As the national legal battle continues over the abortion pill mifepristone, Massachusetts is expanding the number of facilities that offer it. Health centers on Cape Cod, the South Coast, Martha's Vineyard and Nantucket will begin offering medication abortion in July. But not every patient can use the pills. For those who need a surgical procedure, travel time from our region can exceed two hours each way. CAI reporter Jennette Barnes visited an abortion clinic in Attleboro to learn more about what it takes to access abortion from the Cape and Islands.
A woman in a pale pink T-shirt is calling across a parking lot to someone entering an abortion clinic.
“Good morning, beautiful mom,” she says. “You don't have to do this today.”
Protests happen regularly here, but this isn’t a political hotspot. It’s a quiet corner in Attleboro, surrounded by homes, a park, and a corner store. The region’s only abortion clinic, Four Women Health Services, is set back at a distance from the street, among a collection of small office buildings.
“You don't have to do this today,” she calls again from the sidewalk. “It's a beautiful day for life, and a beautiful day for love.”
The 10 or so protesters at this five-way intersection stay out on the sidewalk, but anyone driving by the clinic passes their signs and an eight-foot wooden cross.
A couple of times a week, a patient enters the wrong building. That’s not an accident. The adjacent building uses the term “women’s health,” and the protesters sometimes direct people toward it.
“There's free medical care right around the corner,” says one woman, “free ultrasound, with women who are really caring for you, to help you make an informed choice.”
The main purpose of that adjacent office, according to the owner of Four Women, is to lure patients in and convince them not to have an abortion.
The Massachusetts attorney general’s office warns that “crisis pregnancy centers,” as they’re called, not only aim to prevent people from accessing abortion, but may also mislead them about how far along the pregnancy is.
No one at the center was willing to talk.
Standing between patients and all this confusion is Dianne Sawyer — “not the reporter,” as she says, but a volunteer escort.
She guides people who are looking for the actual abortion clinic.
“It's your choice,” she says. “Everyone has a choice. And there's many reasons why a woman could be here.”
She says she feels bad for people who have to run the gauntlet of shouting and signs. As is common with abortion protests, one of the signs is a poster-size photograph labeled as an aborted fetus.
“To have such graphic signs out there, it's just — it breaks my heart for the kids in the neighborhood,” she says. “And that's a park — right there, a public park, with a playground and everything.”
So why come to a clinic like this, when you could go to a Boston hospital?
Here in Attleboro, the physician has his own take. To get the answer, we head inside.
But first — no surprise — the clinic has a locked door.
“You can come in the door and have a seat,” says a member of the staff over the intercom.
Hanging on the wall of the waiting room is a pro-choice version of the Gadsden “don’t tread on me” flag, with the snake coiled in the shape of a uterus.
Dr. Marcus Gordon has owned this clinic for about 15 years. It provides medication abortion up to 10 weeks, surgical abortion, contraception, and routine gynecology.
He says the flag and a poster of Ruth Bader Ginsburg are just a hint at the support patients get from a dedicated clinic — support he says may not be as clear if they opted for a hospital.
“It can be very judgmental,” he says. “You may run into someone doing an ultrasound who has a different view on pregnancy termination. And I've had patients where the sonographer will start commenting about the baby when doing the ultrasound, or said other things that were not very sensitive.”
Abortion clinics in Attleboro and Boston are widely considered the closest to Cape Cod and the Islands.
The exception is Nantucket, an hour ferry ride from the mainland, where Nantucket Cottage Hospital offers surgical and medication abortion.
But for patients on the Cape, the drive to a clinic — plus getting time off from work and finding child care for the day — can be prohibitively difficult. From Provincetown, the trip is at least two hours, without traffic. And residents of Martha’s Vineyard have to add a ferry to the drive.
Dr. Gordon says that’s not bad compared to what it can be like in the South.
He travels once a week to help staff a clinic in North Carolina. Patients come from other southern states that ban or tightly restrict abortion now that Roe v. Wade has been overturned.
“Here, we are likely to schedule, at the most, 60 procedures a week,” he says. “The Charlotte facility that I go to schedules probably five-to-six hundred a week. And it's certainly increased with what's happened with Roe v. Wade.”
Yet even with the pro-choice laws in Massachusetts, the southeastern part of the state has been called an abortion desert — until now.
Shortly before leaving office in January, Gov. Charlie Baker announced grants to 11 organizations to expand access to abortion.
One of them is Health Imperatives, which operates seven health centers, including locations in Hyannis, Wareham, and New Bedford, and on the islands of Martha's Vineyard and Nantucket.
CEO Julia Kehoe says no matter what happens with the legal battle over abortion pill mifepristone, all seven of the clinics will offer medication abortion starting in July.
“We're trying to just focus on how we're going to proceed, and how lucky we are to live in a state like Massachusetts that prioritizes health care and recognizes that abortion is health care,” she says.
But back in Attleboro, Dr. Gordon says there’s a twist to expanding access to medication abortion in southeastern Massachusetts. Without the revenue from medication patients, he says his clinic may eventually close.
“Honestly, if the majority of early-first-trimester patients were now not to come here and have their services a little more locally, we wouldn't be able to stay open,” he says. “So that's the reality of it. … We could not survive only doing surgicals. There just aren't enough of them.”
That would cut off a major access point for surgical abortion, which is generally required after 10 weeks of pregnancy — and at any stage for some patients, based on their medical history.
Kehoe, of Health Imperatives, says the Attleboro clinic is important, but adding locations for medication abortion helps fix what she calls a serious access problem in the region.
“I just want people to not lose hope,” she says. “I think it's so harrowing, actually, to be in this point in time where people's rights are being taken away. … It’s chilling.”
In Massachusetts, abortion is certainly legal. But for people on Cape Cod and Martha’s Vineyard, time and distance have often been hurdles to real-world access.