'We Have No Choice': A Story Of The Texas Sonogram Law.

January 22, 2013

Guests: Carolyn Jones – Carolyn Cline

TERRY GROSS, HOST: This is FRESH AIR. I'm Terry Gross. Today is the 40th anniversary of Roe v. Wade, the Supreme Court decision that legalized abortion. But since then, many states have passed laws that restrict women's access to abortion. According to the Guttmacher Institute, more state-level abortion restrictions were enacted in 2011 than in any prior year. And last year brought the second-highest number of restrictions ever.

We're going to look at what's happening in Texas, with a journalist who wrote about her abortion under the new Texas sonogram law. Later, we'll hear from the executive director of two Christian-run pregnancy centers, in Dallas, that encourage teens and women with unplanned pregnancies to keep the baby or put it up for adoption.

My first guest, Carolyn Jones, learned halfway through her pregnancy with her second child that the baby she was carrying had a severe developmental problem. She and her husband wanted a baby very much. But they decided to get an abortion, a decision she describes as heartbreaking.

She had her abortion in Austin, last February; just two weeks after Texas implemented its mandatory sonogram law. For reasons she'll explain, this law made the abortion even more heartbreaking. Her personal experience led her to write a series of articles for the Texas Observer, about how the state legislature has restricted access to abortion and has cut off state funding to Planned Parenthood clinics.

Carolyn Jones, welcome to FRESH AIR. Let's talk about some of the things you learned about changes in the Texas abortion law, from your own abortion experience. You wanted this child very much. You were hoping to have a brother for your little girl. And you had the abortion in January of last year. You had had a sonogram halfway through the pregnancy. What did the sonogram reveal?

CAROLYN JONES: What we'd expected the sonogram to reveal was the gender of the baby, the sex of the baby, which it did; but it also revealed that our baby had a major neurological flaw. And his brain, spine and legs had not developed correctly. And the doctor wasn't even sure whether he would make it to term - that the flaw was so serious - but that if he did make it to term, he would lead a life of great suffering. He would be in and out of hospitals, and it would be a life of pain and suffering for him.

GROSS: This was a hard choice for you to make. Can you talk a little bit about how you and your husband chose to proceed with an abortion instead of having the baby?

JONES: Mm-hmm. For me and my husband, we already have one child - a daughter; she's almost 3. And we love her so intensely. And I know that anyone else who, as a parent - will understand that intense parental impulse to protect your child from anything; absolutely any pain, you want to protect them from it. And when we heard that our second, very much-wanted child, if we brought him into the world, his life would be one of constant pain and suffering - to us, it was an instinctive response to think for this very brief moment, we have a choice about whether to introduce him to a life of pain or not.

And so to us, it was actually - it was a terrible choice; it was a heart-wrenching one. But it was also a simple one because as his parents, we chose what we believed was best for him, to prevent him from knowing a life of pain. And that was, in fact, quite a quick choice we were able to make as well, within minutes of my doctor giving us the terrible news. It was also almost an instinctive response about the choice that we would make. And this month, it's almost a year to the day that we made that decision. It was still the right decision for us because it was an instinctive one about protecting our child from pain.

GROSS: Once you made that choice, there were several steps you had to go through before the state permitted you to have the abortion that you chose to have. One of those steps had to do with a mandatory sonogram. You had already had a sonogram, the one that revealed the defect in the baby's nervous system. Why did you have to have another?

JONES: I actually, I'd had two sonograms that day. The first one was the one that revealed the anomaly. The second one was, we went straight to a specialist to confirm it. Those were both medically necessary sonograms, to understand exactly what the problem was. The third sonogram was one that was mandated by the state of Texas. It was a new law that had come into effect just two weeks prior to that day. And the law was intended to - let's see, the way the politicians described it, was to promote informed consent. The politicians want women who are having abortions to have the sonograms so that they can see the life of the child that they're about to end. So it's an entirely ideological justification for why a woman would have to have a sonogram. It's got nothing to do with - there are no medical reasons that the state required me to have it.

GROSS: Now, as it turns out - before we go any further, I want to mention that, you know, the law had just gone into effect, and a lot of health care providers weren't sure what they were mandated to do. As it turns out, under the law, you wouldn't have had to undergo this mandatory sonogram because the baby you were carrying had irreversible developmental problems.

JONES: That's right.

GROSS: But your doctor didn't know that yet because it was so unclear, and I don't think...

JONES: That's right, yeah.

GROSS: Yeah. So you had the mandatory sonogram that women - with few exceptions - have to get in Texas now. So what are the requirements surrounding the mandatory sonogram? And as we just explained, you ended up having this sonogram because your doctors didn't realize yet that you were exempted.

JONES: The requirements are that a woman must have the sonogram 24 hours before the abortion procedure can go ahead. The doctor who performs the abortion must also perform the sonogram - which, as you can imagine, creates all sorts of logistical nightmares for clinicians who are traveling from clinic to clinic. They're now having to add in this extra day, to provide the sonograms as well.

On top of providing the sonogram that every woman - with a few exceptions - must undergo before having an abortion, every woman must then wait for 24 hours. And, I mean, even though I was technically exempt from having had the sonogram, I wasn't exempt from the 24-hour waiting period.

Sorry, just to go back to the sonogram itself, the doctor would then have to describe the physical characteristics of the fetus. And the doctor - he or she - would also play the fetal heartbeat as well, for you to hear. The doctor would then have to read through a formal script, written by the state, about the abortion procedure as well as the risks of abortions. And two of the risks that are mentioned in this list are an increased chance of getting breast cancer, as a result of having an abortion; and an increased chance of having negative psychological outcomes - both of which, I should point out, have been discredited by mainstream medical science. Nonetheless, these two discredited facts, as well as - sort of unnecessarily graphic description of the abortion procedure itself, are part of the government script that a clinician must read to a patient before the abortion can go ahead.

Other parts of the requirements, as well, is that before the woman can go ahead with the abortion, she must also listen to a government script that tells her that the father of the child is liable to pay child support, whether he wants the abortion or not; and that the state may or may not pay for your maternity care. So these are all things that have to be included in the script that the woman hears, regardless of whether she wants to have this abortion or not.

GROSS: Let me just back up a bit. So the doctor performing the abortion, that has to be the same doctor who's doing the sonogram ...

JONES: Yes.

GROSS: ...and describing what he or she sees, to the woman who's having an abortion. So does that mean - like, in your case, the sonogram reveals terrible developmental problems in the fetus. Would the doctor be required to tell you that? Or is the doctor just supposed to say, I see arms; I see beginnings of legs; I see a little head - do you know what I'm saying?

JONES: I do, and I do think there is - you know, there are sort of formal characteristics that the doctor is required to describe. I have to admit that I imagine that the doctor, if he or she saw, you know, anomalies, they would describe them. But I have to admit, with the doctor, when he began to read this description to me - describe it to me, I found it so traumatizing that I heard the beginning; where he said that he could see four healthy chambers of the heart. And it's true - is that my very unwell child did have a healthy heart; not much else that was healthy, but the heart was. And to hear that was so traumatizing, that I did try and turn away, and try not to listen. So I really can't say what is part of the formal (technical difficulties), but I do imagine that they would have described what they saw, and perhaps my doctor did. I can't say.

GROSS: It sounds like the nurse wanted to help you not listen...

JONES: Mm-hmm. That's right.

GROSS: ...because she saw how traumatized you were, and she turned up the volume of the radio as the doctor was describing the fetus while reading the sonogram. Did that make you feel any better - like, at least somebody was trying to protect you from this mandatory sonogram?

JONES: In a very strange way, it did because in the room, at the time, was me, my husband, the doctor and the nurse. And there was not one of us in that room who wanted to go through that process of having to go through the sonogram. And, you know - and the doctor said to me, before it all started - and I was, you know, I was in a very emotionally fragile state. He did say to me, I'm so sorry I have to do this but if I don't, I will lose my license.

And that actually really helped; to imagine that all four of us were in it together, in a way. They showed such compassion for me in that no one agreed with it. And that did, in a strange way, help. And also, with the nurse turning the radio on - you know, I think it was, you know, maybe a D.J. or perhaps a commercial for used cars or something, clattering in the background. It was, you know, a slightly surreal experience. But again, the whole experience was so unpleasant that I appreciated any efforts they could make to stay within the law but still, you know, behave compassionately towards me and my husband.

GROSS: And one more sonogram question. You know, we've heard so much about transvaginal ultrasounds being mandated; you know, attempts to mandate that in some states. In Texas, it's not transvaginal; it's just an on-the-belly sonogram, right?

JONES: Actually, it is transvaginal. For anyone in the early stages of pregnancy, the only way that you can actually get a good look at the fetus is to use a transvaginal probe. For me, because I was at 20 weeks of pregnancy, I had the old - what would be called the jelly on the belly; which is, you know, the wand that you pass over your stomach. But for any woman in early stages of pregnancy - and in fact, you know, thousands of women in the last year have had to have a government-mandated transvaginal probe, for no medical reason.

GROSS: The goal of the mandated sonogram is to get the woman who is planning on having an abortion, to reconsider. What impact did the sonogram, and the recitation of the information that the government mandates the doctor to tell you - which is intended to discourage the woman from having an abortion - what impact did that actually have on you, and on your frame of mind, when you proceeded with the abortion?

JONES: It had no impact on my decision to go ahead with the abortion; none whatsoever. It was a private choice I'd made, and I was going to stick with that private choice no matter the people who tried to interfere with me. In terms of my broader frame of mind, it did make me feel very angry, and I still do. I still feel very angry that someone who has absolutely no say in, you know, my personal decisions, could still be there at that moment. The darkest day of my life was the day that we - I found out that information and had to make that decision. That someone could invade upon that - a politician, who has absolutely no jurisdiction over my private life - that they could invade upon that and so reduce my dignity, I do feel that that's an incredible injustice; and I still do, which is why I felt the need to write about it.

GROSS: We've talked a little about the abortion that you had because you were carrying a baby that had severe neurological impairments; and the doctor told you if the baby survived to the point of childbirth, that it would be basically condemned to a life of suffering. Let's broaden that discussion into what the Texas state legislature has been doing in the area of women's reproductive health care. In the 2011 session, the legislature cut the state's family planning program by two-thirds. What was the program, and who was most affected? What services were most affected?

JONES: The program - this would have been the state family planning budget; and before the 2011 legislature, it accounted for about $112 million. And that pot of money funded family planning and well-women services for about 220,000 of the poorest men and women in Texas. And not only did that provide birth control but also well-women exams and STD screenings, and breast cancer and cervical cancer screens. So it was really quite a comprehensive program.

During the 2011 legislature, that budget was slashed by two-thirds. It brought it down to about $40 million. Now, the reason that this money was slashed was because the conservative legislature wanted to starve Planned Parenthood of any state funding. And in a very unfortunate development, the legislature had somehow conflated abortion with family planning.

And these are not big chains, family planning chains across Texas. Many of them are actually small, mom-and-pop providers out in the rural areas, working with very small communities. You know, what we discovered at the Texas Observer was that within about six to eight months of these cuts happening, more than 60 family planning clinics across Texas were forced to close.

GROSS: Now, you write that many clinics that didn't close rely on funding from another endangered source in Texas, the Women's Health Program. What is that program?

JONES: That's right. The Women's Health Program, before the 1st of January of this year, was a federally funded program aimed at - again - the poorest men and women in Texas. I think it covered about 115,000 men and women. And it provided them with contraception and well-women care, and breast and cancer screening. As I said, it was federally funded; which means that for every $1 that Texas spent on this service, the federal government spent another 9. So as you can imagine, this was a good program for us to have in Texas.

Now, Planned Parenthood was the dominant provider of women's health program services in Texas. Forty-five percent of the clients in this program were seen by Planned Parenthood providers. And because this is Texas - and the conservative legislature have a vendetta against Planned Parenthood - in the 2011 legislature, they decided they needed to do whatever they could, to get Planned Parenthood out of Texas. So another way that they chose to do that was to exercise another law that meant that - it was called the affiliate rule - which claimed that Planned Parenthood would not be able to access federal funds because they were affiliated with abortion providers.

So Texas tried to exercise this affiliate rule. The federal government said it was not legal to remove one of the providers from the program. And it was then litigated in court; back and forth, between Planned Parenthood and the state of Texas, about whether they can or cannot be within this program. On the 31st of December, the federal government said that they would not be able to provide federal funding towards a fund that had evicted one of the providers.

And so the state of Texas said they would happily walk away from that 9-to-1 federal match because they really did not want to have to have Planned Parenthood in the program itself. So on the 31st of December, we lost the federal funding for that program. On the 1st of January this year, it became an entirely Texas-funded program. So it's now called the Texas Women's Health Program.

GROSS: Is there an estimate of how much money Texas is walking away from?

JONES: Yes, I think in - over a two-year period, it will probably cost Texas $70 million that they wouldn't have had to have spent if they'd stayed within the Medicaid program.

GROSS: We've talked about cuts to women's reproductive health care. We've talked about counseling against having abortion. What effect do you think all of this is having on the quality of women's health care and access to women's health care in Texas?

JONES: Well, we already know that at least 60 clinics across Texas have closed. We also know that even those clinics that still receive state funding, it was much less than what they were receiving before. So where they were providing family planning services for free, now they must share the costs with the patients. And that's very tough for these women, these low-income women who are in dire economic straits as it is. The other impact that we're seeing is that the family planning clinics that are still able to stay open, they aren't able to offer some of the more expensive yet more effective contraceptive options. So that's reducing women's choices as well.

Something else we're seeing, too, is that the Texas Health and Human Services Commission - the state agency that's responsible for all of this - they've already started their projected budget for 2014 and 2015. And they have projected 24,000 extra births as a result of these cuts to the family planning budget. And they have said that their budget will need, probably, about $273 million in order to cover the costs of all of these extra births. Now, this has more than doubled the size of the family planning budget that was slashed so dramatically in 2011.

We won't yet see exactly how many births there are, for a while. We won't see the impact of women whose cancer screenings - who weren't picked up in time. Those will come later. But, I mean, if the state agency itself is already projecting for so many extra births and so many greater costs, I think we can be sure that the collateral damage from those decisions made in 2011, will be far-reaching - and very damaging for women and men in low-income state, across Texas.

GROSS: I don't know if you can answer this, but are the extra births because women are deciding against abortion, or because they don't have access to contraception?

JONES: I would guess that there are both. I mean, we won't know this until we've got the figures. But I would imagine that there will be extra births from lack of access to contraception, and more women being funneled towards crisis pregnancy centers whilst those family planning clinics they might have gone to before have closed.

GROSS: The state of Texas is funding a program called Alternatives to Abortion, and this is a state program that funds crisis pregnancy centers.

JONES: Mm-hmm.

GROSS: What are these centers?

JONES: Crisis pregnancy centers are - their sole raison d'etre is to convince women with unplanned pregnancies to keep the child rather than have an abortion. And they're often Christian organizations, and they promote either parenting or adoption. And they really do their very best to persuade women that abortions are not the right decision for them.

GROSS: So what do you know about the information that is provided, and if there is information that is withheld for women at these centers?

JONES: Yes. The information that they will provide is, in fact, the same information that was provided to me when I went to the abortion clinic. It comes from a pamphlet written by the state, called "A Woman's Right to Know," which describes exactly - which describes the abortion procedure in very graphic detail. They speak about suctioned body parts and crushed skulls. It's really a very graphic, and very upsetting description.

And they also - the pamphlet will also speak about the link between having an abortion and getting breast cancer; the link between abortion and thoughts of suicide or depression; all of which, as I said before, have been discounted by the medical community. So this is the information that crisis pregnancy centers - or certainly, the ones that are receiving funding from the state - will give to women who come in there; women that they call - in their terms, abortion-minded women.

The information that they will give to them about parenting or adoption is overwhelmingly positive information. And, for example, the one crisis pregnancy center I was looking at in Abilene, Texas, the information they'll say is: Now that you are pregnant, you are already a mommy. And if you choose adoption, it's the most unselfish choice you can make for your child. So they lay out the choices that these women have. But as you can see, you know, they weight them all very differently.

GROSS: Since Texas has cut funding to family planning centers and to clinics that provide abortions, where is the money for the Texas Alternatives to Abortion program coming from?

JONES: The money came, interestingly, from the family planning budget. So during the - the one that was slashed so heavily in the last legislative session. Each session that goes by - the Alternatives to Abortion program has been running since 2005; it gets more and more money siphoned towards it. So that money is coming out of a program that is designed to prevent unwanted pregnancies, and is now going towards a program that's designed to promote childbirth and prevent abortion. It's sort of missing out the middle bit - which is, you know, the trying to help women prevent the pregnancies that would lead them to have an abortion, or lead them to end up in a crisis pregnancy center.

GROSS: In discussing alternatives to abortion, does the state allow the crisis pregnancy centers to discuss birth control with women who, after they deliver the baby, they can - if they so choose - not get pregnant again in the near future, until they're ready?

JONES: The terms of the contract are pretty sparse. So no, the state does not require the crisis pregnancy centers to discuss family planning with their clients. And in fact, that many of the crisis pregnancy centers - but they choose to discuss it anyway, and many of the crisis pregnancy centers promote abstinence as the only form of birth control. And this has much to do with the sort of religious affiliation of many of these crisis pregnancy centers; where they believe that chastity is actually the only effective form of birth control. And in fact, there are a few crisis pregnancy centers who believe that abstinence is also the only form of birth control for women who are married.

So that's quite an extreme position to take. And anyone who is at a crisis pregnancy center is, by definition, sexually active. So for these centers to promote abstinence as the only way to prevent future pregnancies is very irresponsible, from a public health perspective; and very troubling that the state does not require these centers - that are receiving state funding - to actually give them scientifically valid information about preventing future pregnancies. And not only is this concerning for women in that they're not receiving the information they need about preventing future unwanted pregnancies, but it's also, they're not giving them information about preventing things like sexually transmitted infections.

Again, these centers, crisis pregnancy centers will talk about the dangers of sexually transmitted disease; but again, they'll say that the only way that they can prevent getting a sexually transmitted infection is to abstain from having sex. But in fact, for teens and women in their 20s and 30s, that's not a realistic choice for many people. And again, it's - you know, very worrying, from a public health perspective, that these centers are promoting this information and in fact, they are receiving state funding to do so whilst at the same time, the evidence-based centers that were providing women with medically accurate information about their health, are being de-funded.

GROSS: But Texas doesn't mandate that these crisis pregnancy centers have an abstinence-only approach.

JONES: No, not according to the contract that these centers have with the state. It's not mandated. But it's also - there's nothing included in there, that says that they should give them accurate advice, either.

GROSS: You grew up in Zimbabwe, and I have no idea what Zimbabwe's abortion policies are. But is there anything that's particularly surprised you about the abortion debate in America, compared to who - what you were exposed to in Zimbabwe?

JONES: Mm-hmm. You know, I can't really speak to the abortion policies in Zimbabwe. But I can certainly just say, it surprised me just how restricted women's access is, in the U.S. I - honestly, before my personal experience, I was extremely naive about what kind of rights we have in the U.S. I mean, my understanding - and it was, as I said, very naive understanding - was since Roe versus Wade 40 years ago, women in the U.S. had the right to have an abortion. And to me, it was as simple as that, really.

And it wasn't until I had my own, personal experience that I started looking into this and thinking actually, though women have a legal right to an abortion, that those rights are being chipped away at - all of these different states. And in fact, what surprised me the most is that the legal right to abortion was enshrined, in 1973, for all women in the U.S. But then the Hyde Amendment - then actually removed that right for low-income women. The Hyde Amendment prohibited federal funds from paying for women's abortions unless - in the cases of, I think, rape or incest, or perhaps fetal anomaly as well; there were fewer - exceptions but essentially, it took away women's economic access to having an abortion. And that that has had a huge impact on women in the U.S.

So we may have a legal choice to have an abortion in the U.S. but actually, our choices are very much constrained by the kind of social and economic access that we have in society. And I'm horrified by how hollowed out that legal choice actually is.

GROSS: Well, Carolyn Jones, I want to thank you very much for talking with us.

JONES: Thank you for having me, Terry.

GROSS: Carolyn Jones has written about her abortion, the Texas mandatory sonogram law, and state cutbacks to family planning centers, for the Texas Observer. You'll find links to some of her articles on our website, freshair.npr.org.

Coming up: Carolyn Cline, the CEO of a Christian group that runs centers that discourage women with unplanned pregnancies from having abortions; and offers counseling and assistance to help with their pregnancies.This is FRESH AIR.

TERRY GROSS, HOST: Today is the 40th anniversary of Roe v. Wade, the Supreme Court decision that legalized abortion. While there are now only 1,800 abortion providers around the country, there are 2,500 pregnancy centers, according to The New York Times. These pregnancy centers - many of which are run by Christian groups - discourage women with unplanned pregnancies from getting abortions, and help them through their pregnancies. Some of these centers have been criticized by medical experts, for giving incomplete or inaccurate information that exaggerates the risks of abortion.

My guest, Carolyn Cline, is the president and CEO of Involved for Life, a ministry partner of First Baptist Dallas. It runs the Downtown Pregnancy Center of Dallas, which offers alternatives to abortion; and provides counseling, ultrasound, adoption options, STD screening and treatment, and parenthood classes. The center's clients are largely women with low incomes.

Involved for Life also runs a center for college women and young professionals, called the Uptown Women's Center; and it has a mobile sonogram unit that offers sonograms to pregnant women, with the goal of discouraging them from having abortions. Involved for Life is not a state-funded program.

Carolyn Cline, welcome to FRESH AIR. When people come to the Downtown Pregnancy Center, do they know that you are pro-life and anti-abortion; or do some of them come to you not sure of what to do, and not sure which side you're going to fall on?

CAROLYN CLINE: Well, we don't come across as anti-anything when we speak with people on the phone, or with our advertising. So we are very pro-woman, and they know that. We do not ever mislead because there would be no integrity in that. And if we have anything, we have very high integrity. So people do know. If they are asking about abortion information - or how much does an abortion cost, or do you perform abortions - we are very straightforward in that we do not offer or refer for abortions, in our organization. What we are there for is to give women all the education; that they can make an informed decision.

GROSS: And you have a couple of information sheets on your website. So on one of these sheets, you compare the difference between adoption and abortion. For example, it says women that - if they put their child up - if they carry to term, and put their child up for adoption, they can feel good and positive; whereas if they have an abortion, they may feel guilt and-or shame.

You don't tell them, oh, you might feel guilty, too, if you put your child up for adoption. And you don't tell them, if you have an abortion you might decide, boy, that was really the right choice. You know, you're sorry you had to have one, but given that you got pregnant, it was the right choice to terminate that particular pregnancy, at that particular time. You're not telling them that those are possibilities.

CLINE: Well, we are telling them those are possibilities. When we talk to a woman about adoption, we tell her it's not going to be an easy decision. So we don't sugar-coat it in any form or fashion. If a woman chooses abortion, we will tell her that we are there for her regardless of what she chooses, and we stand behind that statement.

It has been our experience - because we do offer post-abortion support and counseling and healing - that we have many, many women that are hurt by abortion. And we do say, you may regret that decision. And if there's any way that we can be there for that woman afterwards, we're there for her as well. I don't know what that woman's going to feel. But I think she does deserve to know that she may regret that decision. And we have many women in our center that have told us that they regret that decision.

GROSS: You also have a program of - life after abortion. And in the literature in your website, for that program, you talk about how abortion affects women differently, but they can suffer from something called post-abortion stress. And the symptoms of post-abortion stress include social and relational breakdown, sexual dysfunction, loss of self-esteem, nightmares, anxiety attacks, guilt and remorse, inability to enjoy previously enjoyable activities, drug abuse, alcohol abuse, depression and suicide.

Is there anything in the scientific literature about post-abortion stress? Because I will say that the American Psychological Association says that they have found no link between, for example, depression and suicidal thoughts after an abortion - or at least, after a single abortion.

CLINE: Yes, that's one organization that says that. But there are also medical studies that show that there's a link. You'll see, in our language, that we do not say everyone is going to experience post-abortion stress. But do I have women that come into my office and have experienced that? Absolutely. We certainly do. We give them a safe place where they can come and talk about that without the condemnation; without them worrying if their employer knows that they're struggling with that decision; without the embarrassment or the guilt or the shame of knowing their church would know about that decision.

Yes, there are women that are seeking out a safe place where they can discuss that. And we want to give them the opportunity to have a voice; to be able to say, you're heard. We hear what you're saying. We're not out soliciting, waving billboards, charging for our services saying, you know what? Abortion has hurt you. We know it; you come in here. We are just offering it on our website; that if you have a struggle after your abortion, then we're a safe place for you to come and to discuss that.

GROSS: Now, you mentioned one of the three programs that you offer is a mobile sonogram unit.

CLINE: Yes.

GROSS: And that it often parks near - did you say near Planned Parenthoods? Or...

CLINE: An abortion clinic. We don't name which one it is.

GROSS: Near abortion clinics. OK.

CLINE: Mm-hmm.

GROSS: Yeah. What's the purpose of parking near an abortion clinic?

CLINE: Because we want a woman who doesn't know that there's other options, to know there's other options available to her; and to give her that opportunity to hear about her other options.

GROSS: Well, any doctor performing an abortion is - I think, at this point - legally required in Texas to talk about other options.

CLINE: They will give you a piece of paper, yes. Or they'll have you sign off and say that you have read a piece of paper. I will tell you that our experience is that the women who come outside of the abortion clinic and speak with us, said, nobody told me that; I didn't know that. Even if they've had a sonogram, it wasn't a clear picture - I didn't see that; well, y'all must have a much better machine than they have.

GROSS: What's an example of something that a woman has told you that she learned through your sonogram unit, that she hadn't been told before; and she was glad that she found out?

CLINE: Well, just that that, in fact, is a baby that is there; how far along she is; what the fetal development of that child is - that kind of definitive information that's not given her; and even more importantly, probably, than that, is that there is support for her if she wanted to make another choice; that there are other options for her, and there are people there that will help her, if she wants to make a choice other than abortion.

GROSS: Now, is the sonogram unit diagnostic? Like, my understanding is that the point - or part of the point - of the sonogram unit is to show a pregnant woman who might be considering an abortion, look, you have a baby growing inside you. See? This is what it looks like. Listen; this is how the heartbeat sounds.

But if there's anything going wrong with the development of the baby, will the person reading the sonogram be able to diagnose that, and will they say something to the woman?

CLINE: Well, we use it strictly to diagnose if there is a viable pregnancy or not; if it's developing in utero. If it's not developing in utero, she has a possibility of having an ectopic pregnancy. Then we let her know that immediately, and advise her to go to an ER. An abortion's not going to help her at that point, either, because it scrapes the inside of the uterus. So if that's the instance, yes. Do we do diagnostic? Neither does an abortion clinic. We - that is not our purpose. We're there just to show if it's a viable pregnancy or not. That's what the sonogram law in the state of Texas requires.

GROSS: The mobile sonogram unit - are there people working with that unit; who go out to the women who are going into the abortion clinic where the sonogram mobile unit has set up, and say, you should come to our unit - you know - and we'll give you a sonogram; like, do they go out and approach women, and invite them in?

CLINE: No. We have sidewalk counselors that are there. And they have a business card, and they can hand it to them and say, we are here; we have support services, if you'd like to hear about them, and we will provide a free sonogram - and point to Sonograms on Site, to our mobile unit. I will tell you, you have about 10 or 15 seconds to speak with someone, if you're not chasing them down to their car - which we absolutely, would not ever do. We stand in one spot and as they go by, we'd speak to them. They don't have to even speak to us, or even get anywhere near us because there's plenty of room for them to walk into the door. We're very limited on where we can stand, and where we can park. And so we're very observant of all the laws.

And we are not there to attack women.That's not our point at all. We're there to provide a service. They either want it, or they don't want it. I will tell you, about one out of 10 say they want it. Some nine out of 10 say they don't; and they walk on by.

GROSS: So, in the two women's clinics that you have - the uptown and the downtown one - if a woman has come there because she has had an unwanted pregnancy; and you're going to try to convince her to carry it to term, and keep the baby or give it up for adoption, do you counsel that person? You write in your literature that 60 percent of the clients at your downtown pregnancy center are age 15 to 24. So I imagine there's a fair amount of - you know, young teenagers there. So if you convince, say, a 15-year-old to carry to term and keep the child or give it up for adoption, do you then counsel the 15-year-old about birth control options, to prevent another unplanned pregnancy?

CLINE: Certainly, we do. And that's why we are also talking to them and do the STI screening and treatment - is because these girls are engaging in activity; obviously, in unprotected sex. And just because they get on a birth control pill - is not going to protect them from the STIs. And so we want to fully educate them and help them to understand that their sexual health is very important, and it needs to be a long-term plan that they have.

GROSS: What forms of birth control do you counsel about?

CLINE: We don't counsel in detail about any forms of birth control. We - obviously - talk about that if they have sexual integrity, if they choose to not have sex until they're ready to be pregnant, or - then that is the best protection. If a woman is interested and wants to have birth control, then - again - we give her a medical doctor that she can speak with, and that he can talk to her about - for her health, what would be the best birth control method that she could use.

GROSS: But basically, the counseling you're offering at the center - when it comes to preventing unwanted pregnancy, or preventing sexually transmitted disease - is abstinence.

CLINE: It's 100 percent effective.

GROSS: So that's what you teach, basically, is abstinence.

CLINE: Yes. It is 100 percent effective.

GROSS: When you're counseling people about whether they should have an abortion, or have the child - again, if somebody's really young; if they're, say, 15 or 16 and they're single; do you mention the kind of loss of opportunity that might mean for them, that particularly if they keep the baby - as a 15- or 16-year-old, single woman - how challenging it might be to continue their education; how difficult it might be to support, you know, themselves and the child; how it might really negatively affect certain opportunities they otherwise would have had - which is not to say that being a mother wouldn't be terribly rewarding; but just in terms of like, balancing the pros and cons of whatever decision they finally choose to make.

CLINE: Of course we address that, Terry, because we wouldn't care about the woman if we weren't talking to her, regardless of her age, about what kind of difficulties that she's going to have. And that's exactly why we offer so much support. We know this is not going to be an easy decision. It's not going to be an easy life.

But I think every one of us know women that have been successful, even though they had unplanned circumstances happen in their life. That's why we want her to have support. That's why we think it's so important - if she is willing, and wants to do so - to have a mentor that's going to walk through this situation with her, for at least the next 18 months. That's why we work with the schools - is to make sure that these young ladies stay in school, and stay in their education. And you know, what's wonderful is that the schools have really come alongside.

I don't know about the rest of the United States but I know in the Dallas area, so many of the school districts have adapted to young women that have children; and even have day care that's available in the schools, so the girls do stay in school. There are scholarships that are available for colleges, for single parents - because it's so important that these women do go ahead and get their education. We don't try to paint a rosy picture. That would be very lacking in integrity, for us. It's not realistic. It doesn't serve the woman. And we are there because we care about her, and we want to help her. There is not an easy solution, as I mentioned early on; there's not an easy answer to an unplanned pregnancy.

GROSS: This is the 40th anniversary of the Supreme Court decision that legalized abortion, Roe v. Wade. Could you share some of your reflections on this day?

CLINE: Well, I believe that it was a decision - it was made 40 years ago - that would - thought would help women; that it would be something that would provide women more freedom in their choices, and perhaps that that has been true, for some women. My experience - in what I have seen, in the 25 years that I've been involved in pregnancy centers - is that I've seen a lot of women that have been hurt by abortion. And I don't think that - probably - the Supreme Court had any idea that there would be thousands and thousands of women who regret that they ever had an abortion. And so I think there's two sides, always; and somewhere in between is the reality of it all.

We've learned so much more, even, about prenatal care and - prenatal development, rather. And with the advent and the usage of sonograms, we see so much more; that there is a beating heart at 21 days. And that's not a lump of tissue. That's a life. It has a heart beating. We do know that brainwaves can be detected and measured at only six weeks, in a child in the womb. And so we know that's a child. Medical science has caught up in 40 years, and gone ahead. So we understand now, there's a child's life that's involved, and hangs in the balance with every abortion decision.

But we also need to understand that women don't need to be lied to. They need to be able to make that decision with all the information that they can have. And then if they decide - in their life, and in their situation and their circumstance - that this is their best decision, then they have that option. But if they also decide, boy, I would choose differently if I just knew I had some kind of support, or if I had enough information, then they deserve to have that right as well.

GROSS: Well, Carolyn Cline, thank you very much for talking with us.

CLINE: My pleasure. Thank you so much, Terry, for having me.

GROSS: Carolyn Cline is the executive director of Involved for Life, which runs the Downtown Pregnancy Center, the Uptown Women's Center and Sonograms on Site in Dallas.

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