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She had considered abortion when tests showed this baby, too, was doomed, but couldn’t afford the cost. It would have involved traveling nearly six hours to the Sioux Falls clinic. And because her life wasn’t at risk, Medicaid in her state wouldn’t pay for it, even though it was clear her baby would be born dead or die shortly after birth.

In Illinois, laws are relatively lenient. The Hope Clinic in Granite City in Southern Illinois caters to women from neighboring states like Missouri and Kentucky where it’s harder to get an abortion.

Tamara Threlkeld, the clinic’s executive director, said despite increasingly difficult access, Hope Clinic has not seen any increase in patients with later-term pregnancies seeking abortions.

Though you’d expect to see that trend, “they’re able to find us” early on, she said.

Most abortions occur in the first 12 weeks when the embryo is about the size of a lima bean. Major organs have begun developing, but the embryo at this stage looks nothing like the photographs of mangled fetuses that abortion foes promote. Those pictures generally represent late-term abortions, those after five months, which account for less than 2 percent of abortions.

Women who visit Hope Clinic can expect to find Angela Michael. She is a long-shot Democratic candidate seeking to unseat longtime GOP Congressman John Shimkus in Illinois’ 15th district.

Michael is a retired obstetrics nurse who has run TV commercials showing graphic images of dismembered fetuses. She regularly pickets outside the clinic, encouraging patients to change their minds. She also photographs them and posts their pictures on her website.

She said she has compassion for these women, but considers abortion murder.

The photographs she promotes may not depict typical abortions, but Michael says they sometimes work to persuade women to continue their pregnancies.

“I really didn’t go into this race with the hopes of winning. My point was to be the messenger” against abortion, she said.

Some Hope Clinic patients come from Kentucky, where the number of abortions has steadily dropped from almost 4,400 in 2007 to roughly 3,900 in 2010.

Kentucky’s only two abortion clinics are in Louisville and Lexington, an hour apart and several hours from some of the state’s most impoverished counties. Kentucky requires a 24-hour waiting period, and five of the seven surrounding states also have waiting periods. Public funding of abortions in Kentucky is limited to cases of rape, incest or when pregnancy endangers a woman’s life.

Mississippi has similar restrictions and only one abortion clinic, in Jackson, threatened with closure because of a new law requiring providers to have local hospital admitting privileges. State Health Department data show Mississippi abortions have steadily dropped, from nearly 3,000 in 2007 to about 2,200 in 2011. Meanwhile, the number of Mississippi residents seeking abortions out of state grew from fewer than 2,000 a decade ago to at least 3,000 in more recent years, according to data from the state Department of Health.

“Never have times been this restrictive,” said Dr. Willie Parker, a Washington, D.C.-based physician who since June has traveled periodically to Mississippi to provide abortions.

Parker said he’s often struck by the hardship many women face, and told of a 33-year-old mother of four who lost a child to cancer two years ago. She was unemployed and still grieving when she learned she was pregnant again. The woman traveled three hours to the Jackson clinic to get required counseling in June. Then she had to return the next week for the abortion.

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