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In most of the country, pregnant women who face a grave medical diagnosis late in pregnancy have few options. Many states impose heavy restrictions on abortion in the second or third trimester. Only a handful of doctors will perform the procedure in the late stages of pregnancy. One of the few clinics in the country offering that procedure is in Colorado. And as NPR's Sarah McCammon reports, a ballot initiative before voters there could shut it down.
SARAH MCCAMMON, BYLINE: Last year around this time, Tammy, her husband and their son were getting ready for a big expansion of their family. They learned she was expecting twins - one boy, one girl.
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UNIDENTIFIED PERSON: A boy and a girl. It's a boy and a girl.
MCCAMMON: In this video from their gender reveal party around Christmas time, Tammy's growing belly and her smile are hard to miss as they celebrate both babies the family is expecting.
TAMMY: It was great. And I think my husband and I would both say that that was probably the highest point of what had already been a difficult pregnancy.
MCCAMMON: Tammy's 37 and a teacher from the Atlanta area. We're not using her last name because she's worried about facing stigma for sharing her story. Around 25 weeks, Tammy and her husband learned their daughter, whom they named Victoria, had a rare condition that could mean a lifetime of seizures, heart problems and developmental delays.
TAMMY: Thinking about having twins after already having a toddler and then one of those twins constantly being in and out of the hospital, I don't know how I would have been able to give enough love and attention to my boys.
MCCAMMON: Georgia bans most abortions after 22 weeks. Tammy's doctors referred her to a clinic in Boulder, Colo., founded by Dr. Warren Hern, one of few physicians nationwide who specializes in later abortions.
WARREN HERN: The women who come to me are in extremely difficult circumstances. This is the most painful and difficult decision of their lives.
MCCAMMON: Tammy's case was particularly complicated because of the other twin, who was born healthy a few weeks after her procedure. Hern estimates that, like Tammy, about 85% of his patients come from outside Colorado, most beyond 22 weeks. Those procedures would be banned under Proposition 115, which would prohibit abortion after 22 weeks except to save a woman's life. Doctors found in violation could face fines and lose their medical license. Hern says many of his patients are facing a medical crisis. Others have been victims of rape or incest and may have faced delays in getting an abortion.
HERN: And so I think these are very private decisions.
MCCAMMON: Later, abortion is relatively rare. A little more than 1% of abortions nationwide occur after 21 weeks, according to the Guttmacher Institute, which supports abortion rights. The 22-week cutoff is close to the earliest point when doctors say a fetus could survive delivery with significant medical intervention. Tom Perille, a Colorado physician and advocate for the abortion ban, says women should make the decision before that point.
TOM PERILLE: Women have 22 weeks to continue to make their choices about the pregnancy, including in the tragic situations of rape, incest and fetal anomaly. So...
MCCAMMON: For several anxious months, Leah, who also asked us to use her first name, waited to decide whether to terminate a complicated and high-risk pregnancy.
LEAH: So, I mean, it was just something I always wanted to be, was to be a mother.
MCCAMMON: She was told there might be problems with the fetus and that the pregnancy could worsen her own longstanding health problems, even threaten her vision.
LEAH: I just needed to have some type of proof. And if I wasn't ever going to get that proof, I was going to stay pregnant.
MCCAMMON: Leah says she finally got proof around 24 weeks when she was told her fetus had a fatal condition. She was unable to find a doctor in Iowa who would terminate the pregnancy, so she traveled to Colorado. Some supporters of Proposition 115 say they hope it will shut down the clinic. In an interview last year, activist Erin Behrens told Denver radio station KHOW she hopes it's just the beginning.
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ERIN BEHRENS: Let's put the Boulder abortion clinic out of business and prevent those lives from being taken every year. And then let's come back and talk more about it in 2022 and 2024.
MCCAMMON: Recent polling indicates a narrow split among voters on the 22-week abortion ban. Whatever they decide on Tuesday will have implications for pregnant women well beyond Colorado's borders. Sarah McCammon, NPR News.
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