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Nine days in a Michigan abortion clinic, as election looms

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Paulette Parker
/
Michigan Radio
Dr. Audrey Lance, an OB-GYN at Northland Family Planning, knew she wanted to be an abortion provider since the day her school’s chapter of Medical Students for Choice went to a reproductive rights rally.

The night before her abortion, Melissa got off work and dropped her kids off with the grandparents. She then drove nearly four hours from her Ohio home, across the state border into Michigan, arriving at her hotel at 3 a.m.

By 8 a.m., she was at the front desk at Northland Family Planning in metro Detroit, eyes puffy from exhaustion, hair pulled off her face into a loose bun, her hands disappearing inside the sleeves of her black sweatshirt. For the past three months, Melissa had been desperately trying to get this appointment.

“I was so relieved, after the struggle,” Melissa said, sinking into a chair inside one of the clinic’s waiting areas. She put her chin down on her chest, pink splotches appearing on her cheeks. She didn’t expect to cry. “It shouldn’t be this hard.”

On Nov. 8, Michigan voters will decide whether to put the right to an abortion in the state constitution. The vote comes as women from as far away as Florida and Texas have been coming to the state in the wake of the U.S. Supreme Court’s decision to overturn Roe v. Wade, seeking the legal abortions they can no longer get where they live.

Clinics that perform abortions are almost always closed to press. But Michigan Radio got a rare degree of access to Northland Family Planning, a group of clinics in suburban Detroit. For nine days in August and September, we shadowed a doctor and clinic staff through every step of the process. More than two dozen patients shared their stories with us, and what they believe is at stake in this election.

This fall, Michigan Radio and stations across the NPR Network are sharing stories from their communities about abortion access and reproductive rights. Our aim is to give you better insight into the lived reality and implications of these issues for people across the nation. You help Michigan Radio continue to tell the region’s story — and contribute to the national conversation — when you make a donation to our station.

An abortion clinic designed to be welcoming 

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Paulette Parker
/
Michigan Radio
Renee Chelian in one of the Northland Family Planning clinics she helped build. Chelian had an abortion in 1966 at age 16, seven years before Roe v. Wade.

Renee Chelian had an illegal abortion at age 16, in a Detroit warehouse. It was 1966, seven years before Roe v. Wade.

"'You can never tell anyone, because no man will ever marry you if he knows that this has happened,’” Chelian recalled her father telling her afterward, in an account to Michigan Radio earlier this summer. “You're going to be OK. We're going to take care of you. After this conversation, we'll never discuss it again.'"

Talking to Chelian, now a grandmother, is like talking to a hummingbird: a petite powerhouse who never stops moving. She has spent most of her adult life pouring that energy into creating the kind of clinics she wishes existed when she was 16: spaces that are spotless but not soulless, where the halls and waiting rooms are sunny and soothing music plays in the procedure rooms. Large windows look out on pine trees that sway in the breeze. There are inspirational signs on the walls: “Good women get abortions,” one reads. “Wise, beautiful women have been where you are now,” reads another.

When patients leave, their prescriptions are handed to them in a brown paper lunch sack, their names and a small heart drawn on the front in pink marker.

Coming to Michigan for an abortion

Some 30,000 abortions were performed in Michigan last year, according to state data – nearly all of them in the first trimester, and almost always in freestanding clinics like Northland Family Planning.

But when Roe was reversed in June, Michigan clinics became a haven for patients from states that have restricted abortion, like Wisconsin, Indiana, Ohio, Florida, and Texas. One of Northland’s clinics can see roughly 24 patients for appointments each day, and since June, staff say it’s rare a day goes by when at least some patients haven’t traveled to Michigan.

When Melissa, the patient from Ohio, found out she was pregnant this summer, the single mom of two kids panicked. The timing was terrible: She was in school, working, and going through a divorce. “I slept with somebody one time, and then I got pregnant,” she said.

Keeping the pregnancy felt impossible. “I would be struggling for a very long time,” Melissa said. “I would have to drop out of school. And I would have to find a different job, because I would need more daycare.”

So she called what appeared to be a regular women’s health center nearby. Staff there told her they did not perform abortions at their facility, but promised they could refer her to a clinic that did. When Melissa arrived for her appointment, a nurse performed an ultrasound, putting Melissa’s pregnancy at about two weeks along. Then, Melissa said, the nurse told her that if she went ahead with an abortion, “‘People are going to look down on you.’”

Melissa had unwittingly come to a “crisis pregnancy center.” These facilities are typically not licensed medical clinics, and exist to persuade women not to get abortions, often providing them with inaccurate information about their options.

Signs hanging in the Northland Family Planning clinic that say "I don't regret my abortion" and "Every day good women have abortions"
Paulette Parker
/
Michigan Radio
Renee Chelian has spent most of her adult life pouring energy into creating the kind of clinics she wishes existed when she was 16: spaces that are spotless but not soulless, where the halls and waiting rooms are sunny and soothing music plays in the procedure rooms.

“They were posing to be so pro-choice, and they're not,” Melissa said. “[The nurse] wanted to pray for me. She gave me a Bible…. I've never had somebody like a medical person try to shove religion down my throat for so long.”

The center told her she needed to come back for another appointment after the six-week mark. But what Melissa didn’t know is that Ohio’s laws changed after the fall of Roe. The state banned abortions after six weeks. (A judge has since put an indefinite hold on Ohio’s abortion ban while the case moves through courts, but the Ohio Attorney General is appealing to reinstate the ban.)

Once Melissa figured that out, she couldn’t get an appointment anywhere close to where she lives.

By the time she got to Northland, it was two months later. She was 14 weeks pregnant.

“I had to sit with [this pregnancy] for weeks,” she said, in tears .“It's extremely hard. And it shouldn't be. …But I’ve coped with it. So once today happens, I’m going to feel so much better.”

“I feel like I will fail if I’m forced to bring on another child”

Every patient who comes to Northland goes through an extensive intake process. There’s paperwork, an ultrasound to confirm and date their pregnancy, and bloodwork.

Patients pay for the abortion up front. 96% of all Michigan abortion patients pay out of pocket. At Northland, the cost ranges from $700 to several thousand dollars. For patients who can’t afford the full sum, assistance from groups like the National Abortion Fund can bring the price down to $350. But even that is prohibitively expensive for many.

Jessica, a single mom of a toddler son, made “sacrifices,” she said, sitting in a small counseling room next to the waiting area at Northland. Jessica and her son don’t have stable housing right now, she said. She found out she was pregnant just a few weeks before her son’s second birthday. She knew the abortion would cost hundreds of dollars, and she really wanted to be able to throw her son a party. So she worked overtime and drove for DoorDash whenever she could squeeze it in.

“I had to bust my butt,” Jessica said. “It’s not easy coming up with that amount of money in a short amount of time.”

But, she thought, this paled in comparison to how hard it would be to financially support another kid.

“The world is not set up for you to be forced to do something that you know you're not comfortable with, or that you know you will fail in,” she said. “I'm a strong woman, but I feel like I will fail if I'm forced to bring on another child. And I'm not stable at all, except with my one.”

Most of the people who get abortions in Michigan are already parents. Their desire to be “good moms” comes up in nearly every conversation about why they’re getting an abortion. One woman we’re calling M, a married suburban mom with perfect posture and effortless poise, said she “wouldn’t trade my kids for anything. I love them to death.”

M has three kids, and the youngest is about to go to school. After ten years of staying at home, M felt like she was on the cusp of something new. “I want to go back to work and just kind of have something for myself other than just be a mother all day, every day,” she said, tucking a silky strand of hair behind her ear.

“I just feel like that phase of my life is over. And it was an amazing phase. But I don’t want to keep going back,” she said. “I want to go forward.”

It’s not as simple as a “wanted” or “unwanted” pregnancy

Every patient who comes to Northland is asked to answer an extensive series of questions. How sure are you of this decision today? Do you have support from family and friends? Who was the primary decision maker, you or someone else in your life? How do you feel you’ll handle your emotions after your abortion?

And: Do you believe abortion should be against the law?

“It's very interesting that some people do check that box, and yet they are sitting here in front of us trying to have an abortion,” said Dr. Audrey Lance, one of the OB-GYNs on staff at Northland. “...But there are actually people that say, ‘I think it should be against the law, but here I am,’ which is really, really difficult. And honestly, we don't necessarily take care of those patients. I think it's always hard to turn people away. But if somebody feels that this is so wrong that it should be against the law, it doesn't seem like it's the best decision for them.”

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Paulette Parker
/
Michigan Radio
Dr. Audrey Lance prepares her tools.

Lance knew she wanted to be an abortion provider since the day her school’s chapter of Medical Students for Choice went to a reproductive rights rally. Seeing their signs, women of all ages approached the medical students throughout the day, telling them about the abortions they’d had and the doctors who’d helped them at crucial moments in their lives. That night, Lance went home and called her mom: This is what I want to do, she told her.

Now Lance is a mom herself, with two little girls she tells her patients about: what they want to be for Halloween, how the oldest is playing soccer now. For a while, Lance dyed the tips of her dark bobbed hair purple, which helped nervous patients relax when she walked in the room and they realized: Their abortion doctor is a woman, and she has purple hair.

Getting patients to let their guard down with her is critical. Sitting on an exam table in a medical gown, one of Lance’s patients started crying just before the abortion began. Lance gently asked the patient to talk about what had brought her here. "I feel like my boyfriend is forcing me into this,” Lance recalled the patient telling her. So Lance sent her home.

When she first started performing abortions, Lance thought there were only two kinds of pregnancies: wanted, or unwanted. Over the years, however, she’s learned it is rarely that simple.

“It’s not even helpful to really talk to patients about it in that way, because that is not the way that they are thinking about it,” Lance said. “Their lives are much more complicated than that.”

The patient Lance sent home a couple weeks ago was now back in the clinic. She told Lance, she’s sad about it, but wants to end the pregnancy because she doesn’t feel like she can be a single mother again. To Lance, that doesn’t make this patient’s pregnancy “unwanted.”

“I think that honestly, she would not describe it that way,” Lance said. “I think many patients would actually be offended to describe it that way. [They’d say] that this would be a very much wanted pregnancy if my life situation was different, my circumstances were different, my finances, my relationship, my health….”

Lance paused.

“It's just not that simple.”

“I don’t think I could survive if I knew I had to have these babies”

One patient who knows it’s not that simple is a woman we’re calling A — a slender, energetic young woman with big, watchful eyes that crease when she laughs.

She has two toddler girls, and said their father has been violent. It scares her how quickly he can turn on the charm one moment, but she said he crossed a line when he hurt their 3-year-old daughter. She was trying to get a personal protection order against him when she found out she was pregnant. With twins.

“I don't think I could survive if I knew that I had to have these babies with an abusive person,” A said, her voice cracking as she began to cry. “That’s insanity to me. I feel like a prisoner.”

A knew she wanted an abortion. But when she came in for an ultrasound and found out she was carrying twins, she hesitated. She was talking about it with her daughter’s preschool teacher, who knew A had been planning to have an abortion. “But, there’s two of them,” A told the teacher, her voice pleading, trailing off.

But ultimately, A said, she knew she did not want to have more children with this man.

“I had to wake up and realize he's crazy. He's crazy,” she said.

A’s health is also a concern. Her previous pregnancies were high-risk, and one ended in stillbirth. She’s asked for a tubal sterilization in the past, she said, but doctors denied her.

A said she knew her body couldn’t handle carrying twins. Still, she couldn’t resist telling her daughter about them.

“My daughter was so cute. She said, ‘OK, well, maybe another time, maybe later,’” A said, laughing at the memory. “I was like, ‘Yes, maybe later.’ Because she doesn't know that at the end of the day I can't physically, financially or mentally handle two more kids.”

She took some deep breaths. Soon, she was cracking jokes again. “That’s more sharing than I’ve done in like, 10 years. I’m like the Grinch: my heart’s getting bigger.”

“I gotta go,” she said. “Love ya. Bye.”

Inside the procedure room

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Paulette Parker
/
Michigan Radio
Inside the waiting room.

At Northland’s clinics, patients who opt for the abortion pill are taken care of in the mornings. Pills are the method selected by more than half of all abortion patients in the state.

Appointments for these medication abortions took maybe five minutes. Dr. Lance would run through the process and describe the rare, but possible risks. She would explain that, statistically, an abortion is safer than childbirth, and tell patients what to expect when they go home: cramping, and heavy bleeding as the uterine lining sheds, similar to an early miscarriage.

“Feeling sure of your decision today?” she would ask each patient, one more time.

Lance would then hand a patient the first pill, mifepristone, which they would take in the clinic. Before they leave, a staff member would give them that brown paper bag with their name on it. Inside was pain medication, an antibiotic, and a prescription for birth control if they requested it. A few hours later at home, they were instructed to insert the next pills vaginally. Within 24-48 hours, a patient’s body should pass the pregnancy.

FixedinfographicMichiganabortions

Once the patients opting for medication abortions went home, the afternoons were devoted primarily to the surgical appointments. Most patients who get surgical abortions in Michigan are in the first trimester, just like the pill patients. But unlike the pill, patients don’t have to wait hours or days to complete the abortion. Typically, surgery appointments are over in about 10 minutes.

In the procedure room the lights were dim. There was soothing music. And patients had someone next to them, to hold their hand and tell them: you can do this.

For several of the procedures we witnessed, that someone was a Northland staff member named Brandee. “Squeeze my hand, and just keep breathing,” she murmured to one patient, who asked her name not be used.

“OK, so I’m just going to get you set up on the table and we’re going to do that sedation medicine,” Lance told the patient.

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Paulette Parker
/
Michigan Radio
Inside a patient room at Northland Family Planning

It’s typical for patients to be awake during first trimester abortions, especially when the patient doesn’t have underlying medical issues. It not only reduces the risk of complications and the costs to the patient (general anesthesia for an abortion in a hospital setting can cost thousands of dollars); it also means patients can go home the same day.

Northland Family Planning gives every patient numbing medication applied to the cervix, and strong pain and anxiety medications (fentanyl and midazolam) administered intravenously. Some patients also get a cervix softener a few hours before the procedure to make dilation easier, depending on how far along their pregnancy is.

You may feel some strong cramping and intense pressure, Lance would tell patients, “but I know you can do it.”

Once a patient was fully relaxed, Lance would use a speculum to view inside the patient’s vagina, then clean the vagina and cervix with gauze and antiseptic. She then would dilate the cervix, while Brandee monitored the patient’s vitals.

You’re going to blow out your breath like you’re blowing out a candle, Brandee told one patient. “Blow it out, blow it out. You got it,” Brandee instructed, firm and strong, like a parent. The patient gripped Brandee’s hand, her eyes squinting in discomfort. “No, we’re not going to yell. We’re going to breathe,” Brandee reminded her.

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Paulette Parker
/
Michigan Radio
The recovery area inside Northland Family Planning.

“We’re almost done,” Lance told the patient. “Try to catch your breath a little bit.” Then, a roar of noise as the vacuum aspirator turned on. The machine uses gentle suction to remove the pregnancy tissue from the patient’s uterus through a thin tube.

“You can do it,” Brandee told the patient. “You doing it. You got this. Keep breathing. You almost done. Just keep breathing.”

And then, after just a couple minutes, it was over.

“You did it!” Brandee cheered.

The patient’s relief was palpable. “Thank you guys so much,” the patient murmured. “I hope I didn’t do too bad.” Brandee leaned close to her, their faces only inches apart. “Don’t you ever tell yourself what you can’t do again,” she said, smiling.

Abortion rights on the line in Michigan

At Northland, what you hear a lot from patients is: I’m doing this because I have this picture for my life, and the things I want. One woman, who asked that we not use her name, said she knows she wants to be a mom eventually. But first, she wants to finish school and travel.

Sitting in the waiting area, this patient, who asked to be unnamed, talked about how hard it was to come here. How she hid it from her mom at first, before her aunties threatened to tell her mom if she didn’t. How her mom was surprisingly supportive, getting up early with her in the morning, making sure she’d had a good breakfast before her appointment. She shifted side to side in her chair, in spotless sweats, a low ponytail tucked beneath a crisp baseball hat.

Sure, she said, she knows a lot of women get abortions. But that doesn’t make this feel any easier.

“We almost feel like we feel filthy, we feel dirty,” she said, shaking her head. “We feel like we have to sneak in, do this. Some of us put our lives at risk doing it.”

She said she did not want to be trapped with the guy who got her pregnant. She didn’t want to be a mother to a child who would grow up without a dad.

“They, the guys, they're never held responsible for things like this, ever. It's always the woman. We always got to step up and take care of it. Whether we keep it or not, it's always put in our lap.”

This patient said, she asked the guy who got her pregnant if he could pay for the abortion.

He said the most he could do was split it with her.

Nearly every patient we talked to at Northland knew about Proposal 3, the constitutional amendment to protect abortion rights in Michigan.

Some of them were hopeful it would pass. Others were scared it wouldn't. Lots of them were in disbelief that abortion care is something they have to fight for.

And some, like the patient in the baseball cap, were angry.

“Stop thinking it can't touch you,” she said. It could touch you in so many ways. It could be your mother. It could be your sister. It could be your niece. It could be your daughter. Your future, your future daughter. Your future wife. Stop thinking it's not going to touch you, man or woman.”

Kate Wells is a Peabody Award-winning journalist currently covering public health and the COVID-19 pandemic.
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