TRURO — Every two weeks for the last five years, Dr. Nicola Moore has made the 1,800-mile trip from Massachusetts to the Planned Parenthood clinic in Waco, Texas, where she provides abortion services, birth control, and miscarriage management to women who live in one of the most conservative states in the country.
Moore grew up in Los Angeles and spent summers in her family’s cottage in Truro, where she still stays during the weeks when she’s not in Texas. She spoke with the Independent about the events of the past week.
Planned Parenthood of Greater Texas stopped providing abortions on June 24, as soon as the Supreme Court decision overturning Roe v. Wade was announced. The organization’s lawyers are studying what is now legal in Texas, said Moore.
Thirteen states have “trigger” laws in place banning abortion, written to go into effect if Roe was overturned, according to the Guttmacher Institute, a research organization focused on reproductive rights. The Institute expects as many as 26 states to ban abortion in reaction to the Supreme Court ruling. Many trigger laws have no exceptions, including in cases of rape or incest.
Texas has both a trigger law and pre-Roe abortion ban on the books. “That pre-Roe law is what most of the abortion providers in Texas are studying,” Moore said.
Meanwhile, the mood at the clinic has been “extremely sad.”
“I’m just depressed,” said Moore. “It feels like the day after Trump was elected in November 2016, but a bit more hopeless, because more is known about what the future holds.”
Most patients who come to the Waco clinic are the working poor, she said. “About half have no health insurance; most have young children,” she said. “Occasionally there will be an affluent patient, because this is the only place within 100 miles that provides abortion services.”
Protesters frequently gather outside the clinic, yelling at the patients as they enter, Moore said. Some clinics have volunteers who escort patients inside. A fence at the Waco clinic keeps protesters out of the parking lot, so they have access to patients only as they drive in. A “tall and burly security guard” escorts women from their cars to the clinic and back again, said Moore, but many women are visibly shaken when they get inside.
“It’s hard on the patients, who have never before been yelled at by strangers when they go to see a doctor,” Moore said. “We can tell how nasty the protesters are on a given day by how upset the patients are.”
Moore said she has not herself been harassed, “other than being yelled at by name every day in Texas.” In fact, she is a frequent target of national anti-abortion groups.
In 2017, Pro-Life Waco featured two photos of Moore. One was captioned, “Here is ‘Dr.’ Nicola Moore walking into PP in Waco to begin a day of shedding innocent blood.”
Moore said that all her colleagues at the clinic live in Waco and care deeply for those who come seeking help.
“Every woman has a poignant story,” she said. “Barely scraping by with the three children she already has; an abusive boyfriend she doesn’t want to be around forever; a disabled child who requires all her attention; a heartbreaking stillbirth, or a child’s death that leads her to say, ‘I just can’t be pregnant again’; a 40-year-old involved in a post-divorce fling who says, ‘No way.’ ” And the list goes on.
“Many women I see in Texas say they don’t approve of abortion and that ‘I never thought I’d come here,’ ” said Moore. “No one wants an abortion — and no one ever expects to have one.”
Although the abortion rate has generally declined since the 1990s, abortion is still a common experience for U.S. women. About one-quarter (23.7 percent) will have an abortion by age 45, according to a 2017 Guttmacher Institute analysis.
Moore, now 66, has worked with Planned Parenthood in the Midwest and Southwest since 2009. Each clinic operates independently and requires her to be licensed in its state.
“I want to work where I’ll be useful and where clinics have difficulty finding doctors,” she said. That has included clinics in South Dakota, Iowa, and Nebraska.
She earned a B.A. from Yale University as well as a master’s in public health, then spent several years as a health-care administrator. At age 39, Moore entered medical school, graduating in 1999. She completed her residency in family medicine in Rochester, N.Y. and then spent a year as a research fellow focusing on reproductive health services.
With her training completed, Moore says, she wanted to practice medicine in underserved areas. From 2003 to 2009, she worked predominantly in Zimbabwe.
“Except in South Africa, abortion was illegal,” she said. “I did a lot of obstetrics there as a general doctor.”
Every hospital had a ward for pregnant women who were experiencing pregnancy-related medical issues. Women came in bleeding, Moore said.
“You couldn’t tell whether they were miscarrying or did it themselves,” she said. “The women were very sick, suffering from infections. I saw several women die.” Some were brought in wearing handcuffs, having been reported to police for trying to abort the fetus, said Moore.
Her experience in Africa prompted her to seek training in abortion procedures. After returning to the U.S., she began working at Planned Parenthood clinics.
“I wasn’t predestined to be an abortion doctor,” said Moore. “I landed in it because of a political commitment to choice, and I discovered that it’s interesting and very rewarding work.”
While Planned Parenthood and other women’s rights organizations sort the issue out in court, Moore plans to keep doing whatever she can for those seeking help.
“I’ll be back in Texas for one more week to do follow-ups on patients I treated last week,” she said on Monday. After that, “I’ll work at a Planned Parenthood in a state where abortion is legal, close to states where it is not.”
Moore believes there will be money available from nonprofit organizations to help women cover the costs of traveling out of state and staying overnight, and for the abortion procedure itself.
“The messier issue is for a woman to make the decision to leave her state rather than being able to go to a local clinic with local people taking care of her,” she said. “And in many cases, nobody knows: the boyfriend doesn’t know and the father doesn’t know.”
Added to that may be a need to take time off from work and arrange care for other children. Making the arrangements is more complicated for women who don’t speak English, Moore added.
Women seeking abortions come from all walks of life, she said: “They’re really just folks in a difficult situation who have made a decision that this is the best choice for them.”