By Peter Slevin
Washington Post Staff Writer
Friday, February 26, 2010; A03
SIOUX FALLS, S.D. -- Carol Ball's day begins in the dark, in another state. By the time she arrives at work, crosses a snowy parking lot and enters the austere one-story Planned Parenthood clinic here, she has flown 200 miles to do something no South Dakota doctor will do.
Ball performs elective abortions. She is one of four doctors who travel anonymously, for security reasons, to the lone clinic in a state that has seen some of the nation's fiercest battles over reproductive rights. The work is framed by worry and frustration -- and the knowledge that the politics remain as unsettled as ever.
This is a difficult time for Ball and her colleagues. Last month, Scott Roeder told the jury in his Kansas murder trial that he stalked George Tiller, the nation's most prominent abortion provider, for years before he walked up to him in a church and shot him once in the head.
"If someone did not stop George Tiller, he was going to continue as he had for 36 years," said Roeder, who was convicted of premeditated murder. "The babies, they were going to continue to die."
Roeder, who is scheduled to be sentenced early next month, personifies the worst fears of the small, connected community of doctors that Ball inhabits. Unlike Tiller, she does not do late-term abortions, and she has not received threats. But her trips are carefully orchestrated by security officers, and she declined to allow her face to be photographed for this article.
Thirty-seven years after the Supreme Court legalized abortion nationwide in its landmark Roe v. Wade decision, the nation remains deeply divided. To Ball, the national debate has turned her work into a political act.
"I would rather do this without all this hoopla," she says. "I'm dismayed that it's gone on so long. Why don't they just go home?"
She is speaking of the protesters who sometimes stand outside the clinic and whose legislative victories in South Dakota influence how Ball does her job.
But go home? Antiabortion activists have demanded the same of her.
"I don't want them to come. They're coming to kill unborn children," said the Rev. Steve Hickey, pastor of the Church at the Gate in Sioux Falls and a newly declared candidate for Congress. "I don't believe abortion is health care. I find it to be the lowest form of anything that could be called health care."
Sipping coffee aboard a recent flight, Ball describes her state of mind and the state of affairs that carries her in anonymity each month to a clinic where she treats women who drive as many as five hours to see her.
"I think to myself, 'What century do we live in?' " she says.Busy day at the clinic
The Planned Parenthood clinic in Sioux Falls is busy on a January day. Out-of-state doctors have flown into town two days in a row, a rarity, and eight women are waiting to see Ball.
The clinic might be any doctor's office, but there are clues. The security cameras. The windows positioned to block prying eyes. There are bowls of mints and condoms. Also tissues, to soak up tears. The day before, three hardy opponents quietly prayed outside in single-digit temperatures, but not today. Ball, casually dressed in a Scandinavian sweater, jeans and sneakers, leaves a security man's car and steps inside.
Changing into scrubs, she is briefed by clinic staff on the day ahead.
With no South Dakota doctors willing to do elective abortions since 1994, the Planned Parenthood affiliate in Minneapolis coordinates the schedules of the doctors -- three from the Twin Cities, including Ball, and one from Denver -- who take turns staffing the clinic about one day a week.
"It would be a dream to have a doctor in town," says Andrea, the clinic director, who, for security reasons, spoke on condition that her last name not be used. "Until I got here, I didn't understand the magnitude of the political environment and the woman's decision and how much what we do matters."
In 2006, Gov. Mike Rounds (R) signed HB 1215, which would have outlawed all abortions except when the mother's life was in jeopardy. The unborn, he said, are "the most helpless persons in our society."
Voters overturned the law before it took effect and defeated an antiabortion ballot proposal in 2008. But state law requires that women and girls seeking an abortion hear a "script" about abortion written by legislators. They must meet with a staff member one full day before they receive a medical abortion or RU-486, known as the abortion pill.
Ball says doctors and staff have long discussed the procedure thoroughly with the patients, considering it a duty to act responsibly.
"It's important that she be sure that this is what she wants," Ball says. "I tell women that we don't do abortions for boyfriends or husbands or mothers or best friends. We do abortions for women who want them."
She adds, "Women almost universally have given this decision a great deal of thought."
Even so, the patient is sometimes unsure. Late last year, a girl of about 15 or 16 said she feared that an abortion would be killing a baby, Ball recalls. One of the visiting doctors advised her to go home and return in two weeks if she felt certain that an abortion was right for her. Four weeks later, the girl came back, Ball says. The girl said she was sure, sobbed after the procedure was over, and thanked everyone on her way out.'It was legal. It was right.'
Ball entered medical school at the Mayo Clinic in 1973, the year Roe was decided. She did not count herself radical: "I was white, upper-middle-class suburban. I still don't see myself as edgy." Nor did abortion seem controversial to her: "It was legal. It was right. . . . Why would anyone argue with that?"
By 1980, she was working one or two evenings a month for Planned Parenthood in Duluth, Minn., focusing on contraception. When the Duluth Women's Health Center opened, she asked to be trained to do dilation and curettage, better known as abortion. For years, she told few people about her work.
"Now, I say, 'I work for Planned Parenthood,' because I'm not going to mince words anymore," she says. "But there were years when I would say, 'I'm an obstetrician and gynecologist.' "
Along with her desire for privacy, she wanted to protect herself and her family from harm. She remains cautious. But her children are older, and she wants to show them the importance of "standing up for what you believe."
Ball spends 40 percent of her time on other projects, principally as medical director of the regional Planned Parenthood office in the Twin Cities. If doctors openly discussed the issue in their communities, they could reduce the stigma around abortion, Ball believes. One rural woman in South Dakota tried to give herself an abortion in 2007, using a sharp implement that broke off.
"They don't get care early because they don't want the physician to know they're pregnant," Ball says. "And they don't get care after the procedure, or they lie or they're afraid of how they'll be treated if they're honest about having had an abortion."Principles and tears
The eight women waiting for Ball met with clinic staff the day before, and all have returned. Under a 2005 state law, there is more they must be told before they undergo the procedure or receive RU-486. Then they must wait two more hours.
Until late last year, staff was required to tell women: "The abortion will terminate the life of a whole, separate, unique, living human being"; the pregnant woman has "an existing relationship with that unborn human being," a relationship protected by the U.S. Constitution and the laws of South Dakota; and a "known medical risk" of abortion is an "increased risk of suicide ideation and suicide."
U.S. District Judge Karen Schreier eliminated the second and third required assertions, calling them "untruthful and misleading." Another rule specifies that follow-up questions and answers must be in writing.
"I see the anger. I see sadness. And I see people just doing what they're told to do because they'll do what they have to do to get the abortion care they need," Ball says. "We comply with the law. We do what we need to do."
Republican state Rep. Manny Steele is a strong proponent of the antiabortion scripts.
"We feel that the doctor is being very biased in his duties to the mother. He is showing his bias, so is it wrong to express what would be called my bias? Isn't it fair for us both to express our feelings?" Steele asks, especially since the doctor is "the one killing the babies."
Ball spends the end of her day in a small cubicle, recording details in her patients' files before meeting the security man for the ride to the airport. This day, she saw more tears than usual. Mothers with children are more likely to cry, she suspects, because "they have already imagined the baby that would result."
"Tears are okay," Ball says she told more than one patient. "We understand tears."
As she prepares for the trip home, she talks about the struggle ahead. The decision to limit abortion coverage in the health-care legislation before Congress, she says, "makes me less optimistic about the future. It makes me tired. I just have a very deep conviction that we're right and they're wrong. And they as honestly believe that they're right and we're wrong."
With that, she heads for the door. She knows she will be back.