A leading abortion provider on why restrictive laws are taking us back to the Dark Ages

Throughout this election cycle, the term “late-term abortion” has popped up several times, despite not being an actual medical term. Not only did the first presidential debate between President Joe Biden and former President Donald Trump include a very misinformed discussion about “late-term abortions” before Roe v. Wade was overturned by the Supreme Court's Dobbs decision, but the Republican Party adopted a “Make America Great Again” policy platform ahead of its national convention, stating in a 16-page document that the party will oppose "late-term abortion.”

This isn’t the first time anti-abortion advocates have made it seem as if abortions were happening well into the third trimester of pregnancy or after an infant has been born. As Salon has previously reported, the term is nothing more than a made-up phrase that has no basis in medicine yet is frequently used by anti-abortion advocates. 

According to the Centers for Disease Control and Prevention (CDC), in 2021 about 81 percent of abortions in the U.S. occurred at nine weeks of pregnancy or earlier; 94 percent happened in the first 13 weeks, 3 percent occurred between 16 and 20 weeks of gestation. Less than one percent of abortions in the United States occur after 21 weeks of gestation.

Dr. Warren Hern, who specializes in fetal anomaly abortions and director of the Boulder Abortion Clinic, is one of the few providers to provide abortion care later in pregnancy. In fact, he is more than a provider, but also a pioneer in his field. But it doesn’t come without a cost to his safety every day. When Salon spoke to Dr. Hern over a video call, he mentioned that he was sitting behind bulletproof glass. In his latest book, “Abortion in the Age of Unreason,” he discusses stalkers, the assassination of colleagues, like Dr. David Gunn, as well as the “why” behind his work.

The following interview has been edited for length and clarity.

Why do you think we are in the "Age of Unreason?" And why did you make this the title of your book?

As I said at the beginning of the book, we can compare this to the 18th Century, which was called the "Age of Reason," in which people began to discover that you could learn about the world with science, reason, logic, thought and observation — as distinguished from blind belief, superstition, fantasy and supernatural things. That was a very important epoch in human history. But by contrast, we've had several episodes of unreason. And what we are seeing now in our society, American society in particular, is a new age of unreason. 

We have people who are opposed to scientific knowledge about the world, and who are totally committed to fanatic ideas of theocracy, superstition and religion, that have nothing to do with reality. And they’re trying to force the rest of us into that mold, and they are completely opposed to facts. We saw this under the Trump Administration with the COVID pandemic, for example. And now, the new Project 2025, [a set of proposed policies criticized as anti-scientific.]

And in terms of what we're doing here, they want to abolish all health care for women, to take us back beyond earlier than the Dark Ages. And I think that these people are living in the dark ages. There were citations in the Dobbs decision going back to the 17th Century of some guy who prosecuted witches. There are plenty of people, plenty of men, who do not like the fact that contraception and abortion have been effective and safe fertility control for women. 

Dr Warren Hern talk on the phone in his clinic on January 31, 2022 in Boulder, Colorado. He has been performing abortions since the 1970s. (Gina Ferazzi / Los Angeles Times via Getty Images)

You start this book with somewhat of a tone to justify yourself and the work you do, at least that’s what I got a sense of: that it was important for you to explain to the reader why you provide abortions later in pregnancy. I’m curious if you can elaborate more on that. 

Well, let's put it this way. There’s a different way of looking at it. I don't feel that I have to justify what I'm doing. I think I need to explain it to the people, to the public, because there's a lot of misunderstanding about it and it’s a very complicated, difficult subject. 

It begins with the fact that as primates, as animals, we are hardwired to take care of human babies and other small, helpless creatures. And what we're doing in this new situation is we’re giving an opportunity to make sure that women have an opportunity to do what they want to do as people, as citizens, and that includes ending pregnancies for various reasons, some of which are the woman does not want to be pregnant and have a baby, and others, the pregnancy is a clear threat to her life. And I think that this bothers people. 

What I tried to do with my book, as well as to help people understand how I got to this and why what we're doing is so important. How it developed over 60 years, why it's important to women, why it's important to their families, and why it's important to our society. That this is how this works, and this is why we do this, and this is why this is a life and death matter for women. It is not a matter of personal satisfaction or personal whims. It's not capricious. It's not frivolous. It’s vital. I think that we are at a new point in human history of the last 15,000 years where women can make decisions to continue pregnancy or end pregnancy safely. And that’s brand new.

I thought your chapter on the “illness of pregnancy” was interesting. Can you explain how abortion care, in your opinion, is a treatment for pregnancy? How you consider it to be a part of the standard medical care for pregnancy, just like prenatal care? 

When I was a medical student exactly 60 years ago, on my first rotation on obstetrics in 1963 as a third-year medical student, I saw a lot of things happening that were quite frightening. I give the example of a woman named Sharon. She went from being a very healthy young woman about to give birth to a healthy baby, to within a few minutes, the point of dying. I watched this happen, and I watched what needed to be done to help her survive.

It was pretty clear that her baby was going to be seriously brain damaged, and that she was going to give it up for adoption. It didn't have any future, and this was a catastrophic situation. Meanwhile, the obstetrics textbook which I'm using kept saying that a woman is most normal when she's pregnant, that that's the most normal thing that can happen to her. 

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But then the next question is, what is she when she's not pregnant? Does that mean she's not normal? That her function is to be pregnant? That her purpose is to have babies as well as give sexual pleasure to men and make cookies? It didn't add up. I thought about that a lot, and at one point I gave a paper at an anthropology meeting about the cultural definitions of normality and pregnancy, and there’s a discussion of that in the book. And then I published a paper. I was invited to publish a paper in 1971 in the journal Family Planning Perspective, and I pointed out that circumstances have changed. That we now have the possibility of different perspectives about pregnancy that we didn't have 100, 200 or 500 years ago.

And so one of the conclusions of my paper was that the treatment of choice for the condition of pregnancy is abortion unless the woman wants to have a baby. There is no justification for forcing a woman to carry the pregnancy to term. 

In your book, you talk about the harassment and assaults you’ve faced at your job. There have been stalkers. There have been gunshots fired at you, dating back to the '70s. What keeps you going in your job? What has kept you from saying you’re done with this? 

There are various answers, some of the answers could be like a cartoon. And I'll give you an example: in the movie "Midnight Cowboy," there's a scene where Dustin Hoffman and John Voight are walking across the intersection. Hoffman plays a character named Ratso Rizzo, who's a scruffy guy — and the car pushes against him and he slams the hood of the car and says "I'm walking here."

The other answer, which is more complicated, is based on lots of things, including compassion for those who are suffering. I saw many examples as a medical student, as a young physician of women suffering unnecessarily from the effects of unsafe abortion. In the book, I talk about the fact of going to a maternity hospital in Brazil where I was serving as a Peace Corps physician in the ‘60s. My Brazilian colleagues showed me one ward full of women recovering from childbirth, and two wards full of women trying to survive the effects of an unsafe abortion. Fifty percent of those women died by the time they got to the hospital. They were too sick to save at that time.

I have an interest in helping women survive these things and to have the best medical care is a very important part of what I do and why I do it. When people come in, they're all different, and I find it an incredibly satisfying experience to help women and their families in these circumstances. I have developed techniques for doing this as safely as possible. Instruments, I've designed protocols, and procedures that I use and other physicians are using in different ways. And that's very satisfying. 

I thought it was powerful how you pointed out how the maternal mortality rate in the U.S. has been increasing over the past couple of decades. How, in your opinion have abortion bans and restrictions contributed to that?

At the end of World War I, the maternal mortality ratio was about 900 per every 10,000 live births. In 1920, the maternal mortality ratio was 680 per 100,000 live births. By 1960, it was 38 per 100,000 lives of birth. It was reduced because of antibiotics, new surgical techniques, blood transfusions, and a wide variety of medical advantages that had been developed over that time in the medical profession.

By the mid-'90s, for example, the American maternal mortality ratio dropped by about seven per 100,000 live births. The last time I looked at about 33 per every 100,000 live births. We're going backward. Why? Well, there are several reasons, and one of them is the restrictions on access to abortion services. If a woman has a ruptured membrane, for example, even if they have a desired pregnancy, they can't get that treatment in places like Texas or Oklahoma. And this is a five-minute operation. It's absurd.

Could you have ever anticipated, when you started your work in the ‘60s and ‘70s, that this is where you would be? Providing abortion care in this climate?

I couldn't imagine. I was going to have a career in teaching research epidemiology. I wanted to have an academic career. I love to teach research, and I have a major research project going on for Peru over the last 60 years. I find that epidemiology endlessly fascinating.

But I found myself compelled to do this work because of the women. One day in 1974, I walked into the operating room. A young woman, who was in her 30s, I think, who had red hair, I remember quite well, was shaking uncontrollably. And I said, "What's wrong? How are you? Tell me how you feel." She said: "It's so different. The lights are on, you’re a doctor, it's clean, the windows are open."

Then she told me about her illegal abortion, which was the most frightening and humiliating experience of her life. And she looked at me and said, "Please don't ever stop doing this." So I didn’t.

What do you hope people take away from your book?

I want people to go out, vote and organize politically. To throw the Republicans out of office and to take the government back. That's what I hope. And I hope that people understand why it's important to support women's rights to have access to full health care. Safe abortion, is a fundamental, essential component of women's health.