For some voters, the election wasn’t just a referendum on Trump. Abortion access was on the ballot again, this time on the heels of Amy Coney Barrett’s appointment to the Supreme Court. In Colorado, a proposal to ban abortions after 22 weeks failed to pass. Voters in Louisiana, on the other hand, pushed through an amendment that effectively enshrines the state’s endemic lack of abortion access in its constitution.
Many abortion advocates see Barrett’s confirmation as a credible threat to Roe v. Wade. But in states such as Louisiana—where the new amendment is only the most recent maneuver in a sustained attack on abortion rights—the law of the land hardly matters.
Since the passage of Roe v. Wade in 1973, Louisiana has adopted 89 abortion restrictions, including a 24-hour waiting period between required counseling and the actual abortion procedure. The state now has just three abortion clinics, down from seven a decade ago; Planned Parenthood operates two health centers in Louisiana but has been unable to obtain a license to provide abortions. Last year, the Louisiana governor signed into law a heartbeat bill that could prohibit abortions as early as six weeks into a pregnancy, though a court order blocked it from taking effect. But in the event that Roe v. Wade does get overturned, the state’s trigger ban would immediately outlaw abortion in the state.
Amendment 1 introduces language that ensures the Louisiana constitution will not protect the right to abortion or provide funding for abortion. After Louisiana voters passed the amendment, I spoke to Kathaleen Pittman, who runs Hope Medical Group for Women, one of the few abortion clinics that are still standing. Pittman, who has worked at the clinic in various capacities for 28 years, weighed in on how the pandemic has impacted access to abortion care and the immediate effects of the new amendment. Her account has been edited and condensed.
“Most of the patients we see here already have one or more children”
My primary responsibility is keeping our clinic doors open, overseeing staffing and the physical clinic itself to make sure it meets all the standards and regulations as required by Louisiana. We are actually licensed by the state and have been since 2004, which is a requirement. In Louisiana, in order for a physician to perform more than five abortions per year—and that includes medical abortion—that physician would have to be licensed as an abortion clinic.
Since Hope is located in the northwest corner of Louisiana, we pretty much pull in from a 200-mile radius. We do see a lot of patients coming from rural areas. Even though there are clinics in South Louisiana, we do have some that come up from there. We see quite a few [from] East Texas because we are just a few minutes from the Texas border. We have patients coming to us from Arkansas, Oklahoma, and also Mississippi. Most of the patients we see here already have one or more children; most of them live at or below the federal poverty line. The most common reason given for terminating a pregnancy is the lack of financial resources.
“Our challenge since the pandemic began has primarily been keeping our doors open”
Our challenge since the pandemic began has primarily been keeping our doors open. We did have a bit of a battle with state officials early on, when we initially received the closure orders for a lot of non-critical facilities. There was a lot of pushback from state legislators; the attorney general did everything he could think of, even [sending] a team of investigators in on us to try to get us to defer patients until later on. But time is of the essence when you have an unplanned pregnancy. We’ve had to rethink a lot of the way we handle patient care, as far as trying to do social distancing within the clinic. We have a 24-hour waiting period and have had since the mid-90s—so in order to not have too many people in the clinic at one time, we’ve had to separate days that we do the consults from the days we do our procedures.
One of the biggest complaints we’ve had from patients is the fact that because everybody is masked, and we’re having to be extra cautious, we’re no longer able to serve cookies and tea as we traditionally have. I know it sounds funny, but for years now, that’s kind of been our thing. Patients call us years after the fact wanting to know what we put in our tea.
Another very difficult thing for us during this pandemic has been having to limit support persons coming into the clinic with our patients. On day one, unless it’s a minor, we only allow the patient inside, and on day two, when they return for the procedure, the driver has to check in and then leave. And that’s heartbreaking to me. Because there’s something about having your best friend, your partner, or your sister or mom sitting next to you, waiting until you’re called. We ran into a problem with Texas clinics having to be closed temporarily, so we were seeing more patients come to us from Texas. It made it more difficult for us to see patients as quickly—we were literally scheduling almost a month out, just to get them in for that first visit. That’s difficult because most of these [patients] can’t wait that long.
“When you provide abortion care in Louisiana, there’s always some battle”
I can tell you four years ago, the morning after the election, I literally said, ‘I just don’t know that I can even get out of bed.’ Truly. It was that devastating, and then all our worst fears came true. [I have] said for years that my biggest fear isn’t that Roe will be overturned. It was that these trap laws that are passed by Louisiana legislature every year will make abortion inaccessible, in which case it doesn’t matter that we have Roe.
We can hardly catch our breath before we have something else that we’re having to deal with. Amendment 1 did become a big issue for us. It threw a lot of people into panic mode. The day after the amendment passed, we were fielding phone calls from people who were very concerned. Some were crying. I mean, we literally had people calling saying, ‘Are you going to be able to stay open? Are you closing? Are you already closed?’ That’s not happening—not now, anyway. But so many people were so frightened and concerned. I mean, I literally had my assistant administrator crying on the phone with one caller. When you provide abortion care in Louisiana, there’s always some battle.
The amendment itself was written specifically, I think, to create some confusion. Your average voter might say, ‘It’s not that I’m against abortion, but I don’t need to pay for it.’ When the truth of the matter is, state law prohibits state or federal funds from paying for abortion care; that’s already on the books. Also already on the books is a trigger ban passed in 2006. So if Roe v. Wade is overturned, abortion immediately becomes illegal in Louisiana. If that ever occurs, [the amendment] will make it more difficult to challenge not being able to have an abortion in Louisiana. And the fact that there were no exceptions allowed for rape or incest? I mean, the amendment itself I find appalling, but not having any exceptions—that’s stepping over the line into cruelty, as far as I’m concerned.
We need to focus on the reality that more and more in Louisiana, access to abortion is being denied. And it’s because it has become so difficult to keep clinics up and running. Women are having to travel further for care—and these are women that do not have transportation necessarily. They do not have childcare or can’t afford it. They cannot afford to take off time from work or school. They’re faced with so many things. And it’s not just one day, but two that they have to come in. So I think instead of making it more difficult to obtain an abortion, we need to focus more on [making] it less necessary to even need one.
“Just when you’re having a really, really, really bad day, something sweet happens”
This is going to sound rather corny. But my office is located off the main hall in the clinic. Patients who are leaving at the end of the day [are] walking by my office. I see them leaving, and the absolute difference in the way they carry themselves. It’s like, head up, shoulders back. [They’re] no longer defeated—let me put it that way. I see them, and they pop their head in to say thank you and compliment me on the staff. We get some really sweet notes from our patients. So just when you’re having a really, really, really bad day, something sweet happens, and that makes all the difference in the world. I’m surrounded by an absolutely outstanding staff. Some of my staff have been here almost as long as I have, and they’re here with meaning and for a purpose.