The windows of The Boulder Abortion Clinic in Colorado are made of bulletproof glass. Staff enter and exit through a secure door, and the owner of the clinic, Dr Hern, goes to work expecting to be assassinated any day.
These kind of abortions are very rare - according to sexual and reproductive health research body The Guttmacher Institute, just over 1% of abortions are performed at 21 weeks or later.
In Britain, abortion is legal and available on the NHS for up to 24 weeks, but if there is substantial risk to the mother or baby’s life, there is no time limit.
“We oppose abortion at any time during pregnancy, including late-term. A new human life begins the moment the egg is fertilized by the sperm; that human life is precious and deserves protection. Members of the pro-life movement have opened their arms and their hearts to women who face a difficult pregnancy. Every woman should know that killing her child will not make her life easier or make her more successful. Every abortion stops a beating heart.”
Colorado, where Dr Hern’s clinic is based, is one of only seven US states that doesn't limit abortion by gestational age at all.
Patients travel to see Dr Hern from all over the world. He estimates that, since 1975, he’s seen around 40,000 patients.
The women we see are usually desperate. There’s this sense of fear and despair - they see us as the last resort on the planet.Natalie, Nurse at The Boulder Clinic
Natalie (not her real name) has been a nurse at The Boulder Clinic her whole working life, from age 19 to 37.
She saw a job ad in the paper that simply said, ‘Support a woman’s right to choose’, and applied.
Over those 18 years, she’s cared for women in all kinds of circumstances. But one thing has united them all.
“The women we see are usually desperate. There’s this sense of fear and despair - they see us as the last resort on the planet.”
There are many reasons for seeking a late-term abortion, but the most common is severe medical complications.
As Natalie explains, “Things can just go wrong with a pregnancy. Everything can look fine at 20, 25 and even 30 weeks. Then, all of a sudden, the baby or even the mother can be at serious risk.”
Kate Carson, a teacher from Massachusetts, was told at 35 weeks that her baby had a congenital disorder, a brain disorder and a condition called Dandy-Walker malformation. This meant that her daughter, who she and her husband had already named Laurel, was expected to never walk, talk or even swallow – and that’s if she even survived birth.
Kate and her husband felt they couldn’t bring Laurel into such a world of pain, and after many counselling sessions, went through with the abortion at Dr Hern’s clinic.
Reflecting afterwards, Kate said, “I did not ever doubt I was doing the right thing for her, but that did not make it easier.”
Natalie remembers a patient who had not one, but two diagnoses of foetal abnormality within a year, and had to visit the clinic on both occasions.
“Her strength and resilience will always stay with me,” Natalie says. "She was going through such tragedy, but there she was, greeting us like old friends, bringing us chocolates. Having that kind of grace in those circumstances just makes you want to be more like that yourself.”
For some of Dr Hern’s patients, other factors are at play.
“We have had many, many patients over the years that have been victims of incest or sexual assault,” Natalie tells me.
“Some are from such religious backgrounds that they fear being kicked out or even killed by their parents just for being pregnant. Often they just hope the pregnancy will disappear, or not even realise it’s happening until it’s too late.
"We had one very, very young girl travel to us from Canada. She had been a victim of rape and incest, and was accompanied by the protective services – no family, no friends.
“She came to us in winter, so young she was still wearing Tweetie-bird cartoon mittens. We were just all so desperate to help her, and to help her get through this.
“I think now, she’ll be a young woman in her twenties. Is she ok? Does she have a family? You have all these unanswered questions working here, all these holes inside you that never get filled.”
Almost everyone has tremendous anxiety. They’re worried about whether I know what I’m doing, about the disapproval of others, and about being attacked by demonstratorsDr Hern of The Boulder Clinic
How does Natalie put these women, who are often suffering extreme emotional distress, at ease?
“I just try and put myself in their shoes.
“We treat them like they are our friends or our sisters going through this. And reassure them by telling them that Dr Hern and all the staff do this procedure every single day."
Dr Hern tells me, “Almost everyone has tremendous anxiety. They’re worried about whether I know what I’m doing, about the disapproval of others, and about being attacked by demonstrators.”
Boulder is a fairly liberal place, but the clinic is very aware that it’s a target for anti-abortion campaigners. After Dr Tiller’s assassination in 2009, they were given US marshal protection, where Dr Hern had a team stationed around his office, home and anywhere he travelled, for 24-hour protection. In 1988, five shots were fired (unsuccessfully) at a staff member, and there have been countless incidents of slashed tires and vandalism.
But, Natalie says, “Usually after meeting us all on the first day, the patients realise we’re going to treat them with dignity and respect, and they feel much more comfortable."
The procedure itself isn’t cheap. Dr Hern tells me that the later abortions can cost several thousand dollars, because, he says, “There’s a lot of very highly qualified, professional and dedicated people helping me to do this, not to mention the cost of the facility, security and insurance.”
Natalie says, “Many women don’t have the funds for the procedure, so I make it my mission to loop in the right organisation to help.”
Dr Hern is brusque on the phone. Referring to the security risks his jobs entails, he tells me, “No reasonable person would do what I do.” But he’s matter-of-fact about it.
“It’s my work. The patients need my help and I’m here to help them. I’ve had a lot of choices in my life to do other things, but this is what I do, and I’m determined to do it.”
Natalie considers herself extremely fortunate to have worked with Dr Hern, and hints at a softer side.
“He’s really amazing. He has lived this long, adventurous life, and seen a lot. When there’s absolutely nothing he can do for a patient, for example, if they have pre-existing medical conditions that prevent him from operating, that really weighs on him. He wants to be able to help everyone.”
The procedure itself is usually a four-day process, depending on exactly how far the pregnancy has progressed. While every care is taken to ensure the mother is physically and emotionally prepared, it’s an incredibly stressful experience.
With no trainees currently employed, and Dr Hern approaching 80, the future of The Boulder Clinic is uncertain.
“After 18 years of speaking with these women, hearing their stories every day, I know there’s no more important procedure when it comes to women’s health care right now,” Natalie says.
"It can be a matter of life and death, as well as fundamental to the wellbeing of their families and their future.
“Even when the days are really taxing or difficult, someone might tell you as they’re being discharged that ‘you’ve given me my life back’, and you realise just how important, how crucial having the freedom to make this kind of choice is.”