For a long time, many women who had abortions due to dire fetal diagnoses only spoke privately about their experiences: Grieving for their long-desired pregnancies and fearing the stigma of abortion, they sought solace in closely guarded online communities identified by the way many doctors describe the procedure: TFMR, or “abortion for medical reasons.”
Two years after the Supreme Court overturned Roe v. Wade, their pain has turned to anger as new abortion bans go into effect across the country. Though these women make up only a tiny fraction of US abortions, they have emerged as some of the most influential voices in the national post-Roe debate, speaking out against the bans and sharing their stories of being forced to travel across state lines and made to feel like a criminal when seeking medical care.
Many of these women were initially opposed to abortion, but as their views changed, so did the way Americans talked about abortion, going from personal anguish to public outrage and helping to shift public opinion in favor of abortion.
“After all of this, I wondered, why don't we make posters about abortion rights?” said Riata Little Walker, who traveled from her home in Casper, Wyoming, to Colorado for an abortion after doctors diagnosed her fetus with Down syndrome and a heart defect and told her that if it survived to birth, it would require surgery followed by a transplant.
“Yes, it's your body, your choice, but that's not the story people want to hear,” she said. “We have to bring our story to the forefront, because otherwise it's easy for people on this side to say, 'But they're killing babies.'”
Walker is Catholic and has worked for Wyoming Republicans, including Sen. John Barrasso. She is against abortion and did not realize she was having an abortion because the doctor called it an “abortion.” In the months that followed, she became more supportive of abortion for any reason, testifying against the anti-abortion law passed by the Wyoming Legislature after Roe was overturned in June 2022.
While most bans allow for abortions to save the life or health of the pregnant woman, few women are granted such exceptions, and only a handful of bans allow for abortions for fatal fetal abnormalities. There is no clear line that defines “fatal” or “medical reasons,” and the procedure is the same whether it is described as abortion, TFMR, or termination of pregnancy.
That makes these cases complicated for doctors, lawmakers and the women themselves. What are the medical reasons?
The women who spoke out say their experiences have led them to believe the law cannot and should not address the complexities and varied nature of medical cases. They are speaking out to a rare commonality in a bitter, decades-old debate: Whether they identify as “pro-life” or “pro-choice” in polls, Americans overwhelmingly say the decision about abortion should be up to women and their doctors, not the government.
These women say they feel the need not only to speak out but also to use the word “abortion” to dispel the stigma they have attached to abortion.
“I never knew about any of this before because it's never been talked about before,” said Kimberly Manzano, who flew from Texas to New Mexico for an abortion at 18 weeks pregnant after a scan revealed her fetus was missing limbs, organs and genitals.
Manzano described herself and her husband as “devout Christians” who viewed abortions as something “lecherous women” did to end unwanted pregnancies, and the pastor assumed the couple would fall under a medical exception to the Texas ban. But that wasn't the case.
“We feel like we need to talk about this and educate people about our child who passed away because we feel like we've been so uneducated,” she said.
Some of the women appear in ads supporting abortion-rights ballot measures or candidates, some confront politicians on campaign trails, some testify or participate in lawsuits, but most talk to friends, family and colleagues.
Polls show that people who have heard stories of women who had to cross state lines to get an abortion because of serious pregnancy complications are more likely to support legalizing abortion, even among Republicans and those who believe abortion should be illegal in most cases. Such stories have even mobilized anti-abortion voters to support ballot measures that broadened abortion rights in conservative states like Ohio and Kansas.
“Telling people's stories makes it real,” said Megan Kling, who traveled from her home in Wisconsin to Minnesota to get an abortion at 23 weeks pregnant after scans revealed her fetus had no kidneys, would not produce amniotic fluid and would die after birth, if not in utero. “We'd like to think that every woman is perfectly healthy and every pregnancy is perfectly healthy, but the reality is there are a lot of things that can go wrong.”
Kling said some family members argue their situation is different. They support abortion if the fetus has serious conditions, but don't want women to have abortions for birth control. She understands that, since she never thought of herself as the kind of person who would choose abortion. “But women need medical options. They don't get that. Abortion is medical care,” she said. “These stories really highlight that.”
The researchers say it's unclear how many of the roughly one million abortions performed each year in the US are for “medical reasons,” but they are rare.
Many of these women don't fit into the usual lens of the abortion debate: They resent the callous language of abortion-rights groups, and instead of saying “fetus,” they speak of their aborted pregnancies as fetuses. They give them names, celebrate their birthdays, and put tiny footprints on keepsakes.
Kling found herself in an awkward position after she wrote letters to state legislators, including Republicans, to work through the grief and anger she felt after her miscarriage. Only Democrats responded, but then Planned Parenthood and other groups asked her to speak at events in support of President Biden. Kling accepted, but explained that she didn't necessarily support him. She doesn't consider herself a Democrat, but she no longer considers herself a Republican.
“I think most people feel that way,” she said. “They feel like they can't speak up because all the extremists are so loud.”
Abortion opponents argue that the ban only prohibits “elective abortions” for unwanted pregnancies, and that women who need an abortion for medical reasons can get one in exceptions. Accuse Democrats of manipulating Exploiting medical patients for political purposes.
“Women have been misrepresented as having this be a compassionate option, but this contributes to a growing trend of ableism and pressure women face from the medical community to abort babies who may have disabilities,” said Dr. Ingrid Skopf of the American College of Pro-Life Obstetricians and Gynecologists.
Meanwhile, abortion rights groups worry that featuring TFMR's story sends the message that abortion should only be protected when deemed “justifiable,” and not be a right for all women. “People need abortions for all kinds of reasons — economic, medical, life circumstances — and they shouldn't be stigmatized for having an abortion for any reason,” said Nancy Northup, president of the Center for Reproductive Rights.
Debates are brewing within online communities: Is abortion permissible if the baby will only survive a few hours? Days, years? What about “gray” cases, where the fetus has a good chance of surviving into early childhood, but will face a life severely restricted by surgeries, medications, machines and hospitalization?
Women say they waited weeks for additional scans, poring over survival statistics and quality-of-life studies, hoping for a miracle. Some choose to continue the pregnancy.
“In theory, if she was diagnosed with Down syndrome, I would have had the baby,” says Martha Shepherd. She and her husband, a teacher, learned during an anatomy scan at 20 weeks pregnant that their daughter's spine had not fused. The diagnosis was spina bifida, which would require several surgeries, including one in utero. They moved from their home in Virginia to a Ronald McDonald House in North Carolina near a hospital for further testing and investigations. Three weeks later, they decided to have an abortion.
“It would be a loving decision to raise a child with spina bifida,” Shepherd said, “but my husband and I have decided that it would also be a loving decision not to have a child in that body.”
The women may seem to be arguing for a medical exception — dozens of others have joined lawsuits filed in four states by the Center for Reproductive Rights, seeking clarification of what constitutes an exception to the abortion ban — but Texas plaintiff Ashley Brandt said, “We're proving that exceptions don't work.”
Brandt traveled to Colorado to abort her twin, who had an anocephalic defect that put the other fetus at risk. “It wasn't just me who was at risk. It was my viable daughter who was at risk,” Brandt said. “We were no exception.”
She learned about the elective-only option in an online TFMR group; her doctor was afraid to even mention abortion for fear of prosecution. She witnessed the shame and loneliness felt by the women in those groups, and felt it herself. Brandt says some of the harshest comments came from women struggling with infertility, who said they could not imagine choosing to terminate a pregnancy. Like many women who now speak publicly about their stories, she says her experience has made her more sympathetic to women who choose abortion, whatever their reasons.
“We need to stop being picky,” she said. “We need to trust people to make their own decisions.”
But the women say just explaining that what they had was an abortion remains a battle.
A few months after the abortion, Manzano discovered her doctor had recorded it as a “spontaneous abortion” in her medical chart.
“We had to go to New Mexico,” Manzano said. “It wasn't something that just happened out of the blue.”
She is seeing a grief counselor, who is calling hers a “medical miscarriage,” even though Manzano said he prefers to say “abortion.”
“Neither of us can fix the other,” she said, but “we have to be able to say what it is in order to grieve and heal through this process.”