In the seven weeks since a leaked draft opinion, the Supreme Court has voted to strike down Roe vs. Wade, the landmark decision legalizing abortion nationwide, Horvath and Nuzzo have been part of a nationwide shakeup of providers, equipment and even buildings. The National Abortion Federation has created a members-only online marketplace where buyers and sellers can connect.
“We know that patients are going to have to leave the South to come to Maryland, and maybe North Carolina, maybe Virginia,” Horvath said. “We will physically transport abortion care from the South to here. We know the patients are going to be moving, so we’re actually moving the practices, which is…”
“Bittersweet,” Nuzzo interjected.
The clinic will be one of the few facilities in the country that prioritizes abortion later in pregnancy, a term that often refers to abortion after 21 weeks due to how the Centers for Disease Control and Prevention collect data on abortions, according to the Kaiser Family Foundation (KFF).
As access is restricted Following Friday’s decision, Horvath and Nuzzo expect more people to need abortions later in pregnancy as they struggle every day to arrange the procedure and the associated costs, such as the transportation, accommodation and childcare, their pregnancies will progress. The later the abortion, the more expensive and difficult it is to obtain.
The decision overturns a constitutional right to abortion and leaves it up to states to regulate the procedure. Twenty-six states ‘certain or likely to ban abortion’ following court overturn roe deerforcing patients to travel for procedures and exacerbating what is already a long, stressful and expensive process in much of the country, according to the Guttmacher Institute, a nonprofit research organization that supports the right to abortion.
Melissa Fowler, program manager at the National Abortion Federation (NAF), an association of abortion providers, said the decision generally categorizes member clinics and providers into three categories: some are closing preemptively, some are shifting their practices to, for example, gynecological services. or gender-affirming care and some expand to provide additional capability.
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 gestation, according to 2019 data from the CDC. A very small number, less than 1% of abortions, were performed at 21 weeks or older, according to the data, but they attract the most attention from anti-abortion activists.
People may seek an abortion later in pregnancy because they get new information about the pregnancy, such as a fetal abnormality or a life-threatening factor in the pregnant person; their living situation changes radically; they discover the pregnancy very late; or they face barriers to getting an abortion, such as cost or lack of information about clinics, according to a KFF analysis and experts in later abortion.
“These are all valid reasons,” said the NAF’s Fowler. “We should be doing more to help people access care in their communities when they need it.”
Horvath and Nuzzo stood on the concrete floor in a 10ft by 15ft storage space earlier this month and inspected their loot. A $15,000 exam chair for $4,500, a used ultrasound machine that’s $30,000 new, ultrasound gel warmers, blood pressure cuffs.
They had spent a day in the previous month move equipment by U-Haul out of their homes in DC and Maryland and into storage space down the road from their clinic site, a unit in an office complex that they will lease to an investor who supports their mission, the women said.
Nuzzo has rolled out a Safe Space rainbow welcome mat.
She and Horvath talked for years about opening their own clinic, but didn’t seriously think about it until November, when the two found themselves out of work. They anticipated that the court would decide to leave abortion to the states, effectively banning it in about half the country and increasing demand, and knew that the Maryland legislature was about to license advanced practice clinicians, such than Nuzzo, to perform procedures in the clinic. Abortion.
They obtained a grant to hire an anti-doxing service and, convinced that their personal information had been removed from the Internet, published a Go to Fund Me page and watched the fundraiser unfold for months – until everything changed.
They were at dinner in Orlando on May 2 after an annual NAF meeting when the phones started ringing with alerts about the leaked opinion. Fundraising has resumed.
They surpassed their original goal of $250,000, which is about one-fifth of the clinic’s start-up and operating costs for the first six months, and will make up the rest through additional Go Fund Me donations, grants from foundation and private donations. The @prisonculture Twitter account 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 notice did was it lit a fire under people who said, ‘This is never going to happen,'” Horvath said. “But it was all part of the plan forever and ever. From the lowest Courts of Appeals to the Supreme Court.
“We have been living in grief for almost a year,” Nuzzo said. “Now to see other people grieving — it’s partly 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 doctor and a midwife.
They plan to start by performing five to 10 abortions later in the pregnancy, usually a two to three day process, and a few earlier in the 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 DC metro area.
Before Friday’s decision, 43 states banned abortions after a certain stage of pregnancy, with some exceptions, according to Guttmacher. In Maryland, an abortion can be performed at or after viability if the patient’s life or health is in danger or if there is a fetal abnormality, says the institute. The parent of a minor must be notified, but health care providers may waive this requirement in certain circumstances.
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 DC area has a waiting list. to several weeks, which increased last year after Texas banned abortion as early as six weeks.
“Fewer providers are willing or able to provide this care later in pregnancy. There is more discomfort as the pregnancy progresses,” Christensen said. “I understand that there is an unease and a tension there for people in the public.”
Nuzzo and Horvath consider themselves called to do this work on a spiritual level.
“It’s okay to have feelings about it, but it’s not okay to use those feelings to limit someone else’s ability to make the decisions they need to make,” said Nuzzo.
“It’s tough on us, it’s tough on the staff, it’s tough on the person having the abortion,” Horvath said. “The fact that we don’t separate our emotions 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 is a graduate of Ohio Medical University; completed residency at the University of Minnesota; did a fellowship at MedStar Washington Hospital Center, where she pushed back against what she said were efforts to limit her defense of abortion; and had another fellowship with Physicians for Reproductive Health, which supports abortion rights.
“I couldn’t keep saying this care should be provided and not do it, knowing I had the skills to do it,” Horvath said.
Nuzzo earned her nursing degree from New York University and trained as a midwife at Frontier Nursing University in Kentucky and as a midwife at Community of Hope’s Family Health and Birth Center in the district.
“The mystery of the subsequent abortion is that it was in the shadows for a long time,” Nuzzo said. “I’m not a freak for doing this, I’m someone who will take care of you or someone you love.”