that many of her patients lack basic information about reproductive health and have deeply conservative beliefs about sex. “It’s very jarring when you’re sitting in front of somebody who’s about to have their abortion and they say to you, ‘I don’t believe in abortion, but I need this,’” she said. She’s had patients, their feet in the stirrups, tell her that what she does is evil. “What I usually respond with is, ‘I understand—and, you know, no one ever plans to be in this position. But we’re going to take really good care of you. Because that’s our job.’”

Torres has less patience for colleagues who mix their religious beliefs with their medical practice. One male ob-gyn that she’s worked with refuses to prescribe contraceptives to patients who aren’t married. (In the United States, it’s legal for doctors to refuse to provide services they judge to be in conflict with their moral beliefs. Accordingly, some Catholic health systems have gone so far as to try to prevent all of their networks’ doctors from prescribing birth control.) According to Torres, she’s helped three of this doctor’s patients end pregnancies they had hoped to prevent. “Those are the consequences,” she said, with some weariness, of holding the supposed moral high ground.

* * *

In June, in a major opinion concerning abortion regulations in Texas, the Supreme Court ruled that neither the state’s surgical-center mandate nor its admitting-privileges requirement “offers medical benefits sufficient to justify the burdens upon access that each imposes.” It’s likely this ruling will lead to the demise of similar regulations in Utah. How it will affect other types of restrictions, like mandatory waiting periods and the fetal-pain law, is less certain.

Like the two rules in question in the Texas case, the fetal-pain law is based on claims that are directly contradicted by scientific evidence: Current research indicates that fetal neural systems aren’t developed enough to feel pain until about 27 weeks, past the window in which abortion is generally legal. Because the law is so new and so vaguely written, it’s not yet clear what kind of burden it will put on patients. Torres never did get an answer from state officials on how they expected her to implement it. (The office of Utah’s Attorney General did not respond to our inquiry, either.) She told us in June that the state has shown little interest in enforcing it so far, and that she’s found a way to comply technically without changing her practice much. Still, the measure is dangerous in principle, she argued, particularly because it’s a criminal statute and raises the possibility that doctors could lose their medical licenses. “No cardiologist is going to stand for the legislature saying, ‘No, you have to do a stent this way, you have to do surgery this way. But it’s fine and acceptable for them to do this to people who are pregnant, despite objections from the ob-gyn community?”

Torres’s commitment to speaking publicly about her work illustrates a recent shift within the pro-choice movement. Arguments about privacy have been replaced by a focus on justice; calls for abortion to be “rare” have given way to a frank discussion of the fact that abortion is a necessary procedure for many people. Personal testimony from women whose education, careers, and families have benefited from their decision to get an abortion played a significant role in the plaintiff’s argument in the Texas case, as Katha Pollitt wrote recently. That storytelling undercut anti-choice activists’ claims that unnecessary, burdensome laws were “protecting women”; it turned out that women could speak for themselves, thank you.

While anti-abortion activists have deliberately adopted a gentler tack toward women, doctors are still painted as murderous profiteers. They bear the brunt of the movement’s vitriol, and its violence. Torres doesn’t expect to change minds on Twitter and with her advocacy work, but she hopes at least to make some people stop and think, and acknowledge that she’s a human being doing her job. “I’m not driving around in a white van, knocking on doors, telling people they need an abortion,” she said. “I’m not a monster who hates children and makes a lot of money and does abortions left and right because I think [it’s] the right choice. I do abortions because it’s part of health care.” And for the foreseeable future, she’ll continue to provide that care in Utah, despite all the barriers. “I have to stay here and make things right,” Torres said.

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