States within the nation's most restrictive region, the midsection, include North and South Dakota, which each have only one abortion clinic and have seen the number of abortions drop slightly since 2008.
And they include Texas, which has the most prescriptive counseling laws — requiring, among other things, that doctors tell women abortion is linked with breast cancer. A group of scientists convened by the National Cancer Institute in 2003 concluded abortion did not raise the risk of breast cancer.
A Texas law passed last year requires women to get an ultrasound and their doctors to describe the fetus. Texas abortions also have dropped every year since 2008.
Next door, in Oklahoma, state authorities are fighting court action blocking a law with similar requirements. Collett, the anti-abortion attorney, has helped Oklahoma defend the 2010 law. She says it might lead some women to change their minds.
While records from several states with restrictive laws show fewer abortions in recent years, whether there has been a true decline is uncertain. Not all states track the rate — the number of abortions per 1,000 women of reproductive age. Pregnancies are down, too, in many states, a development some experts link to a weak economy. The most recent national abortion statistics are from 2008. The trend shows the number and rate of abortions have generally leveled off after a long period of decline.
In South Dakota, a new law facing a legal challenge would impose a three-day waiting period. During that time, a woman would have to visit a crisis pregnancy center discouraging abortion. Utah is the only other state with a waiting period that long, but it doesn't require such specific counseling.
In July, a federal appeals court in South Dakota upheld a 2005 law requiring doctors to warn that abortions increase risks for suicide. Scientific research disputes this.
Dr. Carol Ball, at the state's lone abortion clinic, in Sioux Falls, says information she's required to tell patients is "of questionable validity" and designed to make them feel shame and guilt.
"They're throwing hurdles in front of us to see when we stop jumping in front of them. If I stop, it means they win and women of South Dakota lose, and I'm not willing to let that happen," Ball said.
Across the state to the west in Rapid City, Dr. Marvin Buehner cares for women with high-risk pregnancies and does a few abortions each year when pregnancy endangers the patient's life.
He's required to describe each fetal stage and explain that abortion ends the life of a separate human being — even to women whose fetuses have deadly abnormalities and won't survive.
"It's just incredible," Buehner said.
One of his patients is a 31-year-old woman who gave birth Oct. 14 to a stillborn baby with a rare, inherited and ultimately fatal condition called achondrogenesis, which causes severe deformities. She had two previous babies with the same condition. One was also stillborn, the other died an hour after birth.
She had considered abortion when tests showed this baby, too, was doomed, but couldn't afford the cost. It would have involved traveling nearly six hours to the Sioux Falls clinic. And because her life wasn't at risk, Medicaid in her state wouldn't pay for it, even though it was clear her baby would be born dead or die shortly after birth.
In Illinois, laws are relatively lenient. The Hope Clinic in Granite City in Southern Illinois caters to women from neighboring states like Missouri and Kentucky where it's harder to get an abortion.
Tamara Threlkeld, the clinic's executive director, said despite increasingly difficult access, Hope Clinic has not seen any increase in patients with later-term pregnancies seeking abortions.
Though you'd expect to see that trend, "they're able to find us" early on, she said.
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