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Maryland

With access in peril, 2 women open a later-abortion clinic in Maryland

Diane Horvath leaned across the table to read the latest list off her phone: operating room lights, waiting room furniture and a storage closet. An abortion clinic closing in Georgia offered to sell all of it, cheap.

Horvath, a physician, and Morgan Nuzzo, a certified nurse-midwife, are scrambling to amass secondhand medical equipment, raise money, hire staff and complete renovations in preparation to open a clinic in College Park.

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In the seven weeks since a leaked draft opinion showed the Supreme Court voted to overturn Roe v. Wade, the landmark ruling legalizing abortion nationwide, Horvath and Nuzzo have been part of a nationwide reshuffling of providers, equipment and even buildings. The National Abortion Federation created an online members-only marketplace where buyers and sellers can connect.

“We know patients are going to have to leave the South to come up to Maryland, and maybe North Carolina, maybe Virginia,” Horvath said. “We are going to physically transport abortion care from the South to up here. We know patients are going to be relocating, so we’re actually relocating practices basically, which is …”

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“Bittersweet,” Nuzzo interjected.

The clinic will be one of a handful of facilities in the country that prioritizes abortion later in pregnancy, a term that often refers to abortion after 21 weeks because of how the Centers for Disease Control and Prevention collects data on abortions, according to the Kaiser Family Foundation.

As access is restricted as a result of Friday’s decision, Horvath and Nuzzo expect more people will need abortions later in pregnancy because every day they struggle to arrange for the procedure and associated costs, such as transportation, lodging and child care, their pregnancies will progress. The later the abortion, the more expensive and harder it is to obtain.

The ruling rescinds a constitutional right to abortion and leaves it up to the states to regulate the procedure. Twenty-six states are “certain or likely to ban abortion” following the court striking down Roe, forcing patients to travel to obtain procedures and exacerbating what is already a time-consuming, stressful and expensive process in much of the country, according to the Guttmacher Institute, a nonprofit research organization that supports abortion rights.

Melissa Fowler, chief program officer at the National Abortion Federation, an association of abortion providers, said the decision generally put member clinics and providers into three categories: Some are preemptively closing, some are shifting their practices to, for example, gynecological or gender-affirming care and some are expanding to provide additional capacity.

The vast majority of abortions, about 93%, take place early in gestation, before 14 weeks, and about 6% take place between 14 and 20 weeks of gestation, according to 2019 data from the CDC. A very small number, fewer than 1% of abortions, were performed at or past 21 weeks, data shows, but they attract the most attention from antiabortion activists.

People may seek abortion later in pregnancy because they get new information about the pregnancy, such as a fetal anomaly or a factor threatening the life of the pregnant person; their life circumstances change drastically; they discover the pregnancy very late; or they face barriers to obtaining an abortion, such as cost or lack of information about clinics, according to a KFF analysis and experts in later abortion.

“They’re all valid reasons,” said Fowler of the NAF. “We should be doing more to help people access care in their communities when they need it.”

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Horvath and Nuzzo stood on the concrete floor in a 10-by-15-foot storage space earlier this month and surveyed their haul. A $15,000 exam chair for $4,500, a used ultrasound machine that costs $30,000 new, ultrasound gel warmers, blood pressure cuffs.

They had spent a day the previous month moving equipment by U-Haul out of their homes in D.C. and Maryland and into the storage space down the road from the site of their clinic, a unit in an office complex that they will lease from an investor who supports their mission, the women said.

Nuzzo unfurled a rainbow Safe Space welcome mat.

She and Horvath talked for years about opening their own clinic but didn’t seriously consider it until November, when both found themselves out of jobs. They anticipated the court would move to leave abortion up to the states, effectively banning it in about half the country and increasing demand, and knew the Maryland legislature was poised to allow advanced-practice clinicians, such as Nuzzo, to perform in-clinic procedural abortion.

They secured a grant to hire an anti-doxing service and, confident their personal information was scrubbed from the internet, published a Go Fund Me page and watched fundraising plod along for months — until everything changed.

They were at dinner in Orlando on May 2 after an annual NAF meeting when phones started pinging with alerts about the leaked opinion. Fundraising picked up.

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They have surpassed their initial goal of $250,000, which represents about one-fifth of the costs to start and operate the clinic for the first six months, and will make up the rest through additional Go Fund Me donations, foundation grants and private gifts. The Twitter account @prisonculture sold T-shifts and raised more than $20,000, they said. Nuzzo’s six-person book club gave them $26,000.

“I think what the draft opinion did is it lit a fire under people who said, ‘This is never going to happen,’” Horvath said. “But this was all part of the plan for ever and ever. From the lowest appellate courts all the way up to the Supreme Court.”

“We’ve been living in the grief for almost a year,” Nuzzo said. “Now to see other people grieving — part of it is wonderful because you’re like, ‘Oh, you get it now.’ Part of it is like, ‘Where have you been?’”

Partners in Abortion Care will be unique in that it will be co-owned by two women — Nuzzo is 34, Horvath 43 — who are mothers, and a rare partnership between a physician and midwife.

They plan to start by performing five to 10 abortions later in pregnancy, typically a two-to-three-day process, and a few earlier in pregnancy, per week. Most of the women they care for will have received money from an abortion fund or practical support network and will be traveling from outside the D.C. metro area.

Before Friday’s decision, 43 states prohibited abortions after a certain point in pregnancy, with some exceptions, according to Guttmacher. In Maryland, an abortion may be performed at or after viability if the patient’s life or health is endangered or if there is a fetal anomaly, the institute says. The parent of a minor must be notified, but health-care providers can waive the requirement in certain circumstances.

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Erika Christensen, a later abortion patient advocate at Patient Forward who had an abortion at 30 weeks, said a clinic that prioritizes later abortion in the D.C. region has a wait list of several weeks, which increased last year after Texas banned abortion at as early as six weeks.

“Less providers are willing or able to provide this care later in pregnancy. There is more discomfort as a pregnancy progresses,” Christensen said. “I understand there is a discomfort and tension there for people in the public.”

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Nuzzo and Horvath consider themselves called to do this work on a spiritual level.

“It’s OK to have feelings about it, but it’s not OK to use those feelings to limit somebody else’s ability to make the decisions they need to make,” Nuzzo said.

“It’s hard for us, it’s hard for the staff, it’s hard for the person having the abortion,” Horvath said. “The fact that we don’t separate our emotions from it makes us really good at it. These patients need a lot of care, a lot of tenderness and compassion and that’s something we can give them.”

Horvath graduated from the Medical University of Ohio; completed her residency at the University of Minnesota; did a fellowship at MedStar Washington Hospital Center, where she pushed back at what she said were efforts to limit her abortion advocacy; and had another fellowship with the Physicians for Reproductive Health, which supports abortion rights.

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“I couldn’t keep saying this care should be provided and not do it, knowing I had the skill set to do it,” Horvath said.

Nuzzo received her nursing degree from New York University, and midwifery training at Frontier Nursing University in Kentucky and midwives at the Community of Hope’s Family Health and Birth Center in the District.

“The mystery of later abortion is it’s been in the shadows for a long time,” Nuzzo said. “I’m not a monster for doing this, I’m a person who’s going to take care of you or someone you love.”


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