The rival sides in South Dakota's historic vote on abortion each are claiming their position protects women's health -- an old argument on the abortion rights side but a new campaign tactic for anti-abortion advocates that has significantly changed the debate.
At stake is a South Dakota law passed earlier this year that would ban virtually all abortions. Voters will decide Tuesday whether to reject this toughest-in-the-nation ban or uphold it, likely triggering a lawsuit that could lead to the U.S. Supreme Court.
The vote also will serve as a barometer, watched by activists nationwide, gauging the effectiveness of the distinctive pro-ban strategy. Rather than stressing a fetus's right to live or vilifying abortion providers, the Vote Yes For Life campaign has focused on depicting abortion as psychologically harmful to women.
"Support Women's Health," says the campaign Web site. Its ads feature women detailing their post-abortion despair.
The South Dakota Campaign for Healthy Families, which opposes the abortion ban, leads in the polls but still has found the strategy challenging to counter. It says there is no scientific evidence of pervasive psychological or medical problems among women who had abortions.
"The marketing is ingenious on their part," said Dr. Maria Bell, a Sioux Falls gynecological oncologist who opposes the ban in part because she feels it jeopardizes women's health. It would allow abortions only to save a women's life, with no exceptions for other health factors or cases of rape or incest.
"'Abortion hurts women' -- that's a great slogan, but they don't have the data to back that up," Bell said. "They have a lot of stories, but we don't make public policies on anecdotal evidence."
There are indeed stories -- hundreds of women who had abortions provided them to a South Dakota task force, which concluded that abortion should be banned because it is "destructive of the rights, interests and health of women."
The chief of the pro-ban campaign, Leslee Unruh, talks often of regrets over an abortion she had, and says "the time has passed for any other strategy" by the anti-abortion movement.
She expresses annoyance at anti-abortion militants, some from out-of-state, who use more strident tactics such as harassing women at the state's one abortion clinic. "It can't be someone on my side," she said.
Nationally, groups like Silent No More and Operation Outcry are mobilizing women who had abortions to campaign against abortion rights, often using words like "empowerment" that recall previous feminist campaigns.
"My experience, personally and with thousands of other women, is that abortion under any circumstances doesn't typically leave you a better person," said Georgette Forney of Sewickley, Pa., who had an abortion at 16 and is now a leader of Silent No More.
"Is abortion a good health policy for women?" she asked. "Over and over again, the answer is clearly no."
Abortion-rights activists acknowledge that some women struggle emotionally after abortions, but say most do not. "There's no denying there are women who have painful reactions," said Susan Cohen of the Guttmacher Institute, which supports abortion rights. "That doesn't invalidate the opposite feeling millions of women have, of relief at being able to move on with their lives."
Cohen noted that roughly one-third of American woman have an abortion.
"If abortion were so harmful, we'd see a mass epidemic of women with severe mental health problems," she said. "But there is no such mass problem."
Mary Jones, a South Dakota therapist who has worked with rape and incest victims, says denying such women the option of abortion could leave deep emotional scars.
"To be forced to carry out a pregnancy that will remind them every day of their sexual assault. ... it's just devastating" she says in an ad opposing the ban.
There has been no comprehensive, broadly accepted U.S. study quantifying abortion's psychological impact. The American Psychological Association says there is no such thing as a "post-abortion syndrome," while a widely cited 1989 article from Science magazine suggests that up to 10 percent of women who had abortions experience "depressive symptoms of a lingering nature."
Anti-abortion groups cite other studies contending post-abortion distress is more prevalent; some such studies are dismissed by abortion-rights supporters as biased.
"Most of the junk science comes from the right-to-life side -- they have to stretch the scientific data," said Dr. Don Burnap, a Rapid City, S.D., psychiatrist who has treated many women who had abortions.
The women in Vote Yes For Life's campaign ads would beg to differ -- women like Kayla Brandt, who describes her emotions after an abortion nearly four years ago.
"Remorse. Guilt. Shame. Sadness. Hatred. Emptiness. Hopeless," she says. "I began merely existing in the hollow shell of what was once a woman."
Engaging in anti-abortion politics, as Brandt has done, is encouraged by several of the national organizations counseling women troubled by their abortions.
One such group is Rachel's Vineyard Ministries, founded 11 years ago by Philadelphia-area psychologist Theresa Burke. Since then, she says, more than 27,000 people have participated in its weekend retreats.
Burke said the ministry didn't start as a political project, but it is now firmly aligned with the anti-abortion movement. "All the victims have a need to find meaning and purpose. ... to exercise their voice to bring about political change," she said.