Dr. Warren Hern is a physician whose career in reproductive medicine began before Roe v. Wade and continues today, after Roe’s fall. Hern, who is eighty-six, founded the Boulder Abortion Clinic, and is one of the most high-profile abortion doctors in the country. For a long time, he has been one of the very few physicians who openly perform abortion in the second and third trimester. At the time of the 2013 documentary “After Tiller,” which followed Hern and other abortion providers, there were only four such physicians; one has since died and the other two are retired. More clinics offering late abortion, procedures done at twenty-one weeks or later, including the DuPont Clinic and Partners in Abortion Care, have opened in recent years. Late abortion is wildly misrepresented by politicians and misunderstood by the public; it is rare, but the need for it has increased as state bans make it harder for pregnant people to seek care.
Hern has written a memoir, “Abortion in the Age of Unreason: A Doctor’s Account of Caring for Women Before and After Roe v. Wade.” The book is partly a firehose of pure screed, demonstrating the radical commitment necessary to sustain a career under unique duress. Hern received his first death threat two weeks after his clinic opened, in 1973, and has spent fifty years under constant harassment from people who view him as a mass murderer. His op-eds from the past several decades, republished exhaustively in the memoir, show Hern hitting the same notes over and over, warning of a future of draconian abortion regulation and pregnancy criminalization that has now come to pass.
The book also provides an answer to the question that has tended to hover over his profession: What kind of person would choose this line of work? In Hern’s case: a hippie with a wife and child, who still takes great solace in hiking and skiing and wildlife photography, whose focus on reproductive medicine comes in part from decades of fieldwork in epidemiology and global health. One of the only regrets Hern mentions in the book is that he never made the time to study jazz piano under Ahmad Jamal, who once agreed to tutor him. A more significant regret comes from his stint in the Office of Economic Opportunity’s family-planning division, in the early seventies; his office launched a voluntary sterilization program in Appalachia, which expanded across the country. But medical abuse followed: two young Black sisters, aged twelve and fourteen, were sterilized involuntarily by a doctor who regarded them as mentally disabled. Hern later testified in Congress that his proposed guidelines for the program were suppressed.
I wanted to talk to Hern in part because I’d seen the profound impact his work had for just one of his patients—a woman named Erika Christensen, whom I interviewed, in 2016, about her third-trimester abortion, and who became an activist instrumental to the passage of New York’s Reproductive Health Act. I also found his candor in the book to be remarkable. The memoir begins with a description of a pregnant patient whose placenta had separated from the wall of the uterus, causing the swift death of the fetus and a coagulation syndrome that caused the patient to start “bleeding everywhere within her body and from all orifices.” Hern methodically walks the reader through what late abortions can entail: dismemberment of the fetus; intentional cranial collapse. In the early years of his practice, knowing that he had to personally prove that abortions could be performed safely, he would, after a dilation-and-evacuation procedure, “empty the cotton sock in the suction bottle of its contents, spread the tissue out on a glass plate, and look at it carefully over a light box” in order to insure that no parts of the embryo remained within the patient to cause infection. Even after reading the memoir, it is hard for me to fathom what it might have been like to confront life and death at this scale for fifty years.
Hern and I spoke on Zoom. He was wearing aqua-colored scrubs, sitting in a wood-panelled office with old photos on the wall. He has a vigorous manner, but looks like a man in his eighties who should by rights be retired. I was expecting him to be impatient, because journalists tend to describe him this way. But even if Hern’s answers tended to run toward political rant, he spoke as if, contrary to the reality that encroaches from every direction, he had plenty of time. Our conversation has been edited and condensed.
I want to talk about what late abortion is and is not. The anti-abortion movement has created a false image: as if late abortions involve the death of a nearly full-term baby, the size and age and shape of a newborn. Even the phrase “late-term abortion” implies this.
For the sake of clarity, do abortions ever take place close to or at full term?
No. There are situations where, in a desired pregnancy, a catastrophic event occurs in the middle of the third trimester. For example, a woman came to me and she was over thirty-five weeks. Her doctor sent her to me because the fetus had a stroke that destroyed the brain. The fetus was not going to be able to survive, and if it did it would not have a life.
She was terribly grieved about this. She came to me. I did the injection [that stops the heart of the fetus in utero]. Her fetus was delivered in her hospital with her doctor and her husband present. Do you want to call that an abortion? I don’t call that an abortion. It was an interruption of a pregnancy that was hopelessly complicated. There was no point in forcing her to carry for another month, and then have a dead baby. That is cruel. It may have been necessary two hundred years ago, but it is not necessary now.
What you’re describing, though, is abortion care. To me, that story illuminates something people are learning at great cost now: that abortion is often procedurally indistinguishable from miscarriage management, stillbirth management.
It is a fundamental, essential part of reproductive health care for women.
But, in discussing late abortion, we’re talking about very rare cases. About 1.3 per cent of abortions take place at or after twenty-one weeks, which is halfway through the second trimester. Still, this is the type of abortion your clinic specializes in, and performs almost exclusively.
Right after Texas passed S.B. 8, and then after the Dobbs decision, we were flooded with patients who needed late abortions because they were being turned down everywhere else. We couldn’t see patients who were earlier in their pregnancies, because we were just too busy taking care of the more difficult patients. We have seen some earlier patients now, but our special interest is in helping women who are having abortions later in pregnancy because they have the most difficult circumstances. They’re at the end of the line. They can’t find anyone else to do this.
What other misperceptions about late abortion have you encountered in your career?
People have the idea that a woman just decides she doesn’t want to be pregnant. She wants to get a new dress, or she wants to go to prom next week, so she decides to end the pregnancy. But women take this decision very seriously. Obviously, the operation is highly stigmatized. Many women, right after Trump was elected, thought that abortion was illegal and were afraid to even make the phone call, much less come in. And now abortion is functionally illegal in about twenty states, and we have situations where women come in, have their abortion, and are afraid to go to their own doctor or any doctor in their home state for a follow-up exam, which they need to have—because they’re afraid to be arrested and sent to jail. That is not a complete fantasy; there are threats to that effect.
In terms of popular speculation about late abortion, there was the partial-birth-abortion meme, which was set up in the nineties when an anti-abortion group took some fragmentary information from a presentation at one of [the National Abortion Federation] meetings and turned it into a weapon. People believed that this was a way that late abortions were being done. And there were a few people doing a few of these procedures, but it was never the principal way things were done. It has been a very damaging bit of psychological warfare.
