Where The Real Action Is...

By KAREN TUMULTY

Not since the doomed Robert Bork has there been a Supreme Court nominee with such a clear record of opposition to abortion. And yet, as Samuel Alito moves closer to Senate confirmation this week, the rumble that many expected over his position on the issue has failed to materialize. That in itself tells us something about the nature of the abortion wars today.

Listening just to the alarms of abortion-rights groups on the one hand and the cheers of opponents on the other, you could come away with the impression that the fate of Alito's nomination will determine whether abortion remains available in this country. That is not what is at stake. Alito's confirmation would not produce the votes sufficient to overturn the Supreme Court's landmark Roe v. Wade decision guaranteeing abortion rights throughout the country. And even if Roe is reversed in the future, states will be free to preserve abortion rights, and many almost surely will. Today the tussle is over not whether abortion will exist but how. In that respect, the terms of the debate have caught up with the public's attitude toward the issue: polls consistently show that most people in the U.S. want abortion to be legal; they just don't want it to be easy.

That sentiment has been expressed in a variety of measures passed by legislatures since a 1989 Supreme Court ruling gave states more leeway to restrict abortion. It's a reality the Supreme Court reaffirmed just last week. In a narrowly written but unanimous decision authored by Sandra Day O'Connor, the high court backed away from directly interfering with a New Hampshire law. The Justices said a lower court should not have struck down a parental-notification requirement entirely, and ordered the judges to come up with a more limited version that would protect the health of girls seeking abortions in emergency situations.

On the eve of the 33rd anniversary of Roe v. Wade, TIME took a look at the situation in the state of Missouri, where the 1989 case originated, to explore how the shifting battlefield affects the making of abortion law and to examine the impact of state restrictions on women who find themselves unhappily pregnant.

Consider, for example, the case of a 22-year-old unmarried woman we will call Lisa, who missed her period last November. Lisa, who was managing a restaurant, decided to have an abortion. Her timing could have been better. Just the month before, Springfield's only abortion provider, which had been operating five days a week just 15 minutes from her home, closed its doors. "The environment here in Missouri is so hostile," its administrator told the local paper. With four abortion doctors left in the state, compared with 10 as recently as 1996, Lisa's closest alternative turned out to be the Planned Parenthood clinic in St. Louis, an eight-hour round trip by car. That meant Lisa, who has no car, not only had to ask a friend to drive her but also had to come up with an excuse for missing two days of work, because she was afraid to tell her boss the truth. Two weeks later, she had to make the trip again, for a follow-up exam that lasted about five minutes. She figures the whole episode--the clinic's bill, the prescription for the abortion drug mifepristone, gasoline, food and incidentals--cost her a little more than $600. "It was all very frustrating," Lisa told TIME a month after her abortion. "I only recently paid back everyone I borrowed money from."

Increasingly, the question of how difficult it is to get an abortion--and sometimes whether you can get one at all--depends on where you live and how much money you have. Last year state legislatures across the country passed 52 new laws restricting abortion, more than twice as many as in 2004.

Few states were more active than Missouri, where Republicans last year took control of the Governor's mansion and both houses of the legislature for the first time in 84 years and thus strengthened the antiabortion majority in the statehouse in Jefferson City. Governor Matt Blunt even summoned the legislature into special session in September to pass bills that allow civil suits to be brought against anyone who helps a Missouri teen obtain an abortion without a parent's consent and that require doctors who perform abortions to have privileges at a hospital within 30 miles of the clinic. Generally, only local doctors can get those, and abortion providers often do not live close to where they work. That was largely why the Springfield clinic closed. The Missouri legislature is back in session this month, and abortion-rights foes have another list of bills they hope to pass, including one that would protect pharmacists who refuse to fill prescriptions for morning-after pills from lawsuits and employer sanctions, give tax credits to centers that discourage pregnant women from having abortions, and require that pain relief be given to fetuses that are aborted after 20 weeks of pregnancy.

One reason that abortion-rights opponents in Missouri and elsewhere succeed in winning restrictions is that regulations on the procedure generally enjoy broad popular support, even among people who say they want to keep abortion legal. Pollsters say that Americans' views on abortion have shifted relatively little since Roe v. Wade, that they have always been complicated and that sometimes they are even contradictory. In a survey by the Pew Research Center last July, for instance, 65% of those polled said they oppose the idea of overturning Roe v. Wade, but nearly an identical percentage said they would like to see more legal restrictions. Among the most popular: mandatory waiting periods, parental- and spousal-notification requirements and a ban on all late-term abortions.

Americans tend to have little sympathy or support for the reasons most women seek an abortion. In a 2004 study, the Guttmacher Institute--an abortion-rights advocacy group whose data are considered the best on the issue and are cited by both sides in the debate--found that the two most common reasons given by women are that "having a baby would dramatically change my life" and "I can't afford a baby now." Both were mentioned by more than 70% of the 1,160 women surveyed. And yet numerous polls have found that most Americans say they think abortion should be illegal in those circumstances--a position that cannot be reconciled with their expressed support for Roe v. Wade. In a Pew poll last October, a majority of Americans said they supported legal abortion only in the case of rape, when the mother's life or health is endangered or when there is a strong chance of serious birth defect.

No one so far has seriously tried to legislate the reasons a woman can have an abortion, but restrictions have taken many other forms. Do these laws actually bring about a reduction in the number of abortions, a goal that abortion-rights advocates also support? Even before many of the restrictions went into effect, the abortion rate and the overall number of abortions in the U.S. were on the decline. In 2000, the latest year for which Guttmacher has compiled statistics, the abortion rate was 21.3 abortions per 1,000 women ages 15 to 44, which was the lowest since 1974 and down from a peak of 29.3 abortions per 1,000 women in 1980 and 1981. In 2000 a total of 1.31 million pregnancies ended in abortion, down from a high of 1.61 million in 1990. In Missouri the reductions in both figures in recent years have been even sharper.

The reason for the declines is a matter of dispute. Economic growth, better contraception and safe-sex practices probably all contribute to the trend. But a 2004 study by researcher Michael J. New for the conservative Heritage Foundation found that states that have adopted laws regulating abortion experienced a larger decline than those that have not. Reductions are particularly steep, he found, in states that restricted the use of Medicaid funds to pay for poor women's abortions and those that required pre-abortion counseling about fetal development and abortion risks. (Lisa complied with that rule by phone.)

Some of those who deal with women seeking abortions have different theories. "The restrictions may stop some, but we think things like the 24-hour waiting period and the reduction of the numbers of clinics do not reduce abortions. They increase later abortion," says St. Louis--region Planned Parenthood CEO Paula Gianino, who has been at the organization for 15 years. While Missouri keeps no statistics that would back up that contention, a 2000 study by Guttmacher conducted in Mississippi found that the percentage of second-trimester abortions increased after the state adopted mandatory counseling and waiting periods in 1992.

Despite that, Gianino says, women overall are having abortions at earlier stages of gestation than ever, largely because better pregnancy tests are on the shelves of every drugstore. And there are alternatives to surgical abortion that weren't around years ago, which give women a greater incentive to make their abortion decision early in their pregnancy. Fully 24% of the St. Louis Planned Parenthood clinic's first-trimester abortions are being done with mifepristone, formerly called RU-486, which was federally approved in 2000 for use in the first 49 days of pregnancy. Two years ago, it was only 18%. And finally, there is an alternative that one side of the debate calls contraception and the other considers abortion: the so-called morning-after pill, which must be taken within 72 hours of intercourse to be effective. The Planned Parenthood affiliate in St. Louis performed about the same number of abortions (approximately 6,300) in 2004 as in 2003. But in the same time period, the number of morning-after kits they dispensed--containing a pregnancy test, four birth-control pills and a booklet advising the user not to take the pills if already pregnant--jumped, to 8,000 from 6,500.

Missouri's new restriction concerning minors is already having an impact. Missouri has become the first state to extend its parental-notification law beyond its state line, a move aimed across the Mississippi River at the Hope Clinic, a low-slung building that sits amid a vast industrial park in Granite City, Ill. A recent morning found a security guard posted out front and a waiting room filled with anxious-looking young women, along with a few boyfriends, husbands and children. Because Illinois has no parental-notification law, Hope Clinic had been the easiest option for Missouri teens seeking to get an abortion without telling their parents. But the new Missouri law that makes it possible to sue anyone who provides an abortion to a Missouri resident under age 18 without written consent of a parent has Hope demanding proof of age of all prospective patients.

Hope counselor Zoila Rendon-Ochoa recently received a call from a St. Louis woman who spoke only Spanish and identified herself as an illegal Mexican immigrant working as a dishwasher in a restaurant kitchen. In her ninth week of pregnancy, she had left Mexico with no birth certificate; she had no driver's license or other identification. "I can't have this baby," she pleaded. Recalls Rendon-Ochoa: "Before the law, we could have given her an abortion. She kept saying to me, 'You can trust me. I'm 24,' but we couldn't prove it. She asked me, 'Where do I go now?' I couldn't tell her. I would guess that she carried the baby to term."

In another case at Hope, a 17-year-old high school student from St. Louis appeared with her boyfriend. She said she did not know where her mother or father was. She was told to get a judge's order that would allow the abortion without parental consent. Another 17-year-old who was turned away said she would return after her birthday in several weeks, thus increasing the risk and expense of the procedure.

Some abortion-rights foes say that if they want to win the political battle in the long run, they will have to prove that there are alternatives to abortion and that they can work. In 1997, for instance, Missouri passed a tax credit for donations to maternity homes. These activists also acknowledge that they bear a special burden to help women trying to raise babies they can't afford. Larry Weber, executive director of the Missouri Catholic Conference, notes that the year after abortion-rights opponents helped rally support in 1993 to make more people eligible for Medicaid, the abortion rate dropped sharply.

It's impossible to say precisely what caused the drop, and the rate was up again slightly two years later. Meanwhile, those on the other side say that reducing the number of abortions is not the only measure of success. "You have to look at the long-term social effects," says Pamela Sumners, Missouri executive director of NARAL Pro-Choice, the abortion-rights advocacy group. "There's a greater likelihood that teenage mothers in particular and their children will wind up on public assistance, drop out of high school, end up in low-wage jobs--all things that are not good for society."

Both sides might look to college dropout Jessica Schutte, 23, to make their point. When Schutte got pregnant in the fall of 2004, her family members urged her to have an abortion, but she resisted, figuring it wasn't her baby's fault that she hadn't used birth control. Things didn't work out with her boyfriend, so he started making calls to find her a place to live and came upon Our Lady's Inn, a St. Louis maternity home. Schutte was 8 1/2 months along and terrified when she moved in, figuring that she had landed in what amounted to a homeless shelter. But the inn gave her classes in child development and taught her how to feed a baby, when to get him vaccinated, even how to clean a house. It also taught her about safe sex. "I learned how to be a good parent, and I became confident that I could do that," she says.

But she still can't do it alone. Earlier this month, she got a $7-an-hour cashier job at a Family Dollar store; about $30 of her $200-a-week paycheck goes to child care for her son Hayden, 8 months old. She still lives in an apartment subsidized and furnished by Our Lady's Inn. Pointing to her spartan surroundings, she notes, "All the furniture in this apartment is theirs. All of it: the TV, the bed, the couch, the crib, the coffee table, dishes--everything I need."

Schutte talks of paying off her $2,500 student debt, getting state grants to go back to nursing school and eventually moving back to her hometown, Cedar Hill. All those things are going to take more than a few donations from a do-gooder group. But just like Lisa, Jessica Schutte had a choice when it came to having an abortion. And she decided, no matter how hard it gets, she wants to watch that choice grow up.

With reporting by Chris Maag, David E. Thigpen