Sabrina Tavernise

Its size says as much about the future as the present: With the Supreme Court’s shift to the right, activists on both sides of the abortion divide are adjusting their strategy, anticipating that Roe v. Wade, the 1973 Supreme Court decision that extended federal protections to abortion, might eventually be overturned and that some states would jump at the chance to ban abortions.

For abortion rights advocates, one response is already taking shape: centers like this one that could provide services to women throughout their region — who could come from states where abortion is legal and states where it is not.

“The idea is that we are creating a regional abortion access hub,” said Yamelsie Rodriguez, president of Planned Parenthood of the St. Louis Region and Southwest Missouri. “In a post-Roe world, this is crucial to our mission.”

The clinic is 15 miles from downtown St. Louis in Missouri, a state whose Legislature has restricted abortion so significantly that only one abortion clinic remains. And it is close to highways that connect to cities like Louisville, Kentucky, Indianapolis and Cincinnati — all in states where abortion access has narrowed significantly.

“These are conversations we’ve been having for years, but they are certainly ramped up now,” said the Very Rev. Katherine Hancock Ragsdale, interim president of the National Abortion Federation. “What are the transportation routes out of haven states? What are their capacity in terms of sheer provider hours? How well-positioned are they to receive folks from places that are likely to lose access?”

Anti-abortion activists in nearby states said they were aware of the clinic but were not changing their strategy because of it.

“Our focus in Indiana is on dismantling Roe, then ending abortion here first,” Mike Fichter, president of Indiana Right to Life, said in an email. “Nothing in Planned Parenthood’s strategy changes our focus on these goals.”

Mallory Quigley, a spokeswoman for Susan B. Anthony List, a national anti-abortion group, said the clinic’s existence showed the importance of federal legislation, like the bill that would ban abortion after 20 weeks gestation that has passed the House three times since 2013.

“It’s sickening to see Planned Parenthood set up these mega-centers,” Quigley said. “There’s no doubt that places like Illinois, California and New York are unlikely to change in the near future.”

She added, “The pro-life movement has a lot to do.”

The nation’s abortion map has grown ever more divided since 2010, when the Republican Party swept statehouses and sped the passage of abortion restrictions. In many red states, access has declined substantially, a victory for opponents of abortion. In six states, there is one clinic left. Many blue states, including Illinois, have passed new protections.

In June, Gov. J.B. Pritzker, a Democrat, signed into law the Reproductive Health Act, which removed prohibitions on some late-term abortions and scrapped rules such as felony penalties for doctors who perform abortions. While Missouri has a 72-hour waiting period before a patient can get an abortion, Illinois has none. The state is one of the few that pays for abortion through Medicaid for residents covered by it.

Here in Fairview Heights, the new clinic, in a low-slung brick building that looks a bit like a bank, is “strategically located” next to several budget hotels and a large shopping center with “a lot of food options,” Rodriguez said. “We know women will travel across state lines and across the country,” she said. It is about 18,000 square feet, six times the size of the current clinic.

Randall K. O’Bannon, director of education and research for National Right to Life, said Planned Parenthood had opened many large clinics over the years. Fairview Heights is simply the latest.

“This is not some brand-new surprising thing and it’s not necessarily just about the laws,” he said. “It’s also about how there is competition going on. Planned Parenthood is competing for business.”

Ragsdale, of the National Abortion Federation, argued it was, in fact, about laws. The more restrictive they become, the more likely clinics will be to close, she said, regardless of how many women go.

“People are not getting rich off providing abortion care,” she said.

She said her office was talking with abortion providers every week about the timing and placement of new clinics, but said she could not give specifics.

“We are prepared to take an influx from places that could lose access altogether,” she said, citing Georgia, Alabama and Texas as examples.

Erica Sackin, a Planned Parenthood spokeswoman, said the organization tracked how many patients it served by state, but not by individual health center. She said it had 600 clinics nationwide that served more than 2 million patients.

The clinic, in the works for more than two years and part of Planned Parenthood of the St. Louis Region and Southwest Missouri, was built in secret. Dr. Colleen McNicholas, chief medical officer for the affiliate, said it was done that way because there had been difficulties with contractors in the past. At one clinic in Springfield, Missouri, a company that was supposed to install fiber-optic lines dragged its feet for more than a year, she said. At another, cabinetmakers walked off the job, leaving the clinic without any cabinets.

“There have been many examples where the politics of providing reproductive health care has really delayed the project,” McNicholas said.

Missouri women have been traveling out of state to get abortions for years. In 2009, nearly half of abortion patients in Kansas came from Missouri, roughly the same as in 2017. Illinois is another destination. Out-of-state residents accounted for about 14% of abortions in Illinois in 2017, double the percentage in 2012, according to data from Illinois and the federal government.

Many of those patients are from Missouri. At the Hope Clinic for Women, a private clinic in Granite City, Illinois, not far from downtown St. Louis, about half of all abortion patients are from Missouri.

Planned Parenthood itself drove some of the movement into Illinois. In the spring of 2018, it began sending women seeking abortion through medication rather than through a surgical procedure across the Mississippi River to a small storefront clinic it operated in Illinois. Doctors had balked at a Missouri rule to conduct pelvic exams for medication abortion patients, saying it was medically unnecessary.

Medication abortion happens early in pregnancy — up to 11 weeks gestation — and involves two sets of pills, one taken at the clinic and one at home. It was approved by the federal government in 2000, and by 2017, accounted for more than a third of abortions in the country, according to the Guttmacher Institute, which tracks abortion statistics.

Samuel Lee, an abortion opponent in St. Louis, who helped push Missouri lawmakers to pass a sweeping abortion restriction bill this spring, said he thought the anti-abortion movement was too focused on physical clinics at a time when a rising share of abortions are done through medication, with some women ordering pills online.

“Between the increased use of medication abortion and of self-managed abortion, should focusing on the clinic itself really be our primary goal?” he said. “We need a progression in our thinking. It’s not enough to make abortion unlawful. We need to make it unthinkable. We need to reverse Roe v. Wade in our hearts.”

Lee also argues that Roe is unlikely to be overturned anytime soon, a view that some legal scholars share. The best way forward for the movement, he believes, is a focus on smaller requirements — for example, that doctors have admitting privileges in local hospitals.

“Overturning any Supreme Court decision requires time and a series of cases where the court questions, probes, explains and distinguishes from precedent,” said James Bopp, a conservative lawyer who was the architect of the Citizens United case about campaign spending by corporations. “With this court, that process has not even begun.”

Rodriguez, formerly the chief operating officer of Planned Parenthood of Illinois, said it was not unusual for new clinics to open. She opened three surgical abortion clinics in the state between 2015 and 2019.

Red states have seen new clinic openings, too, said Elizabeth Nash, a researcher at Guttmacher. From 2014 to 2017, Oklahoma and South Carolina each went from three clinics to four, Tennessee went from seven to eight and Utah from two to three.

This article originally appeared in

New Illinois Abortion Clinic Anticipates Post-Roe World

FAIRVIEW HEIGHTS, Ill. — When it opens just across the river from St. Louis this week, the new Planned Parenthood clinic in Illinois will be one of the largest abortion clinics in the Midwest, set up to serve around 11,000 women a year with various health services, double the capacity of the clinic it is replacing.

A bouquet of white tulips lay on the ground near the door. Four musicians from the Baltimore Symphony Orchestra came to play some music, including an improvisation of “Amazing Grace,” one of Cummings’ favorites.

They were small, quiet gestures in the early hours after Cummings’ death Thursday morning — a kind of calm before the storm of formal mourning ceremonies to come. But they were also a testament to the power of the feeling that the people of Baltimore had for Cummings, a man who walked in the shoes of this city for much of his life.

“When I got the news this morning, tears were just streaming,” said the Rev. Alvin Hathaway, who with Cummings were black graduates from a mostly white high school in Baltimore in 1969. Hathaway was more interested in sports in those years, but Cummings pushed him to excel academically, telling him there was more at stake than his own school record.

“He kept us focused,” Hathaway said. “People don’t talk like that now. But he’d say, ‘We are leaders of our race. We are leaders of our community. We have to do the right thing.’ ”

He added, through tears: “That’s why everybody knew him, because he lived our journey. He was not apart from our journey. He lived our journey and he challenged us to excel in our journey.”

On a windy afternoon, residents recalled Cummings’ friendliness and enthusiasm for local haunts.

“He loved the meatballs,” said Sammy Curreri, owner of Sammy’s Trattoria on North Charles Street. Curreri said Cummings would often come in during the week.

“It would be early,” he said. “He would usually just shoot me a text around 5 p.m.”

He was famous in Baltimore, but he never acted like it, Curreri added.

Cummings was also a symbol of stability in a city that sometimes sorely lacked it. He served in Maryland’s House of Representatives from 1983 to 1996, the year he was elected to Congress from Maryland’s 7th District, which includes part of Baltimore. He was trained as a lawyer, but his passion was politics.

In the late 1960s, during the tumult of the civil rights movement, Cummings, still a teenager, got involved in helping elect the first African American judge in Baltimore.

“He was involved early on with our political growth, even before he graduated from Howard and went to law school,” Hathaway said.

He would go on to become a political powerhouse in Congress, where he stood out for his bipartisan inclinations.

Ralph Moore Jr., a veteran activist in Baltimore who teaches classes for adults getting their GED at Baltimore City Community College, said Cummings’ unflappable optimism sometimes frustrated him.

“He was a moderating influence,” Moore said. “He wanted this system to work. He believed in it. I guess from the vantage point of a congressman that makes sense. But he was mindful that from our vantage point in a city like Baltimore, you have to keep wondering how is this going to work.”

One example was Cummings’ response to President Donald Trump’s attack on Twitter this summer in which the president called his district a “rodent infested mess.”

Cummings replied calmly: “Mr. President, I go home to my district daily. Each morning, I wake up, and I go and fight for my neighbors.”

“He was being nice to him,” Moore said, “and I didn’t agree with him being nice to him.”

But that spirit is what made Cummings unique, his friends in Baltimore said Thursday.

He was “so much larger than who he was,” said Bishop Walter Thomas, the pastor of New Psalmist Baptist Church, a sprawling, cream-colored building in West Baltimore, where Cummings was a member and had attended services most Sundays for decades. “He was something so different,” Thomas said. “He was not the angry protester. He was not the passive peacemaker. He was the deliberate man who stood for right and wrestled wrong until right became the natural winner.”

Even after Cummings faced health challenges, he never lost his drive as a community activist, Thomas said.

Thomas remembered walking arm in arm with Cummings, trying to calm the crowds, during the riots after the funeral of Freddie Gray, who had died in police custody in 2015.

“He was sick that night, really sick, but he came out because he did not want to see a disruption in our city,” Thomas said. “He came out night after night after night until the city was at peace. That is who he was. That’s what he lived for. He was the underdog’s hero and the overlord’s threat. He was loved by all.”

He added, “In his own inimical way, living in Baltimore in the 7th Congressional District, he touched lives all over the world.”

Ray Kelly, the lead community liaison for the court-appointed monitoring team that is overseeing Baltimore’s compliance with mandated police reforms, said it was Cummings’ moral leadership in the era of Trump’s presidency that he will most remember.

“As this Trump administration came in, he kind of moved into the position for all black urban communities against those kinds of oppressive types of governance,” he said. “I think that will be his legacy.”

“I’m going to miss that champion,” he said. “It gives me pause to think who will step into that role with the passion and the vigor that Elijah Cummings had.”

'He Was Loved by All': Friends in Baltimore Mourn Elijah Cummings

BALTIMORE — A tall man in a winter coat took off his hat and bowed his head just outside the office of Rep. Elijah Cummings on Thursday. He stood for a minute, eyes closed, then turned and walked away.

The reason was simple. The bill, which would have been the toughest abortion restriction on record, would be dead on arrival once it reached an unfriendly Supreme Court.

But after seven years of avoiding the ban, Ohio Right to Life’s board gathered in an office building outside Toledo in November and voted unanimously to support it. Last week, in Columbus, it was signed into law.

The reversal is evidence of a fundamental shift in the landscape of abortion in America. The math on the Supreme Court has changed with President Donald Trump’s choice of Brett Kavanaugh last year. And now, in the first legislative cycle after the midterm elections last fall, states are rushing to make changes. Newly confident red states are passing some of the strictest prohibitions the country has ever seen. Blue states are enacting ever stronger protections, like ones for later-term abortions in New York and Virginia.

“Now is our time,” said Michael Gonidakis, president of Ohio Right to Life in Columbus. “This is the best court we’ve had in my lifetime, in my parents’ lifetime.”

In their sights is overturning Roe v. Wade, the Supreme Court case that established a federal protection for abortion in 1973. And many in the movement believe that the so-called heartbeat bill — a ban on abortion as early as six weeks of pregnancy, often before a woman even knows she is pregnant — is the way to do it. The bill flies in the face of decades of Supreme Court decisions, like a dare to the American legal system.

“It’s a pretty bold step, I’ll be honest,” said William Seitz, a state representative in Ohio who voted for the bill. “But at least there is some chance that this would provide an opportunity to either further limit Roe, or perhaps jettison it entirely.”

In the first three months of this year, heartbeat bills, which had been at the fringes of the anti-abortion movement for years, have passed in four states — Kentucky, Mississippi, Georgia and Ohio. More are moving through the legislatures of 11 others, according to Elizabeth Nash, a policy expert at the Guttmacher Institute.

“You weren’t seeing the six-week bans move before,” Nash said. “Now it’s a front burner issue.”

In 2011, Ohio became the first state to attempt such a ban. Its main proponent was a determined activist named Janet Porter, who has a long history of taking on conservative Christian causes.

As president of an anti-abortion group called Faith 2 Action, Porter became the gadfly of the anti-abortion movement in Ohio, giving news conferences denouncing anyone who did not support her bill, even if they were friendly to the cause.

“She disparaged a lot of good elected officials and members of the pro-life community along the way,” said Gonidakis, who at times was the target of her attacks.

(Porter agreed to an interview, but when she answered the door at a house in suburban Cleveland on Monday, she said she would give it only if she was allowed to videotape it.)

Despite all this, the bill remained alive, occasionally coming up for a vote.

Sometimes it would pass the House. Sometimes it would pass the Senate. And John Kasich, the former Republican governor of Ohio, vetoed it twice. In the early years, Seitz, a Republican from Cincinnati, remembers thinking that pushing it did not make much sense, given the composition of the Supreme Court, which as late as 2016 sided with abortion clinics in a prominent case in Texas.

“I didn’t detect any appetite on the part of the court majority to significantly limit Roe,” he said. “I just didn’t see it.”

Then came Trump’s election. Gonidakis remembers meeting with him and other anti-abortion activists in New York and being surprised at the language Trump used. He sounded more like an activist than a presidential candidate, Gonidakis said.

“He said, ‘I’m only going to nominate pro-life judges,’” he recalled. “That’s language we use. To hear the candidate use it was astonishing. In a good way.”

Right away, Trump nominated Judge Neil Gorsuch — replacing one conservative, Justice Antonin Scalia, with another. Then the bombshell dropped: Justice Anthony Kennedy, who had voted with the liberal majority in 2016 on the Texas case, announced he would retire.

“Our phones started lighting up,” said Gonidakis, who was in Columbus at the time. He started calling friendly lawmakers in Washington and Ohio. “There were a lot of unknowns right away and a lot of excitement.”

At the center of the Ohio bill is a legal strategy based on questioning one of the standards that federal abortion protections rest on: fetal viability. The Supreme Court has ruled that states can regulate abortion only after a fetus could survive outside a mother’s womb. The bill suggests that standard be scrapped, and replaced with something else: a heartbeat.

Kristina Roegner, a Republican state senator who sponsored the bill, said viability was a flawed standard because medical technology had changed so much since 1973.

“I don’t think the Supreme Court realized what a moving target they were creating,” she said. “We need a new standard. A heartbeat doesn’t change. It’s there, or it’s not.”

B. Jessie Hill, a lawyer who plans to challenge the law in court on behalf of one of the abortion clinics in the state, thinks the argument is a long shot. The court was not persuaded in the past by arguments that a fetus is a person under state law. Surviving outside the womb is key, and forbidding a woman to end a pregnancy before that is “like the state telling you that you have to give someone a kidney or bone marrow because you have it and they need it to survive,” she said. “The law can’t — and doesn’t — do that.”

Even before the confirmation of Kavanaugh, conservatives had made considerable progress in appointments to federal appeals courts, often a critical last stop before the Supreme Court. Today, Republicans have appointed 69 percent of the active judges on the 6th U.S. Circuit Court of Appeals, which encompasses Ohio, compared with 45 percent in 2001, according to Russell Wheeler, a visiting fellow at the Brookings Institution in Washington. Other states in the 6th Circuit are Tennessee, Kentucky and Michigan.

“Judicial philosophy has been the dominant issue for appellate nominations in Republican administrations for the last 30 years in a way that it has not been for Democrats,” said Jonathan Adler, a law professor at Case Western Reserve University.

That unwavering focus has helped to turn the tide on abortion in a broad swath of the country’s middle and the south: Six states are down to one abortion clinic. In Ohio, there were 16 abortion clinics in the early 2000s. Today there are seven.

Just last month in Ohio, in a rare move that was a major victory for anti-abortion activists, the full 6th Circuit panel of judges reversed its own decision from a year ago, ruling against Planned Parenthood in a funding case.

Hill, the lawyer who will challenge Ohio’s new ban in court, said she had reasonable confidence that the law will be struck down in lower courts and not make it to the Supreme Court, at least in the near term. Taking such a case could be seen as political, and tarnish the reputation of the court, she said. But the long-term outcome is less clear. If Justice Ruth Bader Ginsburg retires and Trump is able to appoint a third justice, that could be the decisive blow against Roe.

Gonidakis said he was cautiously optimistic.

“We haven’t won, but we are winning,” he said. “We are winning a battle that we always used to lose.”

This article originally appeared in <a href="https://www.nytimes.com/2019/04/18/us/ohio-abortion-heartbeat-bill.html" id="abf56cd9-002c-3e8d-addc-20696bb81a58">The New York Times</a>.

How Banning Abortion in the Early Weeks of Pregnancy Suddenly Became Mainstream

COLUMBUS, Ohio — For years, Ohio Right to Life, the state’s largest and oldest anti-abortion group, steered clear of a bill that would ban abortion in the very early weeks of pregnancy — after a fetal heartbeat is detected.

But recently, she began seeing some warning signs in the United States, flashes of social distress that she recognized from her work abroad, and after 29 years of peacemaking in other places, she decided to turn her lens on her own society.

“People are making up stories about ‘the other’ — Muslims, Trump voters, whoever ‘the other’ is,” she said. “'They don’t have the values that we have. They don’t behave like we do. They are not nice. They are evil.'”

She added: “That’s dehumanization. And when it spreads, it can be very hard to correct.”

Green is now among a growing group of conflict resolution experts who are turning their focus on the United States, a country that some have never worked on. They are gathering groups in schools and community centers to apply their skills to help a country — this time their own — where they see troubling trends.

They point to dehumanizing political rhetoric — for example President Donald Trump referring to the media as “enemies of the people,” or to a caravan of migrants in Mexico as riddled with criminals and “unknown Middle Easterners.”

Political violence has flared: A gunman killed worshippers in a Pittsburgh synagogue in October after ranting about a refugee agency. That same week, an outspoken supporter of Trump sent pipe bombs to a dozen of the president’s critics. In 2017, an Illinois man steeped in left-wing politics shot four people at a congressional baseball practice.

“There are a lot of people who have been working internationally who are calling me up and saying, ‘Oh my gosh, what do we do? We have to do something,'” said Elizabeth Hume, a former conflict expert for the government, who is vice president of the Alliance for Peacebuilding, a professional association for conflict prevention experts.

“We are seeing some serious red flags,” she said, “things that make conflict experts like me really nervous.”

Conflict experts said while the United States is not nearly in the dire state of some of the other countries they work in, the resilience of American institutions was being tested. And the deterioration of political stability is always gradual.

“People are realizing we are not as exceptional as we thought,” Hume said of the United States.

Democracy rankers have taken note. The Fund for Peace, a nonprofit that focuses on fragile states, declared the United States the fourth-most-worsened country for 2018, after Qatar, Spain and Venezuela. In 2017, the Economist Intelligence Unit, the research division of The Economist Group, downgraded the United States to a “flawed democracy,” from a “full democracy,” citing declining popular trust in government that began long before Trump’s election.

Daniel Noah Moses, director of educator programs for Seeds of Peace, a nonprofit that began with work on the Middle East, but recently has ramped up its focus on the United States, said when he moved to the United States from Jerusalem in 2017, the political climate seemed strangely familiar.

“I’ve been surprised by how similar it all is — the gaps in understanding, the levels of emotion, the negation of ‘the other,'” he said.

Green’s homegrown peace mission consisted of 18 people from Leverett, a liberal enclave in western Massachusetts, and 11 people from eastern Kentucky. In three-day sessions in both places, Green used tools from social psychology to probe underneath politics. The goal was not to change minds, but to broaden them, by getting the participants to see one another as people.

The beginning was bumpy. The initial overture for a meeting with the Kentucky residents came from Jay Frost, a retired corporate training consultant in Leverett who admits that he did not think much of Trump voters at first.

“'Stupid’ was the adjective I used,” he said, explaining his early thinking.

He wrote in an email that he wanted to understand “how rural white voters could possibly support such a vulgar, dystopian presidential candidate,” language he says he now regrets.

Gwen Johnson, an education administrator, who was part of the Kentucky group that received it, said two people started to cry when it was read. But she did not take offense and decided to make the 15-hour trip in a van to Massachusetts to explain to people there that while some might have been mad starting in 2016, she had been mad for most of her life.

“If these folks want to hear why I voted the way I voted, I’m going to damn well tell them,” she said. “That was my attitude.”

And the people from Massachusetts seemed like eager suitors, trying to get the Kentucky residents to agree to a date.

“They had such desperation,” said Nell Fields, a community health researcher from Whitesburg, Kentucky, said of the participants from Massachusetts. “They are very well educated and I think they’ve always been confident that they’ll just carry people along with their way of thinking. And suddenly, when it didn’t happen, they didn’t hardly know what to do.”

She said she got the feeling that “they were kind of doing a project where at the end they would say, ‘OK, look, we fixed them.'”

When they finally met, in the fall of 2017 in Leverett, Green applied a basic rule of psychology: Once people feel heard, their dignity had been acknowledged and the facts of their lives taken seriously, it is easier to take on harder topics like politics.

She decided to start with the things that people have in common. She asked everyone to talk about their families, because “everybody has one.” They sat in a circle in a white clapboard building surrounded by sheep pastures and spoke, one by one. No interruptions were allowed.

“We have been groomed and educated to have lots of opinions, but that all has to be set aside in dialogue,” Green said. “It’s not about opinions, it’s about profound listening.”

When talk did turn to politics, again in a circle one by one, they managed to stay civil. They talked about Trump, immigration and guns, but participants said they managed to avoid blowups.

Around the country, groups are using listening to tackle the political divide.

Rachel Milner Gillers, a conflict resolution expert who previously worked with the United Nations, has been practicing with college students.

In one exercise, students from Georgetown University, in Washington, D.C., and Radford University, in Southwest Virginia, many with different political views, had to ask curious questions of each other and simply repeat back what they were hearing without giving opinions. This is a technique sometimes used in marriage therapy. It turned out to be very hard.

“You had people turning red hearing what they were hearing,” said Milner Gillers, an adjunct professor at Georgetown Law School.

It got easier as they got to know each other better. The same was true for Green’s group. They had a spirited debate about guns over lunch in Kentucky. The people from Leverett believed they were safer when no one had one. The Kentuckians believed they were safer when everyone did.

To illustrate the point, Johnson pointed out that most of the women in the restaurant — including her — had guns in their purses. The people from Massachusetts were shocked.

Fields said the group was able to talk about hard things because of what came before: the feeling that the other side had heard them and that they had become, in a fundamental way, equals.

“I think we all expected it to be a lot harder than it was,” Fields said. “I really learned that no matter how differently we think or vote, if we take a moment to see the other person for who they are, as somebody with a family and a story, that made the hard stuff easier.”

She added: “It was about having a hard conversation in a soft place.”

This article originally appeared in <a href="https://www.nytimes.com/2019/02/04/us/conflicting-experts-peacebuilders.html" id="0f9fb3cf-9a6a-36fe-ae4f-41095422dfd3">The New York Times</a>.

They Have Worked on Conflicts Overseas. Now These Americans See 'Red Flags' at Home.

LEVERETT, Mass. — Paula Green has spent much of her life working on conflicts abroad. In places like Bosnia, Rwanda and Myanmar, Green, an American psychologist, brings together survivors of war, helping them see past their differences so they can live with one another again.

American Conflict Experts Used to Going Abroad Turn to Their Own Country

Not since 1937, when the country was in the grips of the Great Depression and birthrates were down substantially, has it grown so slowly, with just a 0.62 percent gain between July 2017 and July 2018. With Americans getting older, fewer babies are being born and more people are dying, demographers said.

The past year saw a particularly high number of deaths — 2.81 million — and relatively few births, 3.86 million. If the pattern continues, immigrants will soon be more important to population gains than the so-called natural increase, which is the number of births minus the number of deaths.

“I think we need to get used to the fact that we are now a slow-growth country,” said William Frey, a demographer at the Brookings Institution.

Population change is a major indicator of the demographic health of a country and is made up of three flows — births, deaths and immigrants. In the United States, an aging native population has been buoyed by flows of immigrants, who in the past year made up about 48 percent of the total increase, Frey said.

Over the past 10 years in every area except North Dakota and Washington, D.C., the number of deaths came closer to the number of births, said Kenneth Johnson, a demographer from the University of New Hampshire. But for most states, immigration and domestic migration made up the difference. Nevada, Idaho and Utah were the country’s fastest-growing in the year ended in July.

Meanwhile, populations declined in nine states: Alaska, Connecticut, Hawaii, Illinois, Louisiana, Mississippi, New York, West Virginia and Wyoming.

The pattern of rising deaths and declining births has taken hold in many parts of the United States, leading to fewer students and schools, diminished economic vibrancy and strains on social services.

This article originally appeared in <a href="https://www.nytimes.com/2018/12/19/us/cenus-population-growth.html" id="42928502-9e7c-3950-a151-4e90a4b6481e">The New York Times</a>.

The population of the United States grew at its slowest pace in more than eight decades, the Census Bureau said Wednesday, as the number of deaths increased and the number of births declined.

Fewer Births, More Deaths Result in Lowest U.S. Growth Rate in Generations

The past year saw a particularly high number of deaths — 2.81 million — and relatively few births, 3.86 million. If the pattern continues, immigrants will soon be more important to population gains than the so-called natural increase, which is the number of births minus the number of deaths. That was not the case 10 years ago, when the natural increase accounted for a far higher share of the country’s population gains.

“The aging population is starting to take its toll,” said William Frey, a demographer at the Brookings Institution. “I think we need to get used to the fact that we are now a slow-growth country.”

The new rate puts the United States close to the Netherlands and the United Kingdom, Frey said.

Population change is a major indicator of the demographic health of a country and is made up of three flows — births, deaths and immigrants. In the United States, an aging native population has been buoyed by new flows of immigrants, who in the past year made up about 48 percent of the total increase, Frey said.

Over the past 10 years in every area except North Dakota and Washington, D.C., the number of deaths came closer to the number of births, said Kenneth Johnson, a demographer from the University of New Hampshire. But for most states, immigration and domestic migration made up the difference, and so most saw their populations grow last year. Nevada, Idaho and Utah were the country’s fastest-growing in the year ended in July.

Meanwhile, populations declined in nine states: Alaska, Connecticut, Hawaii, Illinois, Louisiana, Mississippi, New York, West Virginia and Wyoming. And Puerto Rico’s population declined by about 4 percent, the bureau said, dragged down further by Hurricane Maria.

“The drop is simply stunning,” Johnson said. “Just 10 years ago, the surplus of births over deaths was 44 percent higher.”

That pattern of rising deaths and declining births has taken hold in many parts of the United States and in areas with little immigration, like New England, leading to fewer students and schools, diminished economic vibrancy and strains on social services.

Maine and West Virginia each recorded more deaths than births, Johnson said. Even so, Maine’s population did not decline because it saw an uptick in people moving in, said Amanda Rector, the state’s economist. She said in an email Wednesday that the state’s annual rate of net migration in 2018 ranked 19th in the nation.

But James Tierney, a former attorney general of Maine who lives in Lisbon Falls, said that the population increases have been mostly confined to the southern part of the state, and that much of Maine still suffers from acute shortages of police officers, firefighters, town managers, school superintendents and teachers, among other professionals.

“We have an aging problem of immense proportions,” Tierney said, adding that some towns have even had a hard time finding snow plow drivers. “These shortages are immense and growing and, in some parts of the state, desperate.”

Lawyers for the clinic say that the audit, which began this spring, has become wide-ranging and includes demands they consider to be unreasonable. They say the clinic’s license is due to expire at midnight on June 1, and if the disagreement over the audit is not sorted out by then, the clinic will be forced to stop providing abortions.

Helene Krasnoff, head of litigation at Planned Parenthood Federation of America, said the group filed suit Tuesday in court in St. Louis, where the clinic is, to try to prevent that outcome. A hearing has been scheduled for 1:30 p.m. Central time Wednesday.

If the clinic’s license is not renewed, Missouri would become the first state in the United States without access to abortion services since 1974, the year after the Supreme Court extended federal protections for the procedure in its landmark Roe v. Wade decision.

The disagreement comes toward the end of a busy legislative season, in which states across the country, including Missouri, have passed some of the strictest abortion laws the country has ever seen. Earlier this month, Alabama passed a law that would ban abortion at any stage of pregnancy. This week, Louisiana lawmakers are expected to vote to ban abortion as early as six weeks into a woman’s pregnancy.

Abortion politics have changed dramatically since the election of President Donald Trump. His two new appointments on the Supreme Court have shifted the math in favor of conservatives on the issue, and activists on both sides are holding their breath — in excitement and in fear — for what might come next.

So far, the court has held back. On Tuesday, it sidestepped part of a case that could have tested the constitutional right to abortion established in Roe v. Wade, turning down an appeal to reinstate a strict Indiana abortion law.

Missouri has been on the front line of the abortion wars, with increasingly stringent laws leaving the state with one clinic. But the conflict that flared this week seemed to have little to do with legislation.

It began with the audit, a kind of annual inspection, which started around March 11, Krasnoff said. The state found deficiencies, she said, and the clinic, Reproductive Health Services of Planned Parenthood of the St. Louis Region, submitted its plan for correcting them on April 9.

The clinic agreed to meet a number of the state’s demands, including a requirement that it provide an additional pelvic exam for abortion patients. But the clinic is now deadlocked with state officials over a request to interview seven of its doctors, including fellows and residents.

“This is harassment and attempted intimidation of doctors at the highest levels of government,” said Dr. Colleen McNicholas, a physician at the clinic.

Krasnoff said the clinic has objected to interviews with so many of its physicians because the state has not explained what the interviews would be about or whether the doctors could face criminal consequences.

“At this point, we have reached an impasse,” Krasnoff said in a phone call with journalists Tuesday.

A spokeswoman for Planned Parenthood said the legal team for the state indicated that it could refer information from the interviews to the state’s attorney general or to the board that regulates doctors in Missouri.

“They refused to discuss the scope of the interview,” Krasnoff said. “And when asked about whether or not it could lead to criminal referrals,” she added, “they have said, basically, that’s not off the table.”

Krasnoff said that the two most senior doctors at the clinic, Dr. David Eisenberg and McNicholas, agreed to speak anyway. But so far, the others have not.

The state has made clear that it could not complete its investigation — or take the next step, which would be to renew the clinic’s license — until it speaks to all the residents and fellows, Krasnoff said.

The Missouri Department of Health and Senior Services did not respond to a request for comment.

This article originally appeared in <a id="ea3d1a84-587e-3a15-a6a7-8a61e648f7e1" href="https://www.nytimes.com/2019/05/28/us/missouri-abortion-clinic.html">The New York Times</a>.

Missouri's last abortion clinic could stop providing the procedure this week

Missouri’s last abortion clinic might have to stop providing the procedure by the end of the week because of a standoff with state officials over an audit, according to Planned Parenthood, which operates the clinic.

He has done everything he could to avoid thinking about the fact that, after 25 years at the General Motors plant in Lordstown, Ohio, he was losing the only real job he ever had.

For Marsh the plant is personal, but in the three months since GM stopped making cars there, it has become political. A parade of presidential hopefuls has come through, using the plant to make the point that U.S. capitalism no longer works for ordinary people. President Donald Trump has taken an interest, too, berating both GM and the union on Twitter, and then suddenly announcing brightly in early May that the plant would be sold to a small company that few people in Lordstown had ever heard of.

The news caused a stir. TV trucks showed up at the union hall. But after a few days it became clear to Marsh that the buyer — which had no experience in mass vehicle production and quarterly revenues that were less than the price of one high-end sports car — was probably not a solution.

“To me, it’s another flagrant sign that these people, they really don’t have a clue,” Marsh said of the country’s political class. “They are so out of touch with reality and real people. All of them.”

He made no exception for Trump. Marsh voted for him, as did a majority of voters in Trumbull County, a small square on the map of northeast Ohio that hadn’t voted for a Republican for president since 1972.

The path to the White House next year runs through places like Lordstown, and Marsh and many of his neighbors, far from knowing how they will vote, say the GM plant shutdown has only left them more at sea politically. They tried voting for Barack Obama, then Trump. Now they don’t know where to turn.

Jeremy Ladd, a Lordstown plant worker now taking classes to get into nursing school, said that most workers were still coming to terms with what had happened, and that for many, the politics were an open question whose answer would unfold over time.

“People are trying to make sense of this politically,” he said. “It’s like a free radical bouncing around.”

Shawn Wodogaza, a Lordstown plant worker who voted for Trump reluctantly, said he felt politically lost now.

“I don’t know where to go,” he said. “It seems like no matter what he does or tries to do, it doesn’t work out,” he said of the president. “Well, now what? What the heck do we do? Do we go back to beating our heads against the wall? Or do we try something different?”

Marsh, too, is still making up his mind.

For three generations of Marsh men, the GM plant was a golden ticket to a middle-class life in a part of the country where those were not easy to come by. Then, when Rick Marsh got the biggest test of his life — the birth of his beloved daughter, Abigail, and her diagnosis of cerebral palsy at 1 — his job became a central part of how he saw himself. He was her provider, her protector. That was his worth in the world.

So when the last car rolled off the Lordstown assembly line at about 2:45 p.m. Wednesday, March 6, it was like a heart stopping. He had lost the thing that made him who he was.

He knows he is looking for one thing from the country’s political system: a president who will save the plant that has meant everything to his family.

“I really don’t care if it’s a Democrat, Republican, male, female, black, white, I don’t care,” he said.

— ‘Made in Mexico’

This wasn’t supposed to happen. Marsh thought he would retire from the Lordstown plant, just like his father. Richard Marsh Sr. started in 1967, the year after the plant opened. He came straight out of the Army, inspecting headlights for $1.92 an hour. When he got his first paycheck, $100, “I thought I was rich,” the elder Marsh said.

The job lifted the Marsh family from apartment to trailer to house on a pretty street lined with cornfields and long, smooth driveways. Rick grew up there, in a back bedroom with heavy-metal posters on the walls. His grades weren’t good, but he wasn’t worried. When a history teacher told him he’d be stuck flipping burgers for the rest of his life, Rick told him he knew where he’d be working. When his father — at the time an elected union official — got him a job at the plant, it came with two pieces of advice.

“Get to work on time, and don’t embarrass me,” the younger Marsh recalled his father saying.

That was 1993, and the plant was its own little city. It employed about 9,000 people. Its giant parking lot was packed. Workers grilled sausages in the break room. He grew up with his colleagues, going to bars, attending weddings, coaching their children in softball, taking up collections when someone’s parent died.

The truth was, he never really liked the work. He found it boring and physically demanding. He worked in the paint shop, wearing two sets of gloves, big plastic boots and a full body apron, while he wielded a sanding tool that smoothed the primer on the surface of the cars. Every night he came home drenched and exhausted.

But he was grateful for it. With his GM paychecks, he built a big house in the woods just half a mile from his parents. He paid for his wedding in full and bought his new wife, Lindsay Marsh, a blue Chevy TrailBlazer. And when Abby came along — his beautiful girl, his floppy baby — his financial security powered the family through the six years of therapy it took to teach her how to walk.

In those early years, Marsh didn’t care about politics. He voted for Democrats without really thinking about it. It was what his family had always done, more out of union loyalty than ideology.

LORDSTOWN, Ohio — In the weeks since he lost his job at the car plant, Rick Marsh has blasted Pink Floyd while cleaning the house. He has watched the cat watching the birds. He has smoked cigarettes out the sliding glass door. He has watched Motor Trend, a TV network about cars. He bought a grill and built a swing set.

Sabrina Tavernise

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