The waiting room at the Planned Parenthood clinic was packed by the time the doctor arrived — an hour late because of weather delays in Minneapolis.
It was clinic day, the one day a week when the only facility in South Dakota that provides abortions could take in patients. This time it was a Wednesday. The week before it was a Monday.
The day changes depending on the schedules of four doctors from Minnesota who fly here on a rotating basis to perform abortions, something no doctor in South Dakota will do. The last doctor in South Dakota to perform abortions stopped about eight years ago; the consensus in the medical community is that offering the procedure is not worth the stigma of being branded a baby killer.
South Dakota, those on both sides of the abortion debate agree, has become one of the hardest states in the country in which to obtain an abortion. One of three states in the country to have only one abortion provider -- North Dakota and Mississippi are the others -- South Dakota, largely because of a strong antiabortion lobby, is also becoming a leading national laboratory for testing the limits of state laws restricting abortion, both opponents and advocates of abortion rights say.
Conservatives shape local law
In 2005, the South Dakota legislature passed five laws restricting abortion, after a bill to ban abortion outright had failed by one vote in 2004. And new laws are virtually assured for the coming year. A 17-member abortion task force, made up largely of staunch abortion opponents, issued recommendations to the legislature earlier this month that included some of the most restrictive requirements for abortion in the country.
The report states that science defines life as beginning at conception and recommends a law that gives fetuses the same protection that children get after birth, thus banning abortion. Until such a ban, the task force recommends requiring that a woman watch an ultrasound of her fetus, that doctors warn women about the psychological and physical dangers of abortion, and that women receive psychological counseling before the abortion, among other measures.
As national leaders on both sides of the abortion debate focus on the upcoming Supreme Court nomination hearings of Samuel A. Alito Jr., they are watching states such as South Dakota pass more and more restrictions that might be upheld by a newly constituted, more conservative Supreme Court.
"Samuel Alito wrote the blueprint 20 years ago on how to dismantle and eventually overturn Roe," said Nancy Keenan, president of NARAL Pro-Choice America, referring to a memo Alito wrote in 1985 in which he mentioned passing restrictions on abortion as a way to mitigate the effects of Roe v. Wade . "If he is confirmed, Alito could cast the decisive vote that allows additional attacks on women's reproductive freedom from the states to stand."
States already a controlling force?
But Mary Spaulding Balch, director of the state legislation department of the National Right to Life campaign, said South Dakota is one of many states that have had success in passing laws the organization has been espousing for more than 30 years.
"Working within the fact that the Supreme Court said that it's legal to kill unborn children," she said, "it makes sense that you do your best to save whatever lives you can."
Each week, 15 to 20 or so women from across South Dakota find their way to the Sioux Falls Planned Parenthood for an abortion, no easy feat for many of them. South Dakota is home to some of the poorest counties in the country, including the poorest, Buffalo County, seat of the Crow Creek Sioux reservation. State law forbids any public funding for the $450 procedure, even in the case of rape or incest. Beyond cost, there is the distance. It's a long slog here from places like Rapid City, about 350 miles away in the western part of the state. For some women, the only way to do it -- and not pay for a hotel room -- is to make the 700-mile trip in one day.
"Women in the western side of the state don't think about abortion until they need to," said Kate Looby, Planned Parenthood's state director, "and then they're completely shocked that there's no way to receive that care unless they go to Sioux Falls." Even women in a medical or life-threatening emergency have only one hospital to go to that will perform an emergency abortion, she added. "One hospital. In the entire state, again in Sioux Falls."
A long, hard road to the clinic
On a recent clinic day, 13 women were scheduled for abortions but the waiting room was jammed with more than 30 people -- the patients, spouses, children, parents, friends. Some patients coming from far away had to bring their young children because they could not get child care. Others, such as a 23-year-old woman who drove here in the early morning from Rapid City with her boyfriend, left their children at home and would have to turn right back after their abortion to return to their families.
"I figured I could get the abortion in Rapid City," said the woman, who has a 2-year-old daughter. "And I didn't know it would be so expensive. We had to borrow the money to get here."
The woman was 45 days pregnant, she said, the day she drove 350 miles to take the RU-486 abortion pill and then drive back. "I have to get back home to my daughter," said the woman, who said she was working full time and attending college part time to become a medical administrator. (She and the others interviewed did not want their names in the newspaper.) The woman said she had decided on abortion because "I can't afford another child, and I need to finish school and work to support the one I got." She receives $50 a month in child support and less than $200 a month in food stamps but was deemed ineligible for any further public assistance because of her full-time job.
Another patient, a 29-year-old teacher who became pregnant while using birth control with her boyfriend of a few months, who is also a teacher, said she was not ready for a child and neither was he.
"I'm pro-choice all the way," said the woman, who is from a town about 90 miles from Sioux Falls. She found out she was pregnant at seven weeks and had to wait two weeks for the abortion because the clinic's schedule conflicted with her work schedule.
Doctors shy away from procedure
Looby, whose father is an obstetrician-gynecologist, said she has talked to many doctors in South Dakota who say they have no personal objection to performing abortions but cannot risk their careers and community standing by offering the procedure.
When the Planned Parenthood clinic was built six years ago, architects factored in the hostility that clinics faced. It has no windows in the front of the building, so abortion protesters cannot look in, and the parking lot is in the back, on private property safe from picketers. The glass in the encased reception area is bulletproof. Doors are kept locked, and visitors must present identification to be buzzed inside.
But the loud protests anticipated in the building design have not materialized. Instead, abortion opponents have attempted to get laws passed restricting both abortion providers and those seeking the abortions.
One law passed in South Dakota this year is an informed-consent measure that requires doctors to tell women in writing and in person two hours before an abortion of the medical risks of the procedure and that an abortion ends the life of "a whole, separate, unique living human being." Enforcement of the law has been blocked by a lawsuit from Planned Parenthood.
Another measure is a "trigger law" that automatically bans all abortions in the state should the U.S. Supreme Court overturn Roe v. Wade .
Leslee Unruh, one of the prime lobbyists for the law that created the abortion task force, said, "I want abortion to end."