Dr. Sarah Traxler put on her blue scrubs as soon as she arrived from the airport. Fifteen patients were waiting. It was the most they could fit in one day.
She had flown from Minneapolis to Sioux Falls, where Planned Parenthood ran the last remaining clinic that provided abortions in South Dakota. There was no doctor in the state who provided abortions, except for the rare medical emergencies in hospitals. So twice a week, once a month, for seven years, Planned Parenthood paid for Dr. Traxler to make the trip.
Her journey was particularly tense that morning, with rumors swirling and protesters already assembled at the Supreme Court. She was waiting on the jet bridge when the court announced its fifth and final case for the day, and it wasn’t about Roe. Settled in seat 4B, her regular spot, she exhaled as her plane flew west, between two layers of gray clouds into the thin, pinkish-yellow light.
Planned Parenthood had already told her that after this week’s round of patients, it would stop offering abortion at the clinic until the case was decided. If Roe were overturned, South Dakota had a law in place to automatically outlaw nearly all abortions. No one knew when the ruling would come down, so no one knew, exactly, what the legal liability would be if a doctor were in the middle of a procedure when it did.
Inside the clinic, Misty Parrow, the center’s manager, lined up all the patient charts. A delivery came—a vase of sunflowers, a gift of encouragement for the staff from their regional Planned Parenthood affiliates. Parrow set them on a table in the back.
The black-and-white ad from the national Planned Parenthood headquarters, framed above Parrow’s desk, felt particularly prophetic that morning. “The Supreme Court—aided and abetted by the White House—has opened the door for antiabortion extremists to impose limits on abortion in each state,” it warned. “If they succeed, access to reproductive health care for a woman will depend on geography. Or her bank account.”
“To take this battle to fifty state legislatures, your active support is needed,” it said. “The fight to keep safe, legal abortion is entering its most crucial phase.”
It was signed by Faye Wattleton, the first Black woman to lead Planned Parenthood—and dated 1990. That was more than thirty years ago, after the Supreme Court ruled in the Webster case that states could pass their own restrictions on abortion access, even with Roe. Parrow’s job each day was a reminder that South Dakota had long done just that.
Over the seven years they had worked together, Dr. Traxler and Parrow had choreographed their routine to the minute so that Dr. Traxler could get through the long list of state-mandated questions and paperwork for each patient.
The first patient that day was twenty-nine, a veterinarian for large animals. Just recently, she had performed an ultrasound for a cow.
Dr. Traxler took her through the checklist. Did she want to see the ultrasound? Yes. Did she want to take home an image? Yes. Did she want to hear the heartbeat if it was detectable? Yes. She wanted it all, all the information, she said—she and her partner were both scientists, after all.
She was seven weeks and two days pregnant. One of the state-mandated forms asked her to circle on a scale of one to ten how sure she was she wanted to have an abortion. She circled a three.
She had grown up in a Catholic family. Everyone supported her to make her own decision, she said. But one moment she would be decided, then a few hours later, she would change her mind. She had worked so hard to get to this point in her career, she said, and while she and her partner had great jobs, they were not married, and they were not sure if they were ready to have kids. He supported her no matter what, she said, but that also left the weight of the decision entirely up to her.
She had a tattoo on her arm: a verse from the New Testament. She had gotten it seven years earlier, after she was sexually assaulted in a field when she was out with the cows. She remembered telling her father what happened. Her voice grew quiet.
“I said, ‘Give me something that will make me want to live through this,’” she said.
He wrote her a letter, quoting this verse. It was about the power of love. She inked it into her body.
She had driven more than two hundred miles to get here, one way. Three more trips to go.
In South Dakota, abortion was a two-step process. First, patients had to attend a mandatory counseling session. Then, after a seventy-two-hour waiting period, they could return for their abortion. Those laws, passed in 2011, meant women seeking abortions in the large, rural state often had to travel hundreds of miles for the procedure, even as Roe remained standing. Recently, Republican governor Kristi Noem had signed legislation adding a third mandatory visit for women seeking medication abortions.
The laws were burdensome for abortion providers too. There had not been an abortion doctor living in the state since around 1997, so Planned Parenthood paid to fly in providers. Dr. Traxler flew in twice each week when it was her turn, first on Monday for the counseling and intake, then on Thursday for the procedure. On a wall in her office, Parrow had a giant calendar for the whole year, tracking the rotation of which doctors would fly in on which day to provide abortions. She had mapped it out through September, in case the clinic could stay open.
Everything had become so complicated, but the women’s reasons for coming never changed, Parrow said, just the requirements that they had to meet. That was the point of the laws. Roe did not need to be reversed to effectively end abortion. Abortion just needed to be made functionally impossible.
In South Dakota, it was working. In 2008, there were 848 abortions in the state. By 2021, there were only 192.
Those numbers could get even smaller at any moment. If the court overturned Roe, the decision would trigger a 2005 state law prohibiting all abortion except to save the life of the pregnant woman.
In another room that morning, a patient wiggled her hip bones down on the ultrasound table. She chose not to see the images or hear a heartbeat. But when Dr. Traxler asked if she wanted to take home the images, she said yes. Moments later, she changed her mind.
It was not her first choice, being here. When she had thought about being pregnant for the first time, she had imagined being happy. Now, when she read posts on Facebook groups for moms, she just felt anxious. She and her partner had just moved into a new apartment, and they needed to get a new car. It felt like they were struggling to survive, she said. She was twenty-one. Really, she said, she was not ready.
“I’m just a lowly waitress,” she said. “I really don’t make a lot of money.”
Adoption did not feel like an option either. There were so many kids in the system right now who were going to foster care, and she could not do that to another child, she said.
“I don’t want my kid going into the system and then thinking that I didn’t want them, because it’s not that I don’t want them,” she said. “It’s just that I don’t want to have them be struggling with me.”
Her voice grew tight and shaky. The abortion would cost her about $400, and combined with the cost of the first appointment, it was more than she made in a month of tips, she said. She had to come up with the money by Thursday. But the abortion would be much cheaper than raising a child, she thought.
She worried she was not making the right choice. The father was worried about how stressed she was, she said. She was trying to manage several illnesses, including borderline personality disorder, depression, and anxiety, and she had felt terrible since she stopped taking her medications while pregnant.
“It’s so hard taking care of myself as it is,” she said.
During the ultrasound, she did not look at the screen. The fetus measured at twelve weeks and two days. She sat back up and wiped off the gel.
Like most of her friends and family, she was “pro-choice,” she said. But she felt weird about getting an abortion almost into her second trimester. She knew in South Dakota, it was legal to get an abortion through the twelfth week of pregnancy at a clinic and through the twenty-second week at a hospital.
“I don’t know, that feels a little long to me,” she said. “But if it’s legal, I mean, I can’t say anything against it, I suppose.”
Before she left, she asked if they could do the abortion on Friday instead of Thursday. It would still be after the seventy-two-hour waiting period, she said, and she had to work at the restaurant on Thursday and did not want to lose her shift. No, Dr. Traxler explained. The law required that the procedure be done by the same doctor who conducted the counseling, and she could only fly in on Thursday.
“All right,” the patient said. “I’ll just tell them that my doctors say that my pregnancy is nonviable and they’re going to remove it on Thursday. I’ll tell my grandma that, and then she’ll take my shift.”
Dr. Traxler asked if she wanted to talk through her feelings. “We’re here for you no matter what you decide,” she said before walking to her next appointment.
Dr. Traxler remembered when her daughter was about ten, and they went on a mother-daughter date to the ballet. Her daughter started telling a story she had heard about her friend’s cousin, who was nine years old and pregnant. Dr. Traxler stopped. She talked with her daughter about appropriate touch and consent. When they finished, her daughter had a wish for her friend’s cousin: “I wish there was a way she could become un-pregnant,” she told her mom.
Dr. Traxler was relieved to be able to tell her that there was. “I said, ‘It’s called abortion; it’s what I do for a living. I make people not pregnant anymore who don’t want to be pregnant,’” Dr. Traxler remembered telling her. “She looked up, and she said, ‘Oh, she should totally do that.’”
Dr. Traxler was young, too, when she first heard about abortion in the foyer of her Southern Baptist church in Louisiana, and opposed the procedure. But then in college, one of her friends had one. Listening to her wrestle through the decision, Dr. Traxler changed her mind. Eventually, she left the church.
Now, her daughter was almost twenty and very angry about what was happening, Dr. Traxler said. Everywhere, women’s roles were increasingly being confined, by the lack of childcare, by the pandemic, by the pending decision from the court, she said. Everything felt backward.
Dr. Traxler worked her way through the next dozen patients. Julia, twenty-eight, said she was against abortion like her Christian family. But she was also a single mom, with three-year-old twins and a five-year-old, who were living in Honduras with her mother. She sent back $2,000 monthly to support them. She couldn’t afford another child. “I wouldn’t be able to provide them the lifestyle I am providing them,” she said. “It’s not a big lifestyle. But it’s a decent one. I’m preparing them for the future.”
Another woman brought her daughter, who played with her Barbie car in the exam room, as her mother explained that she was not there because of finances but because caring for a child was so much more than that—it was time, emotion, physical labor. Some patients that day did not speak English. Another was a transgender man.
Then Dr. Traxler came to the last name on her list. The final patient, waiting across the hall.
Amber sat in the chair, small and pale and swallowed up in a huge red hockey sweatshirt. Her orange-blond hair was limp around her cheeks.
Her best friend tucked her feet up on Amber’s chair. She was pregnant, too, due on Christmas Eve. When she found out she was pregnant, she called Amber—“You’ll be next!” she said. And she was. They were twenty-one and twenty. But things had changed. “She’s having her kid, and I’m not having mine,” Amber said.
The two women listened to Dr. Traxler’s voice on an audio recording.
South Dakota law requires that I tell you that you have the right to review all of the material and information described in South Dakota Codified Laws Section 34–23A-1. Section 34–23A-1.2 34–23A-1.7 inclusive. Section 34–23A 10.1 and section 34–23A-10.3. Section 34–23A-1 contains the definitions and terms used in South Dakota laws regarding performance of abortions.
The tape stretched on for five long minutes, describing the things the state had determined Amber needed to hear before she had the procedure. It told her she might be able to get some assistance for childcare or neonatal care. That the father of the child would be legally required to pay child support, even if he was the one who said he would pay for the abortion. It told her the name and number of a nearby antiabortion pregnancy health center. Amber had to listen and then report back what numbers she heard at the end, to prove she had listened all the way through.
She didn’t need any of that. She had circled a ten. She asked for a surgical abortion to be sure it was completely over.
Parrow went through her health history. Amber said she was diagnosed with bipolar I, borderline personality disorder, and gastroparesis, but had not found lasting treatment that helped her. She vaped, but had stopped drinking six months ago. She used marijuana for her nausea. Parrow asked her questions, questions she had asked hundreds of patients over the years.
Are you in a monogamous relationship?
Have you been hit, slapped, kicked, or otherwise physically abused by anybody?
Have you ever been forced to participate in a sexual activity that made you feel uncomfortable?
Has your partner tampered with your birth control, refused to wear condoms, or pressured you to become pregnant?
Are you afraid your partner will hurt you if you say you have an STI and your partner needs to receive treatment?
You’re aware of all the other options that are available and you’re confident in your decision to continue the abortion?
Amber answered each one. “I’ve been asked like five times by everybody today. They’re like, ‘Are you sure?’ And I’m like, ‘I’m 110 percent,’” she said.
She felt safe now, living back home and six minutes from her best friend. She told her ex’s parents she planned to get the abortion, and they supported her, she said.
The young women rolled their eyes at the mention of Amber’s ex and railed against his misdeeds. In the breakup, he tried to take furniture she had bought with money she got from OnlyFans, Amber said. They remembered becoming friends, when Amber had just a trash bag with four outfits and a pair of boots.
Amber said she would do the STI test another time, once she checked if insurance would pay. Her paperwork was time stamped 3:34 p.m.
Three days later, just after 3:34 p.m., she returned.
She had the last abortion legal under Roe in the state of South Dakota.
Days later, after the Supreme Court decision, she posted on social media. “If I wasn’t able to get my abortion, I wouldn’t be here right now,” she said. “I would have unalived myself.
“My abortion saved me.”