Inside a Michigan clinic, patients talk about abortion — and a looming statewide vote

The night before her abortion, Melissa had to travel to another state. She drove overnight from Ohio to Michigan, and didn't reach her hotel until 3 a.m. But just a few hours later, she had arrived on time for her 8 a.m. check-in at the front desk of Northland Family Planning in Sterling Heights, Mich.

Melissa is part of a record surge of abortion patients pouring into Michigan since Roe v. Wade was overturned this summer. For nearly three months, Melissa says, she had been trying — and failing — to find an abortion closer to home. By the time she arrived at Northland, she was 14 weeks pregnant.

"I was so relieved, after the struggle," Melissa says, "Because I had to sit with [this pregnancy] for weeks."

NPR agreed to not to use full names for all the patients interviewed in this story because of the intimate medical information discussed concerning a highly politicized and controversial issue.

The Northland waiting room is built to feel welcoming, even pretty. Big windows look out on tall pines bending in the breeze. The TV is set to the cheerful chatter of women remodeling their modern farmhouses on HGTV.

On the walls are inspirational quotes, including "Good women get abortions." And "Brave, beautiful women have been where you are right now."

The patients here wait quietly, and alone — no spouses, no boyfriends, no family or friends.

Melissa had swept her hair into a loose bun, and pulled her hands inside the sleeves of her sweatshirt. Finally she was here. She had made it.

A haven for abortion, but for how long?

Northland was started in 1976 by Renee Chelian. She had undergone an illegal abortion at age 15, back in 1966, seven years before Roe v. Wade.

"'You can never tell anyone, because no man will ever marry you if he knows that this has happened,'" Chelian recalled her father telling her afterward. 'You're going to be OK. We're going to take care of you. After this conversation, we'll never discuss it again.'"

Northland now has three locations in the greater Detroit region. Across Michigan, there are more than two dozen clinics that provide abortions.

In recent months, patients have been traveling to Michigan for abortion care from Wisconsin, Indiana, Oklahoma, even as far as Florida and Texas.

But abortion rights in Michigan are far from certain: court battles have been continuing for months over a 1931 state law that criminalized abortions, with no exceptions for rape or incest. After Roe v. Wade established a federal right to abortion, that law lay dormant for decades, but was still on the books. Earlier this year, both Planned Parenthood and Michigan Gov. Gretchen Whitmer filed lawsuits to prevent the law from going back into effect.

So far, courts have blocked enforcement of the 1931 law. But the appeals and judicial wrangling continue — and the uncertainty has been stressful and confusing for abortion providers in Michigan.

On August 1 for example, rapid-fire court rulings meant that abortion in Michigan was legal at breakfast, illegal at lunchtime, but legal once again by dinner.

Ultimately, if abortion is going to stay legal in Michigan, it could come down to this election. On Tuesday, voters will decide whether to pass Proposal 3, which would explicitly enshrine the right to abortion in the Michigan constitution, as well as other reproductive rights.

Today, anyone visiting Northland Family Planning's website is greeted with a pop-up window urging them to vote 'Yes' on Prop 3 on Nov. 8.

Northland's founder Chelian, now 71, is like a hummingbird: a petite powerhouse who never stops moving. She has spent most of her adult life pouring that energy into creating the clinics she wished had existed when she was 15: spaces that are spotless but not soulless, where soothing music plays in the procedure rooms. After their appointments, patients receive a brown paper bag with their prescriptions inside, and their names and a small heart drawn in pink marker on the front.

Northland feels very different from the first place Melissa went to a few months ago, when she discovered she was pregnant.

A confusing detour to a crisis pregnancy center

At first, she panicked. A mom of two, Melissa was going through a divorce, working full time, and getting her bachelor's degree. She called what she thought was a women's health clinic near her home in Ohio, and staff there promised her they could refer her for an abortion.

When she arrived, a nurse gave her an ultrasound and told her she was a few weeks pregnant.

But then the appointment took an unexpected turn. "She wanted to pray for me," Melissa says. "She gave me a Bible. It didn't even seem like it was religion until the very end ... They were posing to be so pro-choice, and they're not."

Melissa had ended up at a crisis pregnancy center. Such centers are usually religious, and most aren't licensed medical clinics, though their advertising can be misleading. Their primary goal is to convince people not to get an abortion.

At Northland, Melissa cried as she remembered the confrontational conversations she had with staff inside the crisis pregnancy center.

"I'm in this weird situation of, I'm going through a divorce, and I slept with somebody one time. And then I got pregnant. And they were like, 'Are you sure that you don't see a future with this guy? What if we brought him in here?' They were trying to talk me into having a baby that I couldn't have, and then they're trying to talk me into a relationship. It's crazy."

Once Melissa understood the Ohio center wasn't going to help her, she tried to make her own appointment. At the time, abortions in Ohio were banned after six weeks. And every clinic near her home had long wait lists. By the time Melissa got this appointment in Michigan, she was 14 weeks pregnant.

"And I just feel so much better, because I have two kids, I have a ten-year-old and a two-year-old," she says, taking a deep breath. "It shouldn't be this hard."

When Melissa's name is called, a staff member brings her from the waiting area into one of the procedure rooms, where she meets the doctor who'll perform her procedure: obstetrician-gynecologist Audrey Lance.

"Hi!" Dr. Lance says warmly, entering the room. "What questions do you have?"

A clinic doctor tries to stay hopeful

Like many of the patients who come here, Lance has kids, and the shared experiences of parenthood — Halloween costumes, soccer games, the agony and ecstasies of living with a toddler — provide most of the small talk before the procedure begins, or the abortion pills are dispensed.

Earlier this year, Lance was dyeing the tips of her short brown hair purple — it helps nervous young patients relax when she walks in and they see their abortion doctor is actually a woman with cool purple hair.

Every little moment of connection and ease is important, given how public, politicized and ugly the legal fights over abortion have become, Lance says. "It has been a hard couple of months, ever since the Dobbs decision."

In Michigan, the fighting in the courts about the state's 1931 abortion ban continued for months. Was it in effect or not? Could it be enforced?

"And it seems like every week, sometimes every day, there was a new thing happening that was affecting how we could work, or whether we could work and whether we could continue to provide care," Lance says.

"People care about this," Lance says. "People are pissed. They are really, really pissed."

Despite the turmoil of recent months, she's optimistic Prop. 3 will pass, and nullify forever any threat from that 1931 ban. "I am hopeful. But..." she sighs, then pauses. "I think you just have to be. How could I come to work everyday if I wasn't?"

'I don't think I could survive'

Northland's clinic in Sterling Heights sees about 22 to 24 patients a day. On the nine days a public radio reporter visited, about half of the patients agreed to an interview or allowed the reporter to accompany them during the office visit or surgical procedure.

The patients wanted to explain what abortion access meant for their own lives - especially given the upcoming ballot referendum in Michigan: If people are going to be voting on this, I want them to know what this really looks like.

Among them was a woman in her early 30s who wanted to be identified only by her first initial, A.

A. is a slender, energetic mom with big, bright eyes. She's quick to cut through any tension with a joke. But she dissolves into tears when asked about why she came to Northland.

"I don't think I could survive if I knew that I had to have these babies with an abusive person," A. says. "That's insanity to me. I feel like a prisoner."

A. has two toddler girls, and says her former partner had been violent. She took the girls and left, and was trying to get a personal protection order when she found out she was pregnant with twins.

She told her 3-year-old daughter that she wasn't going to keep this pregnancy.

"My daughter was so cute. She said, 'OK, well, maybe another time, maybe later.' I was like, 'Yes, maybe later.'"

Her face clouds over. "Because she doesn't know that at the end of the day I can't physically, financially or mentally handle two more kids."

She's tried in the past to get her tubes tied, she says.

"I've asked and begged to be, like, fixed or snipped or whatever it is that they have to do. They deny me," she says, sobbing. "But then I end up on medication for birth control. It's insanity."

"And I'm so fertile that it's like, literally, I just, I have to stop having sex in order not to be pregnant. So, abortion, even though this is my first one, I'm happy that it's here because I don't know what I would do right now."

After a moment, A. wipes the tears off her face. She manages a small smile. "That's more sharing than I've done in like, ten years. I'm like the Grinch: my heart's getting bigger."

A. is what you might imagine when you think about why someone would need an abortion: An abusive relationship. Money problems. Emotional distress. And you do see a lot of that at Northland.

But you also see patients who are in great relationships, they're financially stable, and emotionally composed. Women like M. — who also asked to be identified only by her first initial.

"I want to go back to work and just kind of have something for myself other than just be a mother all day, every day," she says, tucking a strand of hair behind her ear.

M. is married and has three kids, the youngest of which is about to enter school. After ten years of staying at home with her children, M. felt like she was on the cusp of something new.

"And I wouldn't trade my kids for anything, I love them to death," M. says. "But I just feel like that phase of my life is over. And it was an amazing phase. But I don't want to keep going back. I want to go forward."

At Northland, the pills for medication abortions are prescribed and dispensed in the morning, while the afternoon is dedicated to the surgical procedures.

"Okay, so I'm just going to get you set up on the table and we're going to do that sedation medicine," Lance tells one patient, who agreed that the reporter could observe and record her procedure, but asked that she not be identified.

The woman, who is from Michigan and already has a toddler, was about 11 weeks pregnant. Nearly 90% of abortions performed in Michigan are done within the first 13 weeks of pregnancy — and more than half are medication abortions.

In the procedure room, a comforting hand

Once the procedure starts, the lights are dimmed and soothing music plays. The patient wears a medical gown, her bare legs in stirrups, and the staffer next to her, holds her hand and guides her through it.

For several of the procedures that the reporter observed, Northland staff member Brandee was the person who comforted and coached the patients.

"Squeeze my hand, and just keep breathing," she says, leaning in close.

It's typical for patients to be partially awake during first trimester abortions. Northland Family Planning gives every patient numbing medication applied to the cervix, and intravenous medications for pain and anxiety (fentanyl and midazolam).

You may feel some strong cramping and intense pressure, Lance tells her patient, "but I know you can do it."

You're going to blow out your breath like you're blowing out a candle, Brandee instructs, firmly and clearly.

The patient grips Brandee's hand tighter, her eyes squinting in discomfort.

"I can't," the patient gasps at one point, when the cramps became intense.

"You can do it," Brandee says. "Keep breathing. You're almost done. Just keep breathing."

And then, after just a couple minutes, it's over.

"You did it!" Brandee says.

The patient's relief is palpable. "Thank you guys so much," she murmurs.

Abortion rights on the line in Michigan

At Northland, what you hear a lot from patients is: I'm doing this because I have this picture for my life, and the things I want.

One woman, who asked that we not identify her, says she knows she wants to be a mom eventually. But first, she wants to finish school.

Sitting in the waiting area, this patient talked about how hard the journey to Northland had been. How she hid it from her mom at first, until her aunties threatened to tell her mom if she didn't do it herself. How her mom was surprisingly supportive, getting up early with her that morning, and making sure she ate a good breakfast before her appointment.

The patient shifted from side to side in her chair. She wore a spotless set of matching sweats, a low ponytail tucked beneath a crisp baseball hat.

Sure, she says, she knows that a lot of women get abortions. But that doesn't make this feel any easier.

"We feel like we have to sneak in, do this," she says. "Some of us put our lives at risk doing it."

But she did not want to be trapped with the guy who got her pregnant, she says. She asked him if he could help her pay for this abortion. But the most he could do, he told her, was split it.

"The guys, they're never held responsible for things like this, ever," she says. "It's always the woman. We always got to step up and take care of it. Whether we keep it or not, it's always put in our lap."

Nearly every patient interviewed at Northland knew about Prop. 3, the constitutional amendment to protect abortion rights in Michigan. Some of them were hopeful it would pass. Others were scared it wouldn't. Lots of them were in disbelief that abortion care had become something they had to fight for.

And some, like this patient in the baseball cap, were angry. When asked if there was anything she wanted voters to know, she said yes:

"Stop thinking it can't touch you. It could touch you in so many ways. It could be your mother. It could be your sister. It could be your niece. It could be your daughter. Your future, your future daughter. Your future wife. Stop thinking it's not going to touch you, man or woman."

This story was edited by Carrie Feibel and produced as part of NPR's health reporting partnership with Michigan Radio and Kaiser Health News (KHN).