For a long time, many women who had abortions because of catastrophic fetal diagnoses told their stories only privately. Grieving pregnancies they dearly wanted and fearing the stigma of abortion, they sought the closely guarded comfort of online communities identified by the way many doctors had described the procedure — TFMR, or “termination for medical reasons.”
In the two years since the Supreme Court overturned Roe v. Wade, their pain has been compounded into anger by new abortion bans across the country. While these women account for a fraction of abortions in the United States, they have emerged as the most powerful voices in the nation’s post-Roe debate, speaking out against bans with their stories of being forced across state lines and left to feel like criminals in seeking care.
Many of these women started out opposing abortion, but as they have changed their minds, they have changed the way Americans speak about it. Shifting from private anguish to public outrage, they have also helped shift public opinion toward more support for abortion.
“After going through all this I wondered, why are we not the poster child for abortion rights?” said Riata Little Walker, who traveled from her home in Casper, Wyo., for an abortion in Colorado at 22 weeks, after doctors diagnosed Down syndrome and a heart defect in her fetus, which they said would require surgery and later a transplant if it survived until delivery.
“Yes, your body, your choice, but that’s not the story that pulls people in,” she said. “We have to bring our stories to the front because otherwise it’s so easy for those over here to do, ‘But they’re killing babies.’”
Ms. Walker is Catholic and had worked for Wyoming Republicans, including Senator John Barrasso. She opposed abortion, and did not realize she was having one because doctors called it “termination.” In the months that followed, she came to support abortion whatever the reason, and after Roe was overturned in June 2022, she testified against the ban on abortion passed by the Wyoming Legislature.
Although most bans allow abortions to save the life or health of the pregnant woman, few women have been granted these exceptions, and only a handful of bans allow abortions for fatal fetal anomalies. There are no bright lines to define “fatal,” or “medical reason,” and the procedure is the same whether it’s described as termination, TFMR, or abortion.
That makes these cases complicated for doctors, lawmakers, and for the women themselves: What qualifies as a medical reason?
The women speaking out say their experiences made them believe that the law can’t and shouldn’t try to address complex and endlessly varying medical cases. In this, they appeal to rare common ground in what has been a bitter, decades-long debate: Regardless of whether they identify as “pro-life” or “pro-choice” in polls, Americans overwhelmingly say that the decision to have an abortion should be up to women and doctors, not the government.
These women say they now feel compelled not only to speak out but to use the word “abortion,” to remove the stigma they themselves put on it.
“All these things we never even knew before, because before all of this it was never spoken about,” said Kimberly Manzano, who flew from Texas for an abortion in New Mexico at 18 weeks after scans showed her fetus was missing limbs, organs and genitalia.
Ms. Manzano describes herself and her husband as “big Christians,” who thought abortion was something “promiscuous women” did to end unwanted pregnancies. Their pastor assumed they would qualify as a medical exception to Texas’ ban. They did not.
“We feel it’s our calling to our child that we lost that we do need to talk about it, to educate people, because I feel that we were so uneducated,” she said.
Some of the women are appearing in ads in favor of abortion rights ballot measures or candidates. Others are confronting politicians on the campaign trail, testifying or joining lawsuits. But mostly, they are talking to friends, family members and colleagues.
Polls show that people who have heard stories about women who had to cross state lines for abortions because of severe pregnancy complications are more likely to support legalized abortion. That is true even for Republicans or those who think that abortion should be illegal in most cases. Stories like these have also moved voters who oppose abortion to support ballot measures that have enshrined broad abortion rights in conservative states like Ohio and Kansas.
“By telling people’s stories, it makes it reality,” said Megan Kling, who traveled from her home in Wisconsin to Minnesota for an abortion at 23 weeks after a scan revealed that her fetus had no kidneys, so was not creating amniotic fluid, and would die after delivery, if not in utero. “You want to think every woman is perfectly healthy, every pregnancy is perfectly healthy, when in reality there’s a lot of things that can go wrong.”
Ms. Kling said some family members have argued that her situation is different: They support abortion if the fetus has a devastating condition, they just don’t want women using it as birth control. She understands, because she never thought of herself as someone who would choose abortion. “But women need health care options, and that’s what they don’t understand: Abortion is health care,” she said. “That’s what these stories raise up.”
Researchers say it’s not clear how many of the roughly one million abortions each year in the United States would be considered “for medical reasons,” but that they are rare.
Many of these women don’t fit the usual angles of the abortion debate. They bristle at the clinical language of abortion rights groups; instead of “fetus,” they speak of the pregnancies they lost as unborn children. They name them, mark birthdays and imprint their tiny feet on keepsakes.
Ms. Kling found herself in an awkward position after she wrote letters to her state legislators, including the Republicans who represent her, in an attempt to move beyond her grief and anger after losing her pregnancy. She heard back only from a Democrat, and later, from Planned Parenthood and other groups who asked her to speak at events in support of President Biden. She agreed, but explained that she did not necessarily support him. She doesn’t think of herself as a Democrat, but she doesn’t feel like a Republican anymore, either.
“I feel like most people feel that way,” she said. “All the extremists are so loud you almost feel like you can’t speak up.”
Anti-abortion groups argue that bans prohibit only what they call “elective abortions” for unwanted pregnancies, and that any woman who needs an abortion for medical reasons can get one under the exceptions in those bans. They accuse Democrats of manipulating medical patients for political ends.
“Women have been falsely told this is a compassionate option, however, it feeds into the growing trend of disability discrimination and the pressure women face from the medical community to abort children who might have a disability,” said Dr. Ingrid Skop, of the American Association of Pro-Life Obstetricians and Gynecologists.
On the other side, abortion rights groups fear that elevating TFMR stories promotes the message that abortion should be protected only if it is “justified,” not that it should be every woman’s right. “People need abortions for all kinds of reasons — financial, medical, life circumstances — and none should be stigmatized,” said Nancy Northup, the president of the Center for Reproductive Rights.
Even within online communities, there is debate: Is it acceptable to terminate if a child would live only a few hours? A few days, a few years? What about the “gray” diagnoses — where a fetus is likely to survive into childhood but live a life severely constrained by surgeries, medications, machinery and hospitalizations?
Women describe weeks of waiting for additional scans, hoping for miracles, poring over statistics on survival rates and research on quality of life. Some elect to continue their pregnancies.
“Theoretically, if I had a Down syndrome diagnosis, I would keep them,” said Martha Sheppard. She and her husband, a teacher, learned on a 20-week anatomy scan that their daughter’s spine had not fused — the diagnosis was spina bifida — and would require an unknown number of surgeries, the first in utero. They moved from their home in Virginia to a Ronald McDonald House near a hospital in North Carolina for further tests, and researched. Three weeks later, they decided to terminate.
“To keep a child with spina bifida is also a loving decision,” Ms. Sheppard said, “but my husband and I decided that it was a loving decision not to bring her into the world with the body that she had.”
The women might seem to be making the case for medical exceptions — dozens have joined lawsuits filed by the Center for Reproductive Rights in four states, seeking to clarify what conditions qualify as exceptions under abortion bans. Instead, “Exceptions don’t work, is what we’re proving,” said Ashley Brandt, a plaintiff in Texas.
Ms. Brandt traveled to Colorado to abort a twin that had acrania — it had no skull — and posed a threat to her other fetus. “It wasn’t just me at risk, it was my viable daughter,” she said. “We still were not an exception.”
She learned of the option to selectively abort only from a TFMR group online; her doctors had been afraid to mention termination for fear of prosecution. She saw the shame and isolation that women in those groups felt, and felt it herself. Some of the harshest comments, Ms. Brandt said, came from women struggling with infertility who cannot imagine choosing to end any pregnancy. Like many of the women now telling their stories in public, she said her experience has made her feel more compassion for women who choose abortion no matter what the reason.
“Picking and choosing, it has to stop,” she said. “We need to trust people to make their own decisions.”
But the women say it remains a fight simply to explain that what they had was an abortion.
Months after Ms. Manzano’s abortion, she noticed her doctor had recorded it as “spontaneous miscarriage” on her chart.
“We had to travel to New Mexico,” Ms. Manzano said. “There was nothing spontaneous about it.”
She has been seeing a grief counselor, who refers to it as her “medical miscarriage,” even after Ms. Manzano told him she prefers to say “abortion.”
“Neither one of us corrects the other,” she said. Still, “for me to be able to grieve and heal through the process, I have to be able to say what it is.”
