On a steamy morning in late July, a moving truck maneuvers up to a brick office complex in College Park, Md., outside Washington, D.C.

Shrink-wrapped inside the truck are the workings of a clinic that will offer abortions through all trimesters of pregnancy: an ultrasound machine, recovery room chairs, patient gowns, and boxes upon boxes of medical instruments and equipment.

"I'm looking at this and really glad we got the 26-foot truck, 'cause it's a ton of stuff!" says Dr. Diane Horvath, an obstetrician-gynecologist and co-owner of the upcoming clinic, Partners in Abortion Care.

When it opens sometime after Labor Day, Partners in Abortion Care will be one of only a handful of clinics in the United States that offer abortions into the third trimester — in this case, up to 34 weeks' gestation. A full-term pregnancy typically lasts 40 weeks.

The clinic expects to treat an influx of patients coming north from states with abortion bans enacted after the Supreme Court decision in June that overturned Roe v. Wade.

All-trimester abortion care "is a really politicized topic," Horvath says, "and it shouldn't be. Every time we draw a line and we say 'no more abortions after this point,' someone's going to fall on the other side of that line, and they're going to be harmed."

Rehomed equipment at a new clinic

The equipment in the moving truck has come full circle. The Maryland clinic bought all of it second-hand from a clinic in Savannah, Ga., that shut down in June after 40 years providing abortions.

It was one of many facilities that either shut down or stopped offering abortion services in states with bans enacted after Roe was overturned.

Georgia now bans most abortions after about six weeks.

By contrast, Maryland has liberal abortion laws, and in July a law took effect that further expands abortion access. Now, along with physicians, qualified health providers including physician assistants, nurse practitioners, and midwives are allowed to perform abortions.

As they watch volunteers move the equipment into their office space, Horvath tears up and embraces her business partner, Morgan Nuzzo, a certified nurse-midwife.

"Whooh," Horvath says with a sigh. "I was thinking about how Georgia lost access to abortion, like, this week. And we're getting this equipment from them. So — it feels very heavy."

"We're going to take good care of the equipment," adds Nuzzo. "We keep talking about it as 'rehoming.' "

Third-trimester abortions are rare

According to the most recent statistics compiled by the Centers for Disease Control and Prevention, the vast majority of abortions in the United States were performed on or before 13 weeks' gestation. Fewer than 1% were performed on or after 21 weeks.

When their all-trimester clinic opens, Horvath and Nuzzo expect to treat perhaps 10 people each week.

It could be someone whose fetus has serious anomalies, which are often only discovered later in pregnancy.

It could be a patient whose continued pregnancy threatens their health.

It could be someone who didn't discover they were pregnant until after the first trimester.

Also, Horvath says, tightened abortion restrictions will inevitably push patients seeking abortion care later into their pregnancies.

"We're definitely going to be seeing people who wanted an abortion two or three months ago," she says, "and could not navigate the web of restrictions, or could not come up with the funding, or could not get transportation or child care or time off of work.

"That's a really common story," Horvath says. "And it's really sad, because it doesn't have to be this way."

Partners in Abortion Care expects it will be the southernmost facility offering abortions later in pregnancy.

As she anticipates the patients they'll serve, Nuzzo compares it to "opening floodgates."

"Somebody was saying the other day that a clinic in Maryland got 6,000 calls from patients in Georgia," Nuzzo says. "That's a daunting thing, to think that you're just standing there holding the gates closed. And just waiting for a flood of people to come in, in need."

Nuzzo has worked in abortion care for eight years. Many of those she's treated, she says, have been really young.

"They're children, you know?" she says. "And the worst things that you can imagine happening to people, have happened to the people that I've taken care of. Kidnappings, rape, incest, every type of abuse. And then the whole flip side of finding out that something horrible has happened to the pregnancy that you thought was going to be OK."

Nuzzo considers it a "sacred relationship" to be with someone during such an intimate and difficult time.

Bolstering clinic security

Because theirs will be an all-trimester clinic, the owners know it will be high-profile and especially vulnerable as a potential target of violence.

So their offices are being fortified with layers of extra security: Cameras. Heavy doors. Panic buttons.

When NPR visited in July, the front windows were getting coated with a layer of thick, tinted security film to prevent shattering.

According to the National Abortion Federation, there has been a steady rise in harassment and violence against abortion providers in recent years, including assaults, burglaries, and clinic invasions.

And the threat of murder looms, constantly.

Eleven people have been killed in attacks on clinics and providers since 1993.

"It's scary," says Nuzzo. "It's very hard to continue to do work when you think about all the violence that's directed at you. And it's not imagined. It's not made up. They want to kill us. They want to shoot us."

Which is why, Horvath says, they think about security at every step.

"I'm looking around all the time," she says. "I'm making sure that I have an awareness of all of my surroundings. I always look at all the cameras before I leave."

This has been Horvath's life for the 16 years she's worked in abortion care.

"I don't want to normalize it," she says, "'cause it's not normal. But I still come to work and I do this job because it's too important to not do it. I mean, the whole point of terrorism is to make you afraid. And what the anti-abortion folks are doing is terrorism."

A patchwork of funding

To launch their clinic, the partners have cobbled together funding from a variety of sources.

For starters, the women in Nuzzo's book group donated $15,000.

"These aren't people who have gobs of money," Nuzzo says. "These are people who did it because it was important."

A GoFundMe campaign has brought in more than $360,000.

The partners also got a small-business loan and a foundation grant.

All in all, they figure, it's enough to get the clinic fully staffed and off the ground for the first three to six months.

But when NPR visits the clinic again in mid-August, their hopes of opening right after Labor Day are mired in red tape:

They've been stymied by delays getting an updated application from the state of Maryland for their health care facility license. It's a typical bureaucratic holdup, Horvath says — nothing targeted at them specifically. But she's still frustrated.

"This is very time-sensitive for us, as you can imagine," she says. "We have a lot of people that need this care and have very few other options. And so I'm like – 'C'mon guys, like, we really need to get this together.' "

Meantime, they're hiring and training staff, including two nurses, Paige and Kayla, who asked that we use only their first names, out of security concerns.

Previously, they both worked on maternity wards in labor and delivery.

For Kayla, offering abortion through all trimesters means providing basic, essential health care.

"I know that it can be controversial to some people, but it is part of the scope of women's health. And I am very passionate about women's health, and I'm very passionate about safe abortion care," Kayla says.

For Paige, this summer's Supreme Court decision overturning Roe v. Wade was a turning point.

"This June, I walked out of my grandfather's funeral and turned my phone on to the decision, blasted all over my phone," Paige recalls.

"And it was kind of like the slap in the face I needed of like, why am I not doing this? How many people are lucky enough to have the education, have the skills, and have the passion to be able to do something about it in such a personal level?"

The clinic's owners say they feel called to do this work.

Nuzzo would like people to understand this:

"You know, we're not monsters," she says. "We're trying to help people. We're really, really, really trying to help people who are in absolutely unimaginable situations."

By talking about their work, Nuzzo says, maybe it will help dissolve the stigma around later abortion — and the people who seek it.

--NPR's Marisa Peñaloza contributed to this report.

Copyright 2022 NPR. To see more, visit https://www.npr.org.

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