Originally published by the 19th
Herman Miller never asks his patients why they come to his office, but sometimes they tell him anyway.
There are people who desperately wanted a child and then found out at 16 weeks pregnant that they would give birth to a baby with major health problems – at least one, he recalls, who would have been born without functioning lungs. There are those who had a plan, a partner who would raise a child with them, before they were left on their own. There are patients who drove six hours to get here, who couldn’t get here sooner because rent was due or a kid fell sick. Some just needed a few extra weeks to pull together a few hundred dollars.
And there are the children – 13- or 14-year-olds who didn’t know how to tell their parents. There are even younger kids who didn’t realize they were pregnant because they had never had regular periods before. The youngest patient Miller treated was 11.
Miller, a 75-year-old OB/GYN, sees patients two to three days a week here at A Woman’s Choice, the abortion clinic where he’s worked since 2001. He’s the only doctor at this clinic who provides abortions all the way up to 20 weeks of pregnancy, a medical service that is currently legal in most of the country but that, due to stigma and the threats of violence against physicians, fewer and fewer doctors provide.
Anti-abortion protesters have picketed his house. After Miller’s wife died, a deliveryman once asked him if it was punishment for the work Miller does.
But as a physician, he says, this is his duty.
“People want to judge me because I do abortions, and they’re talking about morality. But as far as I’m concerned, morality cannot be legislated,” he said. “I look at every patient as someone who has a problem or a concern or a reason that, if I can help, that’s what I’m going to do.”
On 1 July, Florida will begin enforcing a law banning abortions for people past 15 weeks of pregnancy. The ban, which has no exceptions for rape or incest, has been framed by its backers as a “moderate” compromise. The vast majority of abortions take place within the first trimester, which ends at 12 weeks, they note. The law is less stringent than the six-week bans and total prohibitions being passed across the country in anticipation of the supreme court overturning Roe v Wade, which guaranteed the right to an abortion, later this summer.
Still, the 15-week ban, which has no medical rationale as a particular endpoint for access, represents a tremendous shift in Florida. The ripple effects could extend far outside of the state’s borders.
Currently, abortions are legal up until 24 weeks in the state, which has more than 60 clinics. If, as expected, Roe is overturned, Florida will become a critical access point. The state, particularly its northeastern region with its cluster of clinics, will offer the most viable option for finding a safe, legal abortion for places such as South Carolina, Georgia, Mississippi, Alabama and Louisiana – all of which are poised to ban abortions, either entirely or for patients beyond six weeks of pregnancy.
Here in Jacksonville, only an hour from the Georgia border, patients already cross over frequently from other states to get care. Staff at A Woman’s Choice are anticipating the number of out-of-state patients coming here to surge in the coming months. And they expect that, as people travel farther for care, more will show up later into pregnancy – making a 15-week deadline that much harder to meet.
With the end of Roe in sight, anti-abortion activists are energized, pressing Governor Ron DeSantis to go further in restricting abortion. So far, the governor – a rising star in the Republican party who is widely believed to be eyeing a 2024 presidential run – has been noncommittal. Incoming leaders in the state legislature have indicated openness to passing a total ban on the procedure when they reconvene next spring.
Miller believes it’s only a matter of time before abortion is inaccessible in Florida.
“I’m scared of the 15-week ban. But it’s not my greatest fear,” he said. “My biggest fear is the fact that, if they overturn Roe v Wade, the first thing DeSantis would do is try to ban abortion here.”
Supporters of the 15-week ban have argued that only a small number of people will be affected. The state’s health department data shows that in 2021, when it recorded 79,817 abortions, slightly over 6 percent of that total – 4,850 people – were for people in their second trimester of pregnancy. The state doesn’t specifically collect data on abortions performed for people at 15 weeks and later.
But the number of abortions performed in the second trimester appears to be growing, at least at A Woman’s Choice. Terry Salas Merritt, a consultant who has worked with the clinic for six years, estimated that last year 10% of the patients they saw sought abortions in the second trimester. Since January, the percentage of people seeking abortions after 12 weeks has doubled.
Now, close to one in five of the clinic’s patients are getting abortions in the second trimester. A significant chunk of those are past 15 weeks, per Kelly Flynn, CEO of A Woman’s Choice. Neither Flynn nor Merritt can fully explain why there has been an uptick, but both suspect that people are having more trouble pulling together the money for an abortion, which can cost hundreds of dollars at a minimum.
“For everything in the universe, costs are higher: for gas, for childcare, for anything and everything. And rents are going up,” Merritt said. “Any disposable income that you had for emergencies – that got depleted. So it takes more time.”
Patients have been coming here from Georgia, Louisiana and South Carolina. When, last September, Texas began enforcing its six-week abortion ban, a handful of patients made the trek to Florida.
If Roe is overturned, those numbers will surge. Alabama has an abortion ban on its books that predates 1973. Mississippi, Arkansas, Texas, Oklahoma and Louisiana have passed trigger laws that will ban abortion almost entirely. Georgia has a six-week ban on its books that would likely soon be enforced. For patients in each of those states, Florida – with its extensive clinic options – will represent one of the safest and closest options. The next best are North Carolina, seven hours to Jacksonville’s north, or, for some Texans and most Oklahomans, clinics in Kansas.
But patients who need to travel will probably be later in pregnancy by the time they can get an abortion appointment, noted Elizabeth Nash, who tracks state policy for the Guttmacher Institute.
”If you think that a 15-week ban is some kind of compromise, that’s a mistaken idea,” Nash said. “Because what abortion restrictions have done, and the stigma on abortion has done, is create delays, which just push people later into pregnancy before they can access care.”
Flynn is working to hire more staff so that the clinic is not overwhelmed when Roe is overturned. A Woman’s Choice is trying to build out capacity in other ways, too, creating networks of volunteers who can house people who will travel from out of state for an abortion, and setting up carpools and ride-shares so they don’t need to raise as much money for gas.
Local abortion funds are taking similar steps. Julia DeSangles, the co-executive director for Florida Access Network, said her fund is preparing to send Floridians past 15 weeks to North Carolina, to Washington DC, and even to Colorado. And they’re raising money so that they can support the anticipated surge in patients relying on Florida for care.
But Florida Access Network has already struggled to meet patients’ needs. Last year, the total amount of money people sought from them approached half a million dollars, DeSangles said. They were able to provide only a fraction of that – close to $40,000.
In Florida, the nation will see one of the most potent tests of whether Republicans can, in fact, find a middle ground between restrictions and total bans.
Historically, stringent abortion restrictions haven’t been a sure political winner in Florida. As recently as a year ago, an effort to ban abortions at 20 weeks of pregnancy couldn’t even make it out of a committee hearing. Abortion is currently protected in the state: In 1989, the state’s supreme court ruled that Florida’s constitution guaranteed the right to an abortion, an extension of its right to privacy.
Even now, restrictions don’t appear popular. A poll conducted in May from Florida Atlantic University found that about 66.7% of Floridians believed abortion should be legal in all or most cases. Just under half of that – 31.8% of all respondents – said they wanted abortion legal in all cases. Polling from the University of North Florida released in February found that 57% of registered voters did not support the state’s new 15-week ban, which passed the legislature in March and was signed into law in mid-April.
But DeSantis’ political aspirations are likely to push him in favor of backing more restrictions, noted Michael Binder, a political science professor and pollster at the University of North Florida who has tracked public opinion regarding the state’s 15-week ban. While abortion bans aren’t popular across the state, they are uniformly backed by Florida Republicans.
If DeSantis hopes to be president, he will face pressure from Republican primary voters across the country to show he has fought against abortion access, Binder said. While both liberal and conservative Democrats oppose abortion restrictions, about 60% of Republican-leaning voters believe abortion should be illegal in most or all cases, per data compiled by the Pew Research Center. Conservative Republicans are more likely to back bans: 72% believe abortion should be illegal in most or all cases.
When asked about any plans for future abortion bans, DeSantis spokeswoman Christina Pushaw directed the 19th to previous remarks about the 15-week ban specifically and stated that the governor “has always been pro-life”.
DeSantis is up for reelection this fall. But after November, the next election on his horizon likely won’t be statewide – it will be the Republican presidential primary.
With that in mind, Binder said, he fully expects the governor and legislature to seriously consider a law banning abortions at six weeks of pregnancy, if not altogether.
Planned Parenthood has sued to stop the 15-week ban from going into effect, arguing that it violates the state supreme court’s ruling protecting abortion rights. The lawsuit was filed in a state circuit court, but is expected to be appealed to Florida’s state supreme court – which has shifted to the right in recent years. Three of its seven members were appointed by DeSantis; a fourth was appointed by former governor Rick Scott, now a Republican senator.
Florida’s political observers and abortion rights experts suspect that, when the time comes, the state supreme court will use a 15-week ban case to overturn Florida’s abortion rights guarantee.
That future is hard to visualize from inside A Woman’s Choice. Miller is one of three physicians who works here and the only one who goes up to 20 weeks. One other sees patients up to 16 weeks, and the third goes to 12. On clinic days, Miller sees anywhere between a dozen and 16 patients.
He worries most, he said, about the people who look like him – Black people, who in America have persistently higher rates of pregnancy-related death than white people.
“What are you going to do about them? If you don’t see them until after 15 weeks? What are you going to do for them?” he asked. “Nothing.”