Abortion. The issue is so divisive that Louisianans often have a hard time just uttering the word in public.
That's according to abortion rights advocate Amy Irvin, who underscores that it's been 43 years since Roe v. Wade, the landmark 1973 U.S. Supreme Court decision that gave women a constitutional right to medically safe abortions. That right is mitigated by states' interests in protecting the potential lives of the unborn.
While abortion still is a fundamental right of American women, the issue is far from settled. Over the years, Louisiana lawmakers have imposed so many restrictions that today it is more difficult, not easier, for women in the state to have the procedure. In 2015, an annual report from Americans United for Life ranked Louisiana No. 1 — for the sixth year in a row — for its anti-abortion policies. (This year Louisiana fell to third.)
The number of abortions in Louisiana decreased by 10 percent from 2014 to 2015, according to the anti-abortion organization Louisiana Right to Life. A total of 9,311 abortions were performed in Louisiana in 2015, compared to 10,211 in 2014.
According to figures provided by the Guttmacher Institute, an abortion rights think tank, abortion has become a common procedure. Using the most recent data available from 2008, the institute estimated that nearly one out of three American women seek an abortion before the age of 45.
During the recently concluded legislative session, Louisiana lawmakers passed seven abortion restriction laws, including one that triples the waiting time between a mandatory counseling session and the procedure. It was signed into law by Gov. John Bel Edwards, a Catholic Democrat who made his anti-abortion stance a central campaign issue.
Although a new Planned Parenthood center has opened in New Orleans, it has not secured a license to perform abortions — and if it does, it's unclear whether it will be able to provide other Medicaid-reimbursable services. In 2011, Louisiana had seven facilities where women could obtain an abortion; today there are four. Mississippi now has only one.
As the executive director of The New Orleans Abortion Fund, an organization founded in 2012, Irvin helps pay for abortions for women facing financial hardships. She said her goal is to help change an environment in which many women find gaining access to the procedure difficult. She recently discussed her own experience, which led her to create the Abortion Fund.
"Perhaps it emboldens women so they can talk about it with friends and family and daughters, and to normalize it a little," Irvin said. "The silence around this issue — the shame and stigma — has been what's most hurtful to our movement, [besides] legislation."
It was five years ago, and Irvin had just moved to New Orleans after finishing graduate school with a master's degree in social work. At the age of 42, she became pregnant. After considering her options, Irvin decided to get an abortion. The procedure was safe, but she remembers being jarred by a large sign at the clinic stating that the facility did not accept any form of public funding.
Irvin was able to come up with the hundreds of dollars needed to cover the cost. She knew, however, that many women in Louisiana, where 20 percent of working-age women live in poverty, were not so fortunate. She said demographics collected by the local fund are on par with national statistics: the average age of a client is 27; about 80 percent say they are religious or spiritual; more than 71 percent have children already; and 70 percent are employed.
The fact that we are even debating this issue is the result of an all-out political war waged on a woman's right to access the reproductive health care she needs, including safe, legal abortion. — Kirby Jane Smith, Planned Parenthood Gulf Coast
Louisiana is one of 25 states that ban insurance coverage for abortions by state insurance exchanges. Nor does Medicaid cover abortion, making economically disadvantaged women most at risk for being restricted by issues such as cost. At the Women's Health Care Center, the only abortion provider in the New Orleans area, abortion procedures now cost $525 or more.
Irvin had worked with abortion rights nonprofit organizations in other states in the past and knew that private assistance with abortion costs was available in other places. She decided something needed to be done for poor women in Louisiana. "I saw a need," she said. Since 2013, her organization has helped more than 600 women make abortion payments, 229 of them in the past year. The average level of assistance currently is just $111, she said, which covers about one-fifth of the cost of an abortion.
Women usually put off rent, buy fewer groceries and borrow money from friends or family to make up the difference. Irvin said she's heard of women selling televisions, jewelry and smaller items — even a toolbox.
Such stories are a testament to why many women choose abortion in the first place, Irvin said, a statement supported by data from the Guttmacher Institute. That organization reports women usually seek abortion because they can't afford to support a child or believe having a baby would prohibit them from caring for other dependents or would interfere with work or school. "We are really helping the neediest in the community," Irvin added.
Anti-abortion activists, meanwhile, point to public and private services that help women who choose not to have abortions.
For example, Louisiana offers free or low-cost health care coverage to children or families and children who qualify, and the state Department of Child and Family Services provides adoption resources. Louisiana also is a Safe Haven state, which means parents who cannot take care of a newborn can bring an infant up to 60 days old to any emergency medical facility and give up custody with no questions asked.
Many faith-based institutions also provide maternity homes and some offer temporary housing to new mothers as an alternative to abortion. Deanna Wallace, legislative director for Louisiana Right to Life, said her organization helps connect mothers to resources such as parenting classes and free diapers.
Abortion Rights activists have claimed a few victories in recent years. In June, the U.S. Supreme Court overturned a Texas law that required admitting privileges at a nearby hospital for doctors who performed abortions, which would have severely limited women's access to the procedure. The court had blocked enforcement of a similar law in Louisiana in March that effectively would have shut down all but one abortion clinic in the state.
Before that, Planned Parenthood Gulf Coast won a court battle that could help the organization provide abortions in the future at its new location on South Claiborne Avenue. On another front, a federal judge last year blocked then-Gov. Bobby Jindal's attempt to defund Planned Parenthood by canceling its Medicaid contracts with the state after the release of controversial videos concerning fetal tissue donation.
A Louisiana law passed this session prohibits state agencies from contracting with entities that provide abortions. Planned Parenthood Gulf Coast spokeswoman Kirby Smith said it's unlikely that law will hold up in court. She notes that the Centers for Medicare & Medicaid Services doesn't allow states to block a patient from a provider simply because the provider offers the "full range of reproductive health care."
"The fact that we are even debating this issue is the result of an all-out political war waged on a woman's right to access the reproductive health care she needs, including safe, legal abortion," Smith said.
Despite those developments, Irvin and other abortion rights activists predict that new laws in Louisiana will make it more difficult for poor women to access abortion. Anti-abortion activists have hailed the laws, particularly House Bill 386, the "Women's Enhanced Reflection Act," which triples the waiting period — from 24 to 72 hours — between a mandatory counseling session and the procedure.
During a hearing on the bill, Louisiana Right to Life's Wallace said it was imperative women have a "reflection period" after counseling to decide if they're making the right decision. "Abortion is a life-changing and life-ending decision, and one that the [U.S.] Supreme Court recognizes many women come to regret," Wallace said.
Louisiana legislators also limited the kind of procedures that can be done once women enter the second trimester of pregnancy. The "Unborn Child Protection From Dismemberment Abortion Act," another new law, prevents an abortion that removes fetuses "one piece at a time."
Some, like abortion rights activist Michelle Erenberg, said the law prohibits the safest procedure during the second term, also known as a D&E (dilation and evacuation). State Rep. Mike Johnson, R-Bossier City, who authored the bill, said the legislation reflects "who we are as a people."
"In Louisiana, we believe every human life is valuable and worthy of protection, and no civil society should allow its unborn children to be ripped apart," said Johnson, a constitutional lawyer who has litigated abortion issues. "Incredible as it seems, we needed a law to say that."
Other laws now require that fetal tissue be cremated or buried following abortion, limit which kinds of doctors can perform abortion procedures, tighten restrictions regarding medicated abortions and ban abortions in cases of genetic abnormalities.
Wallace praises legislators for writing those laws and Edwards for signing them.
"I think that the goal of our organization is to one day see a world in Louisiana where abortion is not only illegal but unthinkable — where there are resources, where there is access to choose life," Wallace said. "It's not just about making it illegal, it's about making it unthinkable."
Last month, the Center for Reproductive Rights sued the state over those latest restrictions. The group's CEO Nancy Northup called the laws "a web of red tape" that puts women's "health and well-being at risk."
Erenberg, director of an organization called Lift Louisiana, concurs.
"Every barrier that you put up in the path of a woman seeking an abortion puts emotional stress on her, can put economic stress on her and can be physically dangerous if a woman is in a relationship where there's violence," she told Gambit.
Recently, women across America have been encouraged to tell their stories about abortion. Many describe the process as complex — and often traumatic.
Such was the case with Bess, a 33-year-old who shared her story with The Abortion Diary, a collection of audio recordings by archivist Melissa Madera. Bess, who didn't give her last name, said she came to regret an abortion she had in New Orleans when she was 28. She describes herself as a feminist who advocates for abortion rights as part of normal gynecological care.
Since then, Bess has become a social worker who hears women share their abortion stories. It helps them, she said, if they're given a safe space to talk, a support system and, most important, education about all of their options.
"Those were the scary things," Bess said. "The not knowing, and the shame and taboo. I think all of that is from people not talking about pregnancy, about abortion, about sexuality and reproductive health."