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Borders without doctors: South Dakota's war on abortion and modernity

In South Dakota, the toughest decision a woman will ever make ends with the long drive into Sioux Falls.

In South Dakota, the toughest decision a woman will ever make ends with the long drive into Sioux Falls.


Angie Buhl O'Donnell grew up in one Catholic household and married into another. As a baby, she was given up for adoption and taken into a loving home. Because of her religious background and her personal history, Buhl O'Donnell detested the idea of abortion.

Then she grew up.

"I am pro-choice, but I did not come to it lightly," says the 30-year-old nursing assistant, who doubles as a Democratic state senator representing Sioux Falls. "Ultimately, it's really hard to imagine a lawmaker having an appropriate place in whether, and when, to start a family."

As Buhl O'Donnell's views evolved over the decades, her state went the other direction, marching backward through time. Thanks to a set of vice-like restrictions enacted in the last decade, South Dakota's abortion laws now look like Saudi Arabia's.

Women in South Dakota must travel to Sioux Falls, home to the state's only Planned Parenthood, for an initial appointment. Against their will, doctors must give patients information that abortion ends the "life of a whole, separate, unique human being," and has a causal connection to suicide. Armed with these "facts," the woman then must go back home, wait three days, and return for the procedure.

In a sizable state like South Dakota, that could mean 16 hours of driving over four days. And it could get worse.

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A law passed in 2011 would force doctors to refer women to counseling at a so-called "crisis pregnancy center," wherein religious nonprofits will try to talk women into keeping the baby. The provision is still tied-up in court, but conservative judges have consistently upheld other equally controversial measures.

These laws — and the hard-right, anti-choice culture behind them — would put a heavy burden on South Dakota's abortion doctors. If they had any.

As it happens, the only people doing elective abortions in that state come from this one. Four Minnesota doctors fly into Sioux Falls twice a month to perform a legal, common medical procedure that no South Dakotan is willing to do. Think of it as Haiti after the earthquake. South Dakota has legislated itself into the Third World.

Dr. Carol Ball has been flying out first-thing in the morning and back the same night for more than a decade. She's "angry, sad, but also just bewildered" by South Dakota's extremists.

"They live, as far as I'm concerned, in the Middle Ages in their thinking about women, and reproduction, and sex," Ball says.

The three-day mandatory wait is nothing more than one last guilt trip for the woman involved. One legal wrinkle, unique in American law, is another slap in the face: Buhl O'Donnell notes that the 72-hour period only counts working weekdays, "as if women can't think on weekends or holidays."

Kate Looby, a former lobbyist for Planned Parenthood, says policymakers have always been "pretty open" about their real intent.

"They thought, 'whatever hurdle we can put in place is good,'" Looby says. "Their assumption is these women have not thought about it, and are just running out the door to have abortions."

They're not getting that idea from anyone who might actually know. Dr. Ball hasn't heard from a South Dakota lawmaker in more than a decade. She'd answer the call, but knows some are probably not worth engaging.

She's thinking about people like Isaac Latterrell, a Republican state rep from suburban Sioux Falls. Earlier this year, he wrote that Planned Parenthood is "worse than ISIS."

Latterrell declined an interview, but did write an email to make clear he thinks abortion is "evil and must be stopped." Most of South Dakota's legislature — 80-plus percent Republican and 80-plus percent male — agrees. Here's who doesn't: South Dakota. In 2006 and 2008, abortion bans were put on the ballot, and both times voters kept it legal by a two-to-one margin.

Undeterred, conservatives ran an end-around, simply making it harder and harder to get a safe, professional abortion. It's working. About 30 percent of unplanned pregnancies in Minnesota end in abortion. In South Dakota, just 13 percent do, with low-income women the least likely to end their pregnancy, according to recent research.

Ball says she can imagine a day, maybe not too far off, when the restrictions become too much, and the last abortion clinic in the state shutters its doors. At that point, South Dakotans who have made the most difficult decision of their lives will have to drive here, or to Colorado. She's already aware of one recent case when a desperate woman attempted to self-abort.

"People stand out in front of our clinics and hold up pictures of aborted fetuses," Ball says. "For every one of those, there is another picture of dead women, just as horrific, from prior to Roe v. Wade."

Ball started practicing as an obstetrician about a decade after that landmark case. Back then, her patients seemed to feel like they were exercising their legal rights. Now, after decades of culture wars over women's sex lives, she's seeing a lot more shame.

Isaac Latterrell's not the only person who didn't want to talk on the record. There's a South Dakota woman who tried to end her pregnancy in three different conservative prairie states — her own, Nebraska, North Dakota — only to find the laws were too onerous in each. Finally, she came here.

She agreed to share her story, but later backed out. I don't know why she didn't want a baby, but I've a pretty good idea why she didn't want to talk.

But she should feel angry, not guilty. The only people who should be ashamed are the ones running her state.