Last summer, the staff at Germantown Reproductive Health Service in Maryland, one of three remaining clinics in the U.S. where women were able to get third-trimester abortions, got surprising news.
Todd Stave, the owner of the clinic — who inherited it along with another facility from his OB-GYN father — had sold it. Although Stave had previously reassured clinic staff he would give them plenty of notice before a sale, staffers were told they would have to stop seeing patients the following week.
Perhaps most shocking, the buyer was Maryland Coalition for Life, an anti-abortion group that had spent years targeting the clinic’s primary physician, Dr. LeRoy Carhart.
Carhart is one of the country’s most public and polarizing abortion providers and had rented the clinic from the Stave family for seven years, offering pregnancy termination through roughly 28 weeks’ gestation and sometimes beyond. For nearly all of that time, Maryland Coalition for Life had organized protests outside the clinic, and in 2011 opened a so-called crisis pregnancy center across the street. Now the group had come up with a reported $1.2 million to buy the Staves’ two clinics and had succeeded in shutting Carhart down.
As word of the closure spread among anti-abortion activists, rapturous stories crediting the power of prayer began to appear on anti-abortion news sites. In a blog post, the Maryland activist group proclaimed that its actions represented a key step on the path toward eliminating abortion in Maryland, and trumpeted the clinic’s “permanent” closure.
For his part, Carhart was “heartbroken” for patients he feared were unable to find care elsewhere while the clinic was closed, he wrote in an email to RR-Magazine.
“My whole team was disheartened at the lengths these extremists will go to in order to limit women’s ability to make their own decisions about their health and future,” Carhart said.
“It was a really dark time for a lot of our staff and for, I’m sure, many of our patients ― and Dr. Carhart especially,” echoed Chelsea Souder, director of clinical services and communications director for Carhart’s Nebraska and Maryland clinics.
But Carhart and his team publicly vowed to continue offering second- and third-trimester abortions — and less than two months later, they made good on that promise, opening a new clinic in Bethesda, Maryland, in late October of last year.
And after the initial shock of the closure wore off, Souder said, they found themselves in a better position than before to provide what they see as an essential, endangered medical service.
Their new location affords patients and staff greater privacy, separating them from anti-abortion protesters who wave graphic posters purporting to show dismembered fetuses and who engage in what they refer to as “sidewalk counseling.” (Others call it harassment.) As of this fall, the clinic has served more than 500 patients.
“A year later,” Souder said, “it’s a complete 180 turnaround.”
The majority of states have laws restricting when a woman can terminate a pregnancy. Seventeen now limit any abortion after around 20 weeks’ gestation, or about halfway through a pregnancy, based on debunked, unscientific claims about when fetuses are capable of feeling pain.
Nationally, only 9 percent of women who terminate a pregnancy do so after the first trimester and 1 percent do so at or after 21 weeks. Women who get later abortions are often facing harrowing circumstances, such as severe fetal abnormalities or a pregnancy that puts their own life at risk. Studies have shown that factors like rape, disruptive life events like losing a job, and living below the poverty line are all linked to later abortion. Poorer women might struggle to come up with the money for a procedure and transportation, for example, while “life chaos” prevents women from getting care earlier.
Despite the fact that they are relatively rare, these “late-term abortions,” as they are commonly called, remain a lightning rod in the abortion debate. The majority of Americans support the broad principle of abortion access codified into law by Roe v. Wade, but public support for later abortions is far less robust. According to recent Gallup figures, 65 percent believe abortion should be illegal in roughly the second trimester and 81 percent believe it should be illegal in the third. States have increasingly chipped away at access to later abortion, while last year the House passed a proposed federal ban on abortions after 20 weeks that threatened to jail providers who offered such care.
I don’t have plans to retire, but someday I won’t be practicing anymore, and I don’t want these services to disappear. Dr. LeRoy Carhart
Carhart emerged as a national figure in the debate over later abortions in the wake of the 2009 murder of his friend and mentor, Dr. George Tiller. Tiller, who was killed by an anti-abortion extremist while he waited to attend Sunday church services, trained Carhart in how to perform third-trimester abortions.
Before Tiller’s murder, Carhart traveled to his mentor’s Kansas clinic monthly to perform these surgeries. But after, he was determined to begin offering them at his own Nebraska clinic and spoke out about the importance of doing so. He told Newsweek in 2009 that he knew the danger he faced providing this type of care, but saw it as a matter of life and death. “Abortion is not a four-letter word,” he said. “I’m proud of what I do.”
A year later, Nebraska became the first state in the country to pass a 20-week abortion ban, preventing Carhart from offering later abortions. He began traveling to Maryland to offer them at the Germantown clinic.
Maryland law limits abortion after viability — typically around 24 weeks, though that, again, is a murky concept — but allows later abortions to protect the life and health of the woman. For seven years, he flew back and forth between Nebraska and Maryland almost weekly, providing second- and third-trimester abortions to women at Germantown Reproductive Health Services until it shuttered last fall.
In the year since, Carhart has seen more than 500 patients for abortion care at the new Bethesda clinic, Souder told RR-Magazine, roughly 75 percent of whom come for abortions in the second trimester or beyond. More than 90 percent of the clinic’s patients travel at least an hour to get to the clinic, she said. It also often sees patients from out of the country, including Canada, Europe, Mexico, South America and Central America, as they live in areas with laws that prevent later abortions or where there are no providers who offer them — or both.
“Our laws in Maryland allow for abortion care to be provided in later stages of pregnancy for fetal anomalies and life-of-the-patient reasons,” said Diana Philip, executive director of NARAL Pro-Choice Maryland, an affiliate of the national activist group. “So we are one of the safe havens for people seeking some of the most complicated care they might have to face in situations that are very unexpected.”
Although Carhart turns 77 this month, Souder laughed at the notion that he might consider retiring any time soon. And yet over the years, Carhart has publicly expressed the pressure he feels to train new providers.
“A lot of abortion care providers are older — especially those who provide care as pregnancy progresses,” Carhart told RR-Magazine. “I don’t have plans to retire, but someday I won’t be practicing anymore, and I don’t want these services to disappear.”
The American College of Obstetricians and Gynecologists has called for OB-GYN residency programs to offer opt-out training in abortion care — in other words, to offer it as a matter of course unless a student objects based on religious or moral grounds — but says the reality is that programs vary widely in terms of the scope and type of training they offer.
These procedures generally carry more risk than those done earlier in pregnancy because they’re a more involved, multiday procedure, and can also come with a different level of emotional intensity on the part of patients who may be ending pregnancies that were very much wanted.
They also make providers a target. The National Abortion Federation, which tracks hostility toward physicians and clinics, has reported an uptick in trespassing on clinic property, obstruction of patients, and threats of violence toward providers. Stave, for example, has said a major motivating factor behind his decision to sell his family’s abortion clinics, including the Germantown location, was as a result of the threatening middle-of-the-night calls he received and protesters going so far as to show up at his child’s school with posters of fetuses.
“Working with the next generation of providers is something I’ve always done, but now that I own my own practice, I’m able to invest in hiring and training physicians and nurses to provide this care,” Carhart said.
“It’s also important to me to work with medical residents and other health care providers — even if they never provide abortion care themselves,” he continued. “I want them to understand why patients seek abortion care, so that they can give their patients the compassion and respect they deserve. That’s something my former colleague, Dr. Tiller, felt strongly about, and it’s work I try to carry forward.”
The Bethesda clinic has hired three relatively young physicians, all of whom are in different stages of learning to perform later abortions and who, unlike Carhart, opt to remain anonymous for privacy and safety reasons. Only one is based in Maryland; the other two travel in every few weeks from the East and West Coasts. For now, Carhart still oversees every single procedure, working 12 out of every 14 days, Souder said.
“I didn’t have any exposure to third trimester abortions until I came to work at Dr. Carhart’s clinic,” one of the new providers, who wished to remain anonymous, wrote in an email to RR-Magazine. “I had been seeking more training and after spending just three weeks at the Bethesda clinic, I was able to see how huge the need is.”
Unlike the Germantown clinic, which was free-standing and therefore a relatively easy target for protesters, the Bethesda clinic is housed in a building with more than 30 medical offices. Protesters are not necessarily aware of which patients are there for abortion services, which Souder says makes for an altogether different atmosphere.
The landlord built a fence to help push protesters toward the edge of the property, also installing security cameras and hiring a towing company for anyone who parks outside. Souder said the community has been open to the clinic, donating financially and calling to express surprise at even the small number of protesters they see when they drive by.
In Germantown, it was typical to see a crowd of as many as 50 protesters lining the sidewalk; now there are not usually more than five, Souder said.
In a blog post from a year ago, Maryland Coalition for Life said it had known it was possible that Carhart would reopen after they shut his clinic down, and held a rally on the new clinic’s first day. But it hasn’t shown much resistance since.
The mood among the four physicians and 15 or so staff members at the Bethesda clinic these days is one of optimism, Souder said, tempered by concern over what could happen to abortion rights nationwide under the current administration.
“Of course there are things happening outside of our control,” she said. “But in the meantime, we’re going to continue to provide care to our patients to the best of our ability.”