Dr. Warren Hern has clear memories from the years before Roe v. Wade granted women the right to an abortion.
He and his medical school classmates would stay up all night caring for sick women. At first, he said he didn’t understand why they were so ill. Then he learned the women had all tried to get illegal, unsafe abortions — and many were dying as a result.
“We were trying to help them and keep them alive,” Hern told Global News in an interview.
It was a dark time for women facing unwanted pregnancies.
What struck Hern most was the “desperation.” One woman drove up to a hospital in Denver to plead for an abortion, but was turned away.
“She went home and shot herself in the uterus, and then drove herself to the hospital,” he said.
“That’s how desperate she was.”
Hern, who has spent decades providing what he describes as “late” abortions at his Boulder-based clinic, said he never thought he’d see Roe v. Wade overturned. But in June of this year, when the U.S. Supreme Court did exactly that, he said it was a “catastrophe for women across the country.”
“It’s really a disaster,” Hern said.
With next week’s midterms shaping up to be a referendum on abortion rights, including a promise to Democratic U.S. President Joe Biden to codify abortion rights federally if given expanded seats in Congress, Hern said the outcome will be “critical” — both for U.S. women, and Canadian women, too.
Before COVID-19 complicated the process of crossing the Canada-U.S. border, Canadian women and people who can get pregnant made up 10 per cent of the patients who showed up to Hern’s clinic in the hope of getting a late abortion, he said.
While Canada provides safe and legal access to abortion in many parts of the country, women in rural areas of some provinces — including Ontario, Alberta, Saskatchewan and Manitoba — are forced to travel to urban centres for surgical abortions.
Roughly 95 per cent of abortions in Canada are performed in the first trimester, which is the first 12 weeks of gestation, according to Kelly Bowden, director of policy and advocacy for Action Canada, an organization that advocates for sexual and reproductive rights.
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But as people try to find the funds, the childcare and the time to travel to another city or another province where they can get an abortion, the clock continues to tick down the timeline of their pregnancy.
Some providers in Canada will perform abortions up to the 24-week mark. But after that point, the number of willing providers drops significantly and healthcare providers often opt to send their patients to the United States, where they can visit a clinic like the one Hern operates.
“They do perform abortions in Canada, and very safely,” Hern said.
“But there were not many doctors who will perform abortions later in pregnancy.”
As U.S. lawmakers pursue increasingly rigid abortion laws — and, in some cases, stringent six-week bans kicking in when a woman is just a week or two late to her first missed period — more and more women are facing delays and outright denial as they try to access abortion services.
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Because so many American women are further along in their pregnancies by the time they can access a safe abortion, demand for late abortions is growing. That’s led to longer wait times at Hern’s Boulder-based clinic, which is one of the only places in North America where women can get a late abortion.
“We became much busier last year when the Texas law went into effect,” Hern said, referencing Texas’ 2021 law that banned most abortions at the first sign of any cardiac activity.
“We have a much higher demand for services than we can meet. We’re scheduled two or three weeks out, which is very bad for women because they’re farther along by the time we can actually see them.”
The further along into a pregnancy a woman is, the more dangerous the surgical abortion becomes, Hern said — meaning delays can be deadly.
“As the Republican laws have shut down early abortion across the country, (it) means that women can’t end a pregnancy early in the pregnancy, when it’s safer, it’s less stressful, it’s easier to do,” he said.
Because so many of the abortions Hern performs are later in the gestation period, they’re higher risk. He characterized his clinic as an “abortion intensive care unit.”
“So we don’t see a lot of patients. We see a small number of patients, and they get very intensive care,” he explained.
“They have numerous visits. A number of staff members are involved in helping them. And the costs are very high.”
With shrinking abortion access causing U.S. patients to flood Hern’s clinic, the Canadian women who rely on these U.S. services will also have a harder time accessing them.
“We’ve always seen people going across the border to the U.S. to access these services,” Bowden said.
“What we’ll see is a kind of bottleneck for service provision in those areas, which will make it more complicated for Canadians who are accessing those services in the U.S.”
Even in the United States, there are very few places where women can get an abortion later in their pregnancy, Hern said.
“We see all the patients we can and take care of them, but there’s a limit,” he said.
“I think that there, increasingly, will be women who simply can’t get an abortion.”
The end result of this, from Hern’s perspective, is a return to a United States he thought he’d left behind.
“We are going backward in time.”
The women who end up at Hern’s clinic often face “unusual and difficult circumstances.”
He has seen patients who were girls as young as 10 years old.
Sometimes they’re 11, or 12. They want to end the pregnancy because they’ve been raped, sometimes by a family member, Hern explained — and giving birth at such a young age is extremely dangerous.
“The death rate for pregnancy for young (girls) is very high compared to older women,” he said.
Pregnancy, Hern explained, is “not a benign condition — women die from being pregnant.”
Still, in many cases, the women he sees don’t initially want to have an abortion but then faced gut-wrenching diagnoses.
“They want to have a baby — but they have a situation where they have a fetus that cannot survive or is horribly deformed, cannot have a normal life, or any kind of a life,” Hern said.
“And the pregnancy is a threat to her life.”
These situations make up about half of the patients Hern sees. Other women, he said, “are simply struggling to maintain their own life and their own family.”
He had one patient who was living in her car with her children. She couldn’t afford to have another child, Hern said.
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Other times, a woman might be in a “violent, abusive relationship with a man she doesn’t want to spend her life with.”
But as Hern, now in his 80s, forges ahead to provide services to as many of these women as he can, Republican politicians continue to make his job more and more difficult through restrictive abortion laws — something the looming midterms could further embolden.
“This is really about getting power for Republicans. They’re not interested in the public health consequences of it,” he said.
“They get the Christians to vote for Republicans because they say they’re against abortion — even though the Republican politicians are having abortions for all their wives and sisters and cousins and daughters and nieces.”
Meanwhile, Hern takes his life in his hands during each and every commute to work.
“Every single person who helps women in the United States is under a threat of assassination by the anti-abortion people,” Hern said.
He bought the building next door to his clinic so no one could point a gun at him from one of its offices. The clinic has been shot at in the past, he said.
The clinic has four layers of bulletproof windows and cameras covering “every square centimetre” of the building.
“I can’t go out the front door when there are anti-abortion demonstrators out there, because I have to assume that they’re carrying weapons and they’ll kill me if they have a chance.”
Despite the threats to his life on the outside of his clinic’s walls, the doctor said has no plans to stop helping those seeking abortions to make decisions about their own lives inside the building.
When asked how long he’ll keep working, Hern said, “I don’t know.”
“Long as I can.”
— With files from Global News’ Farrah Nasser and Katherine Aylesworth
