By now, many in the abortion rights community have heard about the horrific vandalism that recently took place at All Families Healthcare in Kalispell, Montana, the family medicine practice of Susan Cahill, a physician assistant (PA). Cahill includes abortions as one of numerous services offered to her patients and this clearly was the reason for the attack. As reported at RH Reality Check and elsewhere, Cahill’s clinic was completely destroyed and remains closed as of this writing. Less well known, however, is Cahill’s important role, more than 20 years ago, in a consequential event in U.S. abortion care history—an event that continues to resonate today.
Unlike their counterparts in other industrialized countries, abortion providers in the United States don’t simply perform abortions. Because of all the ramifications of the abortion wars in this country—the restrictions on the use of public funds, the scarcity of facilities that are able (or, in the case of hospitals, willing) to perform abortions for sicker women, and, most crucially, the overrepresentation of the poorest women in America in the population of abortion recipients—U.S. providers have become de facto social workers, fundraisers, and travel agents, to name just a few of their ancillary roles.
Note: This post is a lightly edited version of remarks given by Carole Joffee upon accepting the 2013 Lifetime Achievement Award from the Society of Family Planning in Seattle on October 7. It previously appeared on the RH Reality Check.
My journey as a researcher of abortion provision started in the late 1970s. I had just moved to the Philadelphia area for my first academic job, and I began an ethnography of a Planned Parenthood clinic in that city that was in the midst of incorporating abortion services. My interests at that time were in observing how a social movement issue becomes translated into a health-care “service.” But after immersing myself in that clinic for over a year, I became deeply interested in all categories of abortion providers, broadly speaking—counselors, nurses, physicians, clinic directors—and I have been studying providers ever since.
What I would like to do today is revisit some of the main points of my book, Doctors of Conscience: The Struggle to Provide Abortion Before and After Roe v. Wade. What I attempted in that book was to apply a sociological lens to the work of providers, including an investigation of the “social status” of providers, which is sociological jargon for asking, more simply, how did involvement in abortion work affect both the personal and professional relationships of that first generation of providers whose work spanned the years immediately before and after legalization?
I argued, based on the interviews I conducted with those physicians, that abortion provision early on suffered from a marginality from the rest of medicine. As I put it, “mainstream medicine supported legal abortion but not the abortion provider.” Very briefly, I claimed that within medical circles the legacy of the “back alley butcher” of the pre-Roe era carried over and stigmatized all those who had performed abortions before Roe and went on to do so afterwards—even the “doctors of conscience” I interviewed who had provided, at great personal risk, safe and ethical care before legalization. I also wrote of the personal isolation many felt as a result of engaging in this work.
No school district, employee or agent thereof, or educational service provider contracting with such school district shall provide abortion services. No school district shall permit any person or entity to offer, sponsor or otherwise furnish in any manner any course materials or instruction relating to human sexuality or sexually transmitted diseases if such person or entity is an abortion services provider, or an employee, agent or volunteer of an abortion services provider.
The above provision is contained in a nearly 50-page bill that recently went into effect in Kansas. (A judge temporarily blocked two other provisions of the law, but allowed this one to remain.)
To be sure, the relentless assault on abortion that we are currently seeing in other state legislatures—Texas, Ohio, and North Carolina, among others—are far more consequential in the short run. Ambulatory surgical center (ASC) and hospital admitting privilege requirements really do have the capacity to shut down clinics. Should the Texas bill currently being considered become law—as is likely, despite the heroic efforts of the thousands of orange-shirters gathered at the capitol—the number of Texas abortion facilities would go from 47 to five in that huge state. Already, due to a similar ASC requirement, earlier rammed through the Pennsylvania legislature as a cynical response to the Gosnell scandal, a number of clinics in Pennsylvania have closed. And the bans on abortions after 20 weeks, adopted by a number of states, will affect a relatively small number of women, but typically those in desperate medical and/or social condition.
But other provisions of abortion legislation, of which the Kansas one cited above is a prime example, do a different kind of damage. They further the stigmatization and marginalization of abortion providers by making clear that these individuals are not welcome in that most central of community institutions: the schools. It is not just participation in sex education from which Kansas providers are barred. As Stephanie Toti, senior attorney at the Center for Reproductive Rights, which is challenging this law, told me, “This is unprecedented discrimination against abortion providers. … The prohibition on providers serving as ‘agents’ of a school district has the effect of barring them from serving as chaperones on field trips and engaging in most other volunteer activities.”
So abortion providers are at this moment banned from Kansas schools—and supposedly this will promote the safety of adult women getting abortions, as is the typical sanctimonious rationalization of the various laws we are seeing.
I asked several lawyer colleagues if they knew of other instances in which a whole occupational category was banned by law from volunteering in schools. They did not. Indeed, as far as I can tell, only sex offenders as a class are de facto banned from school grounds.
This shocking ban on abortion providers’ involvement in the schools leads me to recollect other instances I have encountered of attempts to isolate this group and keep them from community involvement. I think of a provider I’ve written about who I call Bill Swinton (not his real name), a family medicine doctor in a small town in the Pacific Northwest. He was deeply involved in both his church and his community, and served for three terms on the local school board. But he was defeated for a fourth term in the late 1980s, as the abortion wars intensified; needless to say, his status as a provider was the key factor in his defeat. I think as well of another doctor I’ve written about named Susan Golden (also not her real name), in a town in the Midwest, who integrated abortion provision into her family medicine practice. When she and her partner planned to take part in a community health fair, presenting on the care of newborns, the entire event was abruptly cancelled by the anti-abortion owner of the facility where the fair had been scheduled to take place.
As disturbing as these incidents were, they did not have the force, or the legitimization, of law. The Kansas provision does—and as such, takes the stigmatization of abortion providers to a new level.
Assuming the Kansas law, including this provision, is not overturned, we can only speculate as to what effects it might have. Speaking personally, I remember as a child the enormous pride I felt when my father, a cardiologist, came to my elementary school with his microscope and showed the class wondrous things. As a working mother, I recall how much I valued occasional volunteer stints in my daughters’ schools, getting to know both their classmates and other parents. It is very disturbing to contemplate that providers and their children will be deprived of these experiences. And it is equally disturbing to contemplate the messages that others in the community will receive from such a ban.
It does not take a rocket scientist to realize that in health-care settings a positive relationship between clinician and patient—one comprised of mutual understanding, respect, and trust—is beneficial to both parties. It is only common sense that when such a relationship exists, however brief it may be, the provider develops more sympathy for the needs of the patient, and the latter’s overall well-being can improve if she or he senses personal interest and concern on the part of the former.
Arguably, this point is especially relevant in abortion care because of the extreme politicization and stigma that surrounds the procedure. Some patients, having been exposed to anti-abortion distortions, are terrified of the procedure (one provider told me of a patient who asked, “When are you going to use the steel ball with the knives on it?”) and some do not view abortion doctors as “real” doctors. Some physicians, in turn, depending on the circumstances of their particular facility, have little chance to interact with patients, except when she is on the procedure table, possibly under anesthesia. Therefore, these providers may have an inadequate understanding of the reasons that brought these women to the clinic. Indeed, several research studies of abortion staff done soon after abortion became legal in the United States have shown that those who had opportunities for verbal interaction with patients—for example, social workers and counselors—were more positively inclined toward patients than those whose interactions were confined to just physical care. My own research among abortion providing physicians has revealed that the aspect of this work many find most meaningful is simply talking to patients, and some are wistful that there is not more opportunity for this.
In the period immediately after Roe v. Wade, it was very common in most abortion settings for designated counselors or physicians to have the opportunity for open-ended discussion with a patient. This kind of encounter, which goes beyond offering the patient the requisite informed consent information and ascertaining she has not been coerced into the decision, has been difficult for many facilities to sustain over the years for various reasons, not the least being that in many states patient-doctor time is eaten up by doctors having to impart to patients legislatively mandated scripts about abortion, many of which contain blatant falsehoods. Nevertheless, most abortion facilities with which I am familiar make every effort to offer additional conversational time to patients who seem most in need of it.
What do these efforts to maintain meaningful provider-patient conversations have to do with Live Action, the anti-abortion group notorious for its undercover “investigations” of abortion clinics? For several years, Live Action operatives, pretending to be prospective abortion patients, have gone into clinics, questioning various levels of staff about abortion policies and procedures, and when their hidden cameras manage to catch a staff person making an inopportune comment, the organization triumphantly posts videos (typically highly edited) of these visits.
The latest Live Action “gotcha” moment is in a video of Dr. Leroy Carhart, one of the few providers in the United States who openly provides post-24-week abortions in selected circumstances, and as such is a longstanding target of the anti-abortion movement. In the video, Carhart is repeatedly grilled by a would-be patient, who portrays herself as 26 weeks pregnant, as to the procedure he would use in a pregnancy of that gestation. In response to the woman’s stated concern that a fetus whose demise has been caused by injection “would decay inside of her,” Carhart seeks to reassure her, at one point saying the fetus would soften like “meat in a Crock-Pot.” Predictably, Live Action, and subsequently other anti-abortion groups, have seized upon this statement and used it to further their campaign of what might be called the “Gosnellization” of individuals who provide later abortions—that is, to claim that Carhart and his colleagues are no different than the rogue doctor now on trial in Philadelphia for dangerous and illegal practices.
But Leroy Carhart and Kermit Gosnell could not be more different as abortion providers. As the New York Times pointed out in its coverage of this incident, “[T]he video provides no evidence of illegal action or subpar medical techniques.” Tracy Weitz, my University of California, San Francisco colleague, further pointed out to the paper the evident concern that Carhart exhibited toward the (imposter) patient, and offered this context to his “Crock-Pot” remark: “Doctors struggle to find terminology to help a client understand what’s happening, and while it may seem wrong to us, it may be appropriate for that conversation.” (The recent film After Tiller also amply demonstrates Dr. Carhart’s compassionate relationship with patients.)
What will be the upshot of this latest Live Action incident? Dr. Carhart, who previously provided later abortions in the clinic of Dr. George Tiller in Kansas before Tiller was assassinated, will not be deterred from his “mission” to carry on his friend’s work, as the former military surgeon often puts it. In the years since he decided to devote himself full-time to abortion work, Carhart has had extremists burn down his barn with 17 horses inside, seen the state of Nebraska pass a law deliberately aimed at preventing him from performing abortions after 20 weeks’ gestation, and is subject to constant protestors at his two clinics as well as vilification in anti-abortion media.
But while Dr. Carhart will continue with his work, I do fear that a possible consequence of these well-publicized Live Action videos may be a chilling effect on the free and open conversation between clinic staff and patients that is such an important part of abortion care. Should this occur, I have no doubt the anti-abortion movement will declaim self-righteously about the “coldness” and “impersonality” of abortion facilities.
“…the news came over the radio. It was just an overwhelming feeling. I got tears in my eyes…at last it was all over, finally…never again the fear, the threat of going to prison…the fear of the woman not being able to get service. It was a new day.”
These words were spoken to me several years ago by a doctor I call David Bennett. I was interviewing Dr. Bennett for a book on abortion provision before Roe v Wade and had asked Bennett what his memories were of January 22, 1973. His thoughts were of particular interest to me. Unlike many of the other doctors active before Roe, who, understandably afraid of detection, quietly offered abortions only to a select few, Bennett had made the decision, as a matter of conscience, to offer abortions to all women who sought them.
Dr. Bennett worked closely with the Clergy Consultation Services, an organization of ministers and rabbis started in 1967, which established a referral list of medically competent and ethical physicians to whom these clergy could send distraught women facing unwanted pregnancies. In the years leading up to Roe, thousands of women, either referred by the CCS or who had heard of him through word of mouth, came to his small Southwestern city for abortions. The flood of abortion patients soon overwhelmed the rest of his medical practice, brought considerable strain to his family life, and, as his quote above suggests, led to a constant worry about criminal charges.
Despite his elation upon hearing of the Roe v Wade decision, the decision, of course, did not prove to be a “new day” —or more precisely, a problem-free new era — for Bennett and his abortion providing colleagues at all. (In contrast, it was was a new day for American women, as the death and injury rate from abortions fell dramatically after legalization. Not all those seeking abortions before Roe had managed to find safe providers like Bennett; many women attempted self-abortion or fell into the hands of the notoriously inept “butchers” of pre-Roe days).
The rapid rise of an anti-abortion movement after the Roe decision, including the eventual development of a violent wing of this movement, meant that Bennett and others went from fearing legal authorities to fearing the actions of terrorists. In the 40 years since Roe, eight members of the abortion providing community have been brutally murdered — including Bennett’s close friend, George Tiller of Kansas — and thousands more have been stalked, seen their clinics firebombed and vandalized, and have experienced aggressive picketers showing up at their homes, places of worship, and their children’s schools as well as their workplaces. Bennett himself, over the years, has several times had to rebuild his offices because of the serious damage caused by arsonists.
It’s not just — or even, primarily — episodic violence, however, that has made abortion provision extremely difficult in many places in the years since Roe. Abortion has been regulated like no other branch of American medicine. Since legalization, state legislatures have passed hundreds of laws, with a record number of these occurring in 2011 and 2012. Many of these laws, especially those dealing with the physical requirements of abortion providing facilities, are widely acknowledged to have nothing to do with patient safety and everything to do with making it financially impossible for these clinics to remain open. In more than 20 states, doctors are put in the ethically untenable position of being required by state mandate to impart to patients information that is scientifically invalid, such as the alleged links between abortion and breast cancer, infertility and suicide.
Today, in his seventies, David Bennett continues as an abortion provider, one of the last of the veterans of the pre-Roe era to do so. Encouragingly, a new generation of young physicians — mainly women — have sought training in abortion procedure, ready to carry on with this work. But in order for abortion access to be a reality anywhere other than the two coasts and a handful of other metropolitan areas, there have to exist the conditions under which this medical service can be delivered. Americans may be torn about abortion, but consistently, a majority have made clear their preference that abortion remains legal, as was strongly reaffirmed in the 2012 election. The “new day” that David Bennett dreamed of on January 22, 1973 can only happen if there is a forceful stand by this majority in support of these doctors and against both the violence and legislative persecution that has characterized abortion care in the United States.
Here are some things that have occurred in the immediate aftermath of the tragic slaughter of children and their teachers in Newtown, Connecticut: More signatures on a petition calling for gun control than any other petition that has been sent to the White House; conservative politicians from both parties—for example senators Joe Manchin of W. Virginia, and Marco Rubio of Florida—for the first time signaling their willingness to do something about gun regulation; changing poll numbers about gun control among the general population, with support for stricter control at a ten-year high. And perhaps most significantly, total silence for several days about this incident from the National Rifle Association (NRA), considered to be the most powerful lobby in the United States.
These post-Newtown reactions have led numerous observers to feel that this latest mass murder incident may be a game changer. For years, many politicians have been fearful of offending the NRA and the public has been divided about guns, if not largely indifferent. As a result, there has not been a visible or highly effective gun control movement in this country, in spite of the hard work for many years of groups such as the Brady Campaign to Prevent Gun Violence. Correspondingly, there has been almost no Congressional legislative action to curtail guns during the Obama administration, and at the state level, there have been more efforts to expand gun owners’ prerogatives—for example, concealed carry laws—than to limit then.
To be sure, petitions and expressions of outrage by both politicians and the public do not necessarily lead to a social movement. Even if an assault weapons ban is passed—Senator Dianne Feinstein has pledged to introduce such legislation in January—that might be a one-off event (welcome as it would be), and politicians would then turn their attention to the many other issues on their plates. And recall that there was such a ban passed in 1994 during the Clinton presidency—and then that ban was allowed to quietly expire in 2004. That expiration is a textbook case of what happens when legislation is not accompanied by a vibrant social movement that is able to rally the public and to hold lawmakers accountable.
But let’s assume that the Newtown shootings do lead to a social movement with staying power. What could such a movement hope to accomplish? To answer this question, I find myself looking to the history of the anti-choice movement in this country. To put it mildly, I am no fan of this movement, but I do acknowledge its effectiveness in limiting access to abortion and stigmatizing the procedure. Both the current anti-chocie movement and a potential gun control movement share the feature of wanting to limit something that is legal but contested. As Robin Marty has wittily put it in a recent post, how do we make guns as difficult to get as an abortion?
Here are three pertinent lessons drawn from the forty years of anti-choice activity since the Roedecision. The first is the utility of a “chipping away” strategy. The antiabortion movement has thus far been unable to have Roe overturned, and with Obama’s re-election putting future Supreme Court nominees in his hands, this will be likely the case for the foreseeable future. Nevertheless, the hundreds of regulations passed by state legislatures over the years—the near-absolute restrictions on public funding, the “TRAP” laws that have demanded irrelevant and expensive physical upgrades to clinics, the waiting periods, the parental consent laws and so on—have made access to abortion care very cumbersome for providers, and often unmanageable for patients, especially the young and the poor. In short, Roe technically still stands, but for too many women unable to find and afford abortion care, this is a hollow victory.
Similarly, those gun control activists who would like to see an America where private gun ownership only minimally exists (as in Japan and a number of European countries) will never reach this goal, as a recent Supreme Court decision on the Second Amendment made clear. But a renewed gun control movement could chip away at this right. A ban on assault weapons and on gun magazines with huge amounts of ammunition capacity, higher prices and taxes for ammunition, limitations on the amount of guns and ammunition a person can buy in a given time period, far stricter enforcement of waiting periods and back-ground checks, and of course, serious efforts to keep guns out of the hands of the mentally ill are just some of the items under discussion that would accomplish such “chipping.”
Second, the anti-abortion movement over the years has effectively re-framed its rationale for opposing abortion from moralistic or religious reasons to matters of safety and a defense of the physical and mental health of women. “Abortion hurts women” is a prime example of this re-framing. Given that medical researchers have recently shown that American women are 14 times more likely to die in childbirth than from a first trimester abortion, and given that psychological experts have repeatedly debunked the claims of “post abortion syndrome” made by the antiabortion movement, this re-framing is hardly credible. But these arguments have been eagerly appropriated by anti-choice politicians to justify all sorts of restrictions.
Similarly, a gun control movement might consider framing its arguments against guns not only as matters of reducing crime and mayhem or simply the immorality of a society armed to the teeth—but also, with far more credibility than the above-mentioned anti-choice attempts, as a public health issue, as various clinicians and researchers have long urged. Treating gun violence through a public health lens implies, as with all public health campaigns, a focus on injury prevention and a necessity to regulate guns as consumer items that are dangerous. This framing also leads to the recognition of the burden that our country’s epidemic of gun violence puts on hospital emergency rooms, as well as the lasting costs of caring for people wounded by gunfire.
Finally, one of the most consequential activities of the anti-choice movement has been the stigmatizing of abortion, and especially the abortion provider. Providers have been relentlessly caricatured by the anti-choice movement as greedy, medically-inept and immoral. They also have been the target of unacceptable levels of violence and harassment by the militant wings of the movement. While most in the medical profession are themselves pro-choice and do not accept this portrayal of abortion providers, the controversy surrounding abortion has facilitated the marginality of abortion provision from the rest of the medical community.
For a gun control movement, a comparable strategy that suggests itself is to stigmatize certain kinds of gun ownership. For example, to cite a point currently offered even by some gun owners, why does any private citizen need an assault weapon? The prime targets for stigmatization, however, are the gun manufacturers and dealers, and organizations such as the NRA. These are the groups and individuals who directly profit from gun sales. They are the ones who most strongly resist any kind of regulation and who make little or no effort to screen the individuals to whom they sell dangerous weapons. It is these merchants of death that need to be held accountable for their role in not only the spectacular tragedies such as occurred at Newtown, but for the 88 individuals that die each day in the U.S. due to gun violence. In sum, the lesson that a gun control movement can learn from the anti-abortion experience is that effective action involves both legislative and cultural campaigns.
Similarities aside, there is one very important distinction to be drawn between these two movements. The anti-abortion movement has long tolerated an extremist wing that has murdered eight members of the abortion providing community and has terrified thousands of other providers and patients. The threat of intimidation and violence always hovers around the abortion issue, and explains a large part of the stigma and controversy in this field. Yet another function of this extremist wing is that it makes the rest of the movement and its demands more palatable. A gun control movement, by definition, could never tolerate such a violent flank. But in an ironic connection between these two groups, if a successful gun control movement does emerge in the United States, it may well recapture for Americans what it truly means to be “pro-life.”
we got in around 5:30 a.m., there is two inches of water in the surgery room,
water on the carpets, two offices totally soaked, water leaking in from our
large windows…we put out hundreds of towels and started mopping up… we started
seeing patients at ten a.m.”
Codding, director of Falls Church Healthcare Center, a Virginia clinic that
provides abortions and other reproductive health care services, is calmly
telling me about her and her staff’s response in the immediate aftermath of
Hurricane Sandy. These efforts were successful—the clinic did not close at all,
a tribute both to very careful planning and to the extraordinary dedication of
those who work in the abortion field.
FCHC was able to see patients on both
Monday and Tuesday, the days of the greatest disruption by Sandy in Virginia.
Of her staff of 11, all but two were able to make it to the clinic on those
days, despite quite challenging driving conditions. And half of that day’s
patients were able to reach the clinic as well on Monday and somewhat more on
Tuesday. (Those unable to keep their appointments were mainly women who
depended on public transportation, which was suspended).
Patients, according to Codding, were
surprised and grateful that the clinic was opened. Ironically, the storm in one
sense provided a benefit to the clinic’s patients—given that most workplaces
were shut down, these women did not have to take time off from work. The only
disgruntled patients were those scheduled for Tuesday abortions who had to make
their way to the clinic on Monday for their sonograms, mandated by the state to
take place at least 24 hours in advance of their procedure. “I can’t believe I
had to drive through the rain just for this!” was a not uncommon refrain.
It has finally stopped raining in
Virginia, and while things are getting somewhat easier, they are still not back
to normal. Codding, for example, has been dealing with the aftermath of soaked
carpets and the need to eliminate mold, which can cause a special risk to staff
and patients with asthma. And of course, she and her staff, who heroically rose
to the occasion for several days running and had to add heavy-duty cleanup to
their already crowded work lives, are tired.
The willingness of Rose Codding and the
staff of FCHC to go to such lengths to keep open in the face of natural
disasters mirrors other stories I have heard over the years—stories which speak
both to women’s determination to get their abortions, no matter what, and the
abortion-providing community’s attempt to accommodate these women. I recall
being told by the staff of a clinic in the Seattle area that when a rare earthquake in
the region destroyed half the clinic, women still showed up for their
scheduled abortions. I think of the efforts made by Southern abortion providers
to offer free procedures to victims of Hurricane Katrina who had to flee New
Orleans and thus miss their scheduled abortions. The willingness of FCHC staff
to rise at dawn and deal with their water-logged facility (when most other
workplaces in the region remained closed) reminds me of the efforts of the staff
some years ago at a West Palm Beach abortion clinic who worked
furiously at cleanup efforts after a firebombing, and who were able to reopen
the clinic in a remarkably short time.
Codding is of course proud of her
staff, and by extension, her field. “We always rise to the occasion. We are
dedicated to the profession, and to the women we serve. We just keep on keeping
on.” But she also puts the natural disaster of Hurricane Sandy in perspective,
and makes clear that she, as an abortion provider, faces greater challenges. “It’s
never been easy for the 30 years I have been doing this. A natural disaster at
least is something we can cope with and then it’s over.”
FCHC as a Virginia-based clinic has
been subject not only to protestors, but to relentless attacks by the Virginia
legislature, and is currently facing uncertainty over the fate of the notorious Ambulatory
Surgery Center measure passed by that body—which would require her
facility, which provides only first trimester procedures, to be regulated like
a hospital. Should the current version of the law be upheld, it is widely
agreed, FCHC and nearly all of Virginia’s other freestanding clinics would
close. The Virginia Health Commissioner has resigned
in protest against this blatant politicization of health-care
regulation. It speaks volumes about the current status of abortion care in the
United States that Hurricane Sandy’s impact is trivial next to that of a red
In honor of Independence Day, we asked author Carole Joffe (Dispatches from the Abortion Wars) what she'll be celebrating this July 4th.
Speaking as one whose professional and political life focuses on reproductive health services, there has lately been very little lately about which to feel celebratory. (An obvious exception of course-- the Supreme Court’s recent decision on health reform). Since the 2010 elections, there have been unprecedented, nonstop assaults by Congress and, especially, the states on both abortion and contraceptive services. Nevertheless, what I do feel both celebratory about, and deeply moved by, is the determined pushback shown by the defenders of these services: the more than a thousand who gathered outside the Virginia State House to protest new regulations on abortion, which had nothing to do with “women’s health” and everything to do with politics; the wonderful women legislators in Michigan who, joined by a joyful crowd of supporters, performed the “Vagina Monologues” at the state capitol, after being literally silenced by Republican leadership because they had dared to speak the word “vagina” while objecting to extreme abortion regulation; and “Pillimina,” the human sized birth control pill that Planned Parenthood has deployed to follow Mitt Romney –and remind voters of his rightward turn on contraception.
I celebrate also the indomitable spirit of the abortion providing community, who go to work each day, knowing that there are politicians ever searching for new ways to shut them down, and aggressive protestors who will attempt to intimidate them and their patients. Finally on this day, I celebrate the memory of Dr. George Tiller of Kansas, an abortion provider assassinated three years ago in his church by an extremist. As one of his former staff told me, Dr. Tiller was deeply patriotic, and took the Independence Day and its meaning to heart. One July fourth, in the midst of particularly grueling protests, Tiller and his staff flew a number of American flags at his clinic, and later mailed these flags to abortion providing colleagues across the country. With the flags, he enclosed a letter that said, as the staff person recollected, “We would be honored if you accepted this flag as a symbol of our journey together on the pathway of Justice, Liberty and Freedom.”
“…there is now an unprecedented and sweeping legal assault on women’s reproductive rights. New legislation is being introduced, and sometimes passed, in state after state that would roll back access to abortion and contraception, mainly by intruding on the relationship between doctor and patient…..But where are the doctors? They have been strangely silent about this legal assault, even though it directly interferes with medical practice.”
The above statement is important not just because of the insightful words being said, but because of who is writing these words, and where these words are published. The writers are Marcia Angell and Michael Greene, and the piece they wrote on current abortion restrictions appears in USA Today, the newspaper with the largest circulation in the United States. Dr. Angell, a senior lecturer at Harvard Medical School, is the former editor-in-chief of the New England Journal of Medicine; Dr. Greene is professor of obstetrics, gynecology and reproductive biology at Harvard Medical School and chief of obstetrics at Massachusetts General Hospital.
Why do the credentials of the writers, and the place of publication, matter? The significance of these issues becomes clear if one takes into account the longstanding marginalization of abortion — and abortion providers — in the United States. As I learned in researching a book on the first generation of doctors who provided abortion after Roe v Wade, these pioneers acutely felt their isolation from mainstream medicine. Most hospitals did not establish abortion services, most professional organizations did not set guidelines for abortion care, very little training of residents in abortion procedures was taking place, and many individual providers told me of sanctions they experienced because of their involvement with the abortion issue. I heard numerous stories of academic advancement denied, difficulty in getting research published, but perhaps most poignant of all, the lack of colleague-ship they felt with their fellow physicians. As I speculated, the memories of the “back alley abortionists” were still so strong in the period immediately after Roe that even ethical and competent doctors, such as those I interviewed, were tainted with that legacy. In short, a majority of physicians then (as now) have supported legal abortion — but there was less support for the abortion provider.
To be sure, much has changed for the better since 1973 in U.S. medicine with respect to abortion. The number of training sites has considerably improved; such technological developments as medication abortion (formerly known as RU-486) and an improved device for Manual Vacuum Aspiration have brought many primary care doctors and, where legally permitted, nurse practitioners, midwives and physician assistants to offer early abortion care; perhaps most importantly, organizations such as Medical Students for Choice and PRCH (Physicians for Reproductive Choice in Health) have facilitated collegial contact between numerous clinicians who go on to become abortion providers, or who are already doing so, and clinicians in other fields who, while not performing abortions themselves, firmly support those who do.
However, while the stigma surrounding abortion within medicine may have lessened, in the larger society it has only worsened — as we see from the unprecedented number, and character, of the restrictions proposed in the last year and a half. In fact numerous states even mandate that abortion patients be told misleading or downright untrue facts, such as the links between abortion and breast cancer or infertility — while a number of states have passed, or are proposing, laws that shield doctors from lawsuits if they withhold accurate information, such as the results of prenatal diagnosis that might lead a pregnant woman to seek an abortion.
Back to the forceful statement by Drs. Angell and Greene. They are not the only voices within medicine to object to these egregious measures. The Pennsylvania Medical Society and the Wisconsin Medical Society, for example, are on record as opposing restrictive laws in those states because they interfere with the doctor-patient relationship. Dr. Pippa Abston, a pediatrician in Alabama, has become an outspoken critic of Alabama's mandated ultrasound law, speaking at rallies and making a video of her opposition, and others have voiced objection as well. But given the cultural stigma that now surrounds abortion, the fact of two high profile physicians at one of the country’s leading medical institutions, speaking out in such a widely read newspaper, is a particularly welcome blow against the legislative persecution of abortion providers. To me, it is especially encouraging, given the past marginalization of this field that I have described, that the two physician-writers have not themselves built careers around abortion.
Angell and Greene mince no words in denouncing the assault on medical ethics that such laws represent, and make clear their understanding that the stakes in these battles go well beyond abortion care. “Physicians…have ethical commitments to patients that they cannot and should not be required by state law to set aside. Prominent among them is the responsibility to place the welfare of their patients above all other considerations.” But their statement does not only call for the proper treatment for patients. They end their piece with a call for the relevant medical professional organizations — too timid till now, in their view — to support their members who are caught in this war on those who serve women.
Below is a an interview with Reverend Rebecca Turner of Faith Aloud, conducted by Carole Joffe, author of Dispatches from the Abortion Wars and professor at the Bixby Center for Global Reproductive Health at the University of California, San Francisco. Faith Aloud is a pro-choice religious organization which seeks to eliminate the stigma associated with abortion and sexuality, and to provide support to both women and providers.
“Today we pray for women for whom pregnancy is not good news, that they know they have choices.”
“Today we pray for the men in our lives, that they may offer their loving kindness and support for women’s difficult decisions.”
“Today we pray for Christians everywhere to embrace the loving model of Jesus in the way he refused to shame women.”
Above are some of the individual components of the 40 Days of Prayer, a series composed by the Rev. Rebecca Turner, a United Church of Christ minister, and the head of Faith Aloud, a pro-choice religious organization based in St. Louis, Missouri. Turner originally wrote these prayers to counter religious-based protests against women's rights to choose abortion. For some years, the “40 Days of Prayer” were used in various ways by clinics but ignored by the anti-choice movement. However, recently when a clinic in northern California reprinted the prayers in a brochure, the movement took notice, and Turner’s prayers—and by extension, the concept of a religiously-based prochoice group—drew much attention from the religious right, including interviews by Fox News and Focus on the Family, and follow up stories in various anti-choice publications.
Below is an interview I conducted with Rev. Turner about her organization, the 40 Days of Prayer, and the reactions of opponents of abortion when news of her activities went viral.
What is Faith Aloud?
Faith Aloud is an interfaith nonprofit organization with a history of 30 years of pro-choice activism. Our mission is to eliminate the religious stigma of abortion and sexuality. We train clergy to talk to women about their pregnancy choices and we receive calls from women all over the country as well as internationally. We also provide spiritual resources for abortion clinics to use to help their religious patients.
Most women in the US identify as religious, and those seeking abortion are no different. Our resources, created by clergy of several faith groups, offer support to women during times of distress.
Why did you write the 40 Days of Prayer?
I wrote some prayers and offered them to abortion providers to use whenever and however they wanted to. We've since made a full poster of the prayers that is on the walls in many clinics across the country. We were angered by the swarms of protesters that regularly took siege of abortion clinics and would hurl hateful remarks at the women arriving. As a Christian minister, I was especially angered that most of these protesters who were so hateful and judgmental actually call themselves Christian. I wanted women to know that many Christians are compassionate and supportive, and to help them find strength in their religious faith instead of condemnation.
I also wanted to give spiritual support to the other people [affected] by the daily barrage of hate -- the clinic staff and escorts. Few people know what they go through every day because of their dedication to women. And few people understand that many of them-doctors, counselors, administrators-are deeply religious people themselves who have often felt rejected by their faith communities. This is wrong. I feel that I am a pastor to many of the abortion providers who use our services. Religious faith should give us strength and confidence, not guilt and shame. I have never understood why anyone would support a religion that shames and judges and ridicules its own members. That is abusive behavior and should not be tolerated in any setting.
Tell more about your mindset as you wrote the prayers.
I wrote all of the prayers in one day. I thought about women's reproductive lives, the difficulties of being female, the choices we make, the relationships we have, the various people who work with pregnant women, and I prayed for them all. Many websites are claiming that we're praying for more abortions, which is silly. They can read the prayers and see that isn't the case. Most of the prayers are really all about women and their reproductive lives. We pray for gender discrimination to cease. We pray for women who are abused. We pray for women who are infertile. We pray for women to have confidence. How can they be upset by this? Really I think the only objection to these prayers comes from a deep misogyny that refuses to acknowledge women as autonomous beings with their own spiritual lives.
How would you characterize the main reactions you have received since this flurry of publicity?
The media to date has been from anti-choice groups, so most of the people calling and writing to us are their constituents. They are quite hostile, usually rambling, callers are often screaming. They accuse us of pretending to be ministers or Christians. They accuse us of baby-murdering. Emails quote a lot of scripture and tell us we're going to burn in hell. We have had some new supporters find us through this, though. And we've begun a campaign called "Hate-into-Love" which allows our supporters to pledge donations for each hostile contact we receive.
Why do you think the 40 Days of Prayer has hit such a nerve with the Right, once they became aware of it?
They claim they think it's a mockery of the 40 days for Life campaign, but I don't think there is any mockery in it. The prayers are quite sincere. Apparently the religious right does not believe that anyone is allowed to pray except those who believe as they do. This is not a biblical idea; it is pure arrogance. The Christian scriptures say "Judge not, lest you be judged" and yet these people want to judge us as "fake" or "delusional" or even "possessed." One person who called us after the news broke asked "Are you planning to get groups of people to rally at abortion clinics to pray your prayers?" My answer was "The people inside the clinics are praying every day." Prayer does not belong to one group of people. But this seems to be the source of the outrage, that we dare to pray. It is apparently a very scary proposition to them that women might hear a compassionate religious voice and feel strengthened instead of weakened.
What have reactions to this campaign been in the pro-choice community?
A few pro-choice [organizations] have helped to pass along the information about our "Hate-into-Love" campaign and have re-posted the stories. We're getting pledges from around the country. We've been gaining a lot of new Facebook friends [who] learned about us through the negative media.
Do you think this community is more open now than in the past to a religious presence, such as that offered by Faith Aloud?
The independent abortion provider community has always been very welcoming of spirituality, seeing it as an important part of a woman's life and her decisions. But there is an element of the pro-choice community that is less supportive, seeing religion as the problem rather than a part of the solution, and really I can't blame them for feeling that way. They've been threatened and attacked and shamed by religious zealots. But, as I mentioned, most of the women in the United States call themselves religious or spiritual, and so we need to help them use their faith for strength during difficulty. It shouldn't be about we need, but what women need making difficult decisions.
In the several days that news of the “40 Days of Prayer” has gone viral, you have received much hate mail. Have you received anything from any anti-choice individual or group that suggests some common ground?
No. The hate mail tends to fall into these camps "You have no right to call yourself a Christian or pray" or "I'm praying for God's vengeance on you." We're getting some love mail, too, with people finding us for the first time and saying thank you for being a religious voice of compassion and reason.
The last ten days or so we have seen Republicans, and their religious allies, wage a war against contraception—and bungle it badly. With poll after poll showing that a majority of Americans support contraceptive coverage in health reform, and with the 98 percent figure (of American women who have ever used contraception in the context of heterosexual sex) endlessly repeated in the media, the Republicans nonetheless push ahead with this attack, providing a welcome gift to the Obama reelection campaign and much material to political artists and comics. I have lost count of the number of parodies that have been inspired by that now gone viral picture of five male clerics testifying at the Congressional hearing called by Rep. Darrell Issa (R-CA). A picture that of course immediately brings to mind another image of a similar tone deaf moment on the part of social conservatives, the nine men surrounding President George W. Bush as he became the first president to sign a ban on a particular technique of performing abortion, in the case of so-called “partial birth abortion.” It’s no wonder that the term “patriarchy” has made a comeback in the blogs!
The well-publicized refusal of Issa to permit the testimony of a female witness put forward by the Democrats (Sandra Fluke, a Georgetown law student planning to speak to the health consequences of being denied contraception at Catholic universities) only added to the disastrous p.r. of that event. And the “aspirin between her knees” remark of Rick Santorum’s major funder later that day didn’t help either.
But while the media is momentarily fixated on the second big story this month of a losing fight against family planning (remember the Susan G. Komen Fund fiasco?), less attention has been paid to a related war that is not going well at all. The assault on abortion that has resulted from the 2010 elections--the Republican takeover of Congress and many statehouses and governorships--has arguably produced the most serious threat to abortion access since the Roe decision in 1973. What we mainly have heard about this situation are the statistics, the unprecedented number of abortion restrictions introduced and eventually passed in state legislatures at a time when one might assume politicians’ focus would be on the economy.
But there are real people behind the numbers and details of the restrictions. And the enormous toll that the abortion wars take on individual women seeking the procedure and the providers who try to help them are insufficiently appreciated by the general public. Consider the case of Jennie McCormick, a destitute Idaho woman, a single mother of three, who, facing an unwanted pregnancy and unable to travel several hours to the nearest abortion clinic, ordered abortion medication over the Internet, and is now facing criminal charges. She has also been stigmatized in her own community to a degree to which the fictional Hester Prynne of The Scarlet Letter fame could relate. Here is a description of her daily life, as described in a British newspaper:
When Jennie Linn McCormack walks the streets of Pocatello, the town in southern Idaho where she was born, raised, and still lives, she attempts to disguise her face by covering it with a thick woollen scarf. It doesn't really work. In the supermarket, people stop and point. At fast-food outlets, they hiss "it's her"! In the local church, that supposed bastion of forgiveness, fire-and-brimstone preachers devote entire sermons to accusing her of mortal sin…."I feel like my life is over," Ms McCormack says. "I now stay home all the time. I have no friends. I can't work. I don't want to take my kids out in public. People can be really mean about what has happened."….
Consider as well the case of Amy Hagstrom Miller, who directs a number of abortion clinics in Texas, under the name of Whole Woman’s Health. Being an abortion provider in red-state Texas is always challenging, but especially in the past year. Hagstrom Miller has had to contend with implementing the state’s new sonogram law, which requires that women come to an abortion clinic at least 24 hours before their scheduled abortion, and receive a sonogram from the same physician who will perform their abortion. Additionally, the physician must give the patient a detailed description of her fetus’ development. The state has made it very clear to abortion facilities that it will enforce the law through inspections and will revoke the licenses of those doctors not in compliance.
It is not the fact of sonograms per se that is causing headaches for Hagstrom Miller. Rather it is the way the law is written. Patients at her facilities routinely receive sonograms. But the ultrasound used to be performed by a trained technician, the ultrasound was done abdominally and not through the more intrusive vaginal probe required by the law, and patients have not had to make two separate visits.
So now Hagstrom Miller has to contend with the frustrations of many of her patients, who typically have to take additional time off work and pay for extra childcare. She also has to deal with the scheduling nightmare of making sure the same physician who performs the ultrasound is available to perform that patient’s abortion. Hagstrom Miller is convinced that this new rule achieves nothing more than putting more obstacles in the way of both provider and patient, and has not achieved its stated objective of changing women’s minds. “It’s had no effect whatsoever on our abortion census.”
But coping with the sonogram law is not the only thing that preoccupies Hagstrom Miller. For the past year, her clinics have been subject to an unrelenting campaign of harassment by the notorious anti-abortion group, Operation Rescue. To give just one example, her facilities have been subject to no less than 13 surprise investigations by various state agencies, including the state health department, the Texas Commission on Environmental Equality, the state Pharmacy Board, and seven of the physicians associated with Whole Woman’s Health were formally investigated. All these investigations were triggered by “citizen complaints” made to various bureaucracies. Among the “citizens” making such complaints is Cheryl Sullinger, the OR operative whose name was found in the car of Scott Roeder, who assassinated Dr. George Tiller in May 2009, and who herself has spent time in jail for her anti-abortion activity.
To give a flavor of what Whole Woman’s Health has had to put up with as a result of Operation Rescue’s campaign, one of the complaints alleged that aborted fetuses were discarded in clinic dumpsters. So clinics’ staff and visitors were subjected to the bizarre sight of public health nurses in Hazmat suits pawing through dumpsters, routinely opening and photographing the content of every bag, on order of the state health department--and finding nothing incriminating.
When I asked Hagstrom Miller to reflect on her dual difficulties with both the new state sonogram law and the actions of Operation Rescue, she responded:
“This past year has been one of the most difficult of my career in abortion care. It is almost surreal to be constantly challenged for the very thing we have been recognized for doing well…The very state agencies that have licensed us have to take the word of people who have a stated goal of closing abortion facilities by any means necessary. Even when, time and time again, we are cleared of the accusations, they (opponents) are successful in that they have tied up our time, spirits, money and energy and distracted us from the good work we could be doing with women and families in our communities.”
Unlike Jennie McCormick, the young Idaho women mentioned above, Hagstrom Miller is not isolated and without resources. Indeed, she is a cherished member of the closeknit national community of abortion providers, and operates daily in a world of loving family and friends. But the situation of both of them reveal one of the greatest challenges facing the reproductive freedom movement: how to connect for the public the two reproductive wars currently being waged—the contraceptive one that that thus far seems a slam dunk victory, and the abortion one that we are losing, and about which the public is no doubt weary.
In the real world, these two issues of contraception and abortion exist on the same continuum. The use of both are affirmations of the belief in nonprocreative sex. At Whole Women’s Health, and at most other abortion providing facilities, patients are provided with birth control information and services. It is reasonable to assume that Ms. McCormick, only marginally employed, did not have access to reliable contraception. This connectedness of birth control and abortion is of course a major reason that social conservatives oppose the former. And it is a key reason why the 98 percent-ers should more vigorously support the latter.
What about abortion gives it staying power as the central issue in domestic politics, even in the period of the worst economic situation since the Great Depression of the 1930s? This is a question well worth pursuing.
I sounded a much more hopeful note in my recent book,Dispatches from the Abortion Wars. The book was started in the administration of George W. Bush, a particularly harsh time for the reproductive justice community. I finished the book in the first months of the presidency of Barack Obama, ending on a note of "cautious optimism" about a turnabout for the fortunes of reproductive health services and particularly for the provision of abortion. Candidate Obama, after all, had forcefully voiced his support for legal abortion, and nothing -- at the time -- seemed to be worse than the endless attacks on reproductive health services (not just abortion, but family planning , sex education, condom distribution for HIV patients and more) that were a key feature of the Bush presidency.
Quoting from the distinguished historian Carroll Smith-Rosenberg's work on an earlier period of abortion conflict in 19th century America, I even speculated that we might be entering a period in which abortion and related issues would no longer be "the central drama of (our) culture." Given the devastating recession that had already become very evident around the time of the 2008 election, I, like many others, reasonably thought that the economy would in fact become the "central drama."
But very soon after the 2008 election, it became very clear that social conservatives were not going away. On the contrary, they seemed more energized than ever. It also became clear that Obama the president was not going to be the forceful defender of reproductive rights that many of his supporters, including myself, had fantasized. Indeed, as early as January 2009, in his first weeks in office, reproductive politics emerged as a factor in the stimulus debates, and the new president blinked. The President's proposal had included a modest provision that allowed states to spend more Medicaid funds on family planning. The Republican House of Representatives leader, John Boehner, publically mocked this provision, asking incredulously what "spending millions for contraceptives" had to do with "fixing the economy." The provision was quickly dropped.
And, of course, many reproductive rights supporters are still smarting over Obama's key concessions to anti-abortion forces, particularly the Catholic Church, in order to win support for his health reform legislation. By late 2011, it was still unclear whether Obama would again cave to the Church's demands for very broad exemptions to the requirement that health insurance plans, under Obama's health legislation, provide contraception without co-pays. But while that was pending, the reproductive health community was stunned when, in a clear bow to politics, the Obama Administration took the unprecedented step of overruling the head of the U.S. Food and Drug Administration and rejecting the agency's recommendation that Emergency Contraception be made available without a prescription to women under the age of 17.
How the Wedge Works
My purpose in this essay, however, is not to simply catalogue all the disappointments that reproductive health advocates have suffered in the Obama administration, an indictment that has been done very well by others. (For the record, an unequivocally positive step that has occurred in the Obama presidency is the Department of Justice's vigorous enforcement of the FACE legislation that protects providers and patients from anti-abortion terrorism, an effort that far outstrips such activity by the Justice Department in the Bush years.)
Despite my hopeful predictions, abortion has maintained its dominance as a wedge issue. This is reflected in the various bills put forward by the new Republican majority in Congress after the November 2010 mid-term election, for example the Orwellian-named "Protect Life" Act, which stipulated that hospitals did not have to offer abortions to women, even in life-threatening situations.
Similarly, in state houses across the country after that pivotal election an unprecedented number of abortion restrictions were introduced by Republican legislators, including bans on abortion after 20 weeks, which clearly violate the Roe v. Wade decision and were intended, in the eyes of many observers, to lure pro-choice lawyers into a test case that could possibly overthrow that landmark ruling. Finally, as politicians compete to be the Republican nominee in the 2012 presidential race, the ante has been raised: in this election cycle, to be acceptable to the anti-abortion base, and to compete with each other, candidates must make clear their opposition to rape and incest exceptions and declare their agreement that "life begins at fertilization."
It is actually not surprising that Republican politicians at all levels insist on keeping abortion front and center, the economic crisis notwithstanding. Abortion is not only the best arrow in these politicians' quivers, in terms of pleasing a crucial segment of the Republican base -- it is arguably the only arrow they have. The reality, as has become evident since Obama's election, is that the Republican party is tied to economic policies -- opposition to infrastructure spending, fanatical devotion to tax cuts for the most wealthy -- that will not create jobs, but, in fact, will destroy them. So abortion has, once again, as I termed it in my book, become a "brilliant distraction" from pressing social problems.
For me, the more complicated -- and fascinating -- question is: Why do voters put up with this endless assault on abortion and contraception (and the corresponding neglect of the economy)? Why, for example, is there seemingly no price to be paid by a politician who is on record as saying its okay for a woman with an ectopic pregnancy to die?
The first, most conventional, answer is that the U.S. is a deeply apolitical country, with a notoriously low voting turnout, compared to other countries. Politicians therefore can take actions that speak to the minority of voters who are deeply engaged, and be confident that the rest of the country is not paying attention. A variant on this general political apathy is that the abortion issue, in particular, has been so divisive and raucous, for so long, that voters simply tune out abortion-related political news, assuming a "pox on both their houses" stance.
In contrast, a third intriguing possibility is that the public's backlash against Right-wing overreach may, just may, finally be at hand. The recent defeat, by a substantial margin, of the "fertilized-egg-as-person" amendment in Mississippi, a highly conservative state where the measure was widely predicted to pass, is suggestive of this. Furthermore, the "defund Planned Parenthood" campaigns, avidly pursued by Republicans both in Congress and in a number of states, have polled very badly with the public. Certainly, in April 2011, when Obama refused to bend to John Boehner's demand that cutting Planned Parenthood and other family planning programs be part of budget negotiations, the president gained -- not lost -- political capital.
It is, to be sure, demoralizing from a reproductive justice viewpoint, that it takes such surreal proposals as making fertilized eggs the moral and legal equivalent of living women, and the all-out demonization of birth control, nearly 50 years after the Supreme Court decision legalizing its use, to make the American people wake up to the threats posed by the fanatics of the Right, and the cynical politicians who do their bidding. And it may well be that these extremist proposals -- rather than causing a backlash -- will make more "normal" restrictions on abortion and contraception look reasonable.
So Bad That It's Good?
But the favor that the zealots now in ascendancy in social conservative circles -- that is, those who oppose all sexual activity except procreative sex within heterosexual marriage -- may have given us is the broad sweep of their proposals. In a society that is marked by deep economic inequality, it is hardly surprising that those women most affected by the assaults on both abortion and contraception are disproportionately poor women of color -- that is, those who have the least political, as well as economic power, and who are most vulnerable to cuts in public services. The unfortunate reality is that, while many of those in the reproductive justice movement work tirelessly on behalf of these women, most in this society -- including other women who also use reproductive health services -- worry little about these marginalized women. Nonpoor women have long been able to assume that contraception and abortion will always be available, as long as one has the means to purchase them.
In that sense, the Mississippi egg-as-person amendment, and similar efforts planned elsewhere, may truly be serving as wake-up calls for the electorate. For it was not just abortions (including lifesaving ones) that were on the line -- but most forms of contraception and IVF treatments (a service that, almost by definition, implies a well-to-do clientele).
Just as the Occupy Wall Street movement has brilliantly framed the economic inequality in the U.S. as existing between the one percent of the super-wealthy and the remaining 99 percent of the population, the current battles in reproductive politics reminds us of another 99 percent -- those American women who have ever used birth control in the context of heterosexual sex. The reproductive legacy of the Obama years may well be this huge group's recognition of itself as a political community. Again, I am cautiously optimistic.
"For a woman to 'ask her physician' for a safe and effective contraceptive presupposed that she had a physician, that she could afford a contraceptive, and that the physician would be willing to give it to her, regardless of her marital status."
These are the words of the historian Sheila Rothman, writing about the setbacks Margaret Sanger faced in the 1920s and 1930s in trying to realize her vision of making birth control widely available to all women, including the poorest—and about the ultimate “ownership” of contraceptive services during that era by physicians. Sanger’s original vision was a fleet of clinics, to be run by public health nurses. But as Rothman and others have documented, when she attempted to open such clinics, she experienced repeated arrests and the closures of her facilities, as contraception was then illegal. In the years leading up to the 1965 Supreme Court Griswold decision, which legalized birth control for married persons, only physicians were legally permitted to provide such services, and as the quote from Rothman implies, this situation put poor women at a tremendous disadvantage.
Rothman’s critique, written in the 1970s about events in the ‘20s and ‘30s, is remarkably relevant to today’s leading reproductive controversy: the Obama administration’s overruling of the FDA decision to allow over-the-counter status of Plan B, an Emergency Contraceptive product, for young women under the age of seventeen. If one substitutes “teenager” for “woman” and “Plan B” for “a safe and effective contraceptive” in Rothman’s quote, one can readily appreciate how, once again in America’s longstanding reproductive wars, the needs of the most vulnerable are willfully neglected.
Secretary of Health and Human Services Kathleen Sibelius and President Obama justified the Administration’s action because of concerns about pre-teens’ ability to use EC correctly. But as ha been repeatedly observed, only a tiny portion of this age group is sexually active. It is 15- and 16-year-olds who are sexually active in far greater numbers, and therefore, far likelier to have need of EC (and to be able to use it correctly). But many in this group do not have a primary health care provider to whom they can go for a prescription. Some of those who do have a relationship with a provider may be too embarrassed, or afraid of a breach of confidentiality, to ask for such a prescription.
To be sure, some things have improved in the contraceptive world since the dominance of private practice physicians in Margaret Sanger’s time. In 1970, Congress authorized the Title X program, which made federal funds available for family planning services for poor women including, notably, teenagers. (As a sign of how much the reproductive battle lines have hardened in the last 30 years, Title X was signed by a Republican president, Richard Nixon, and one of its most enthusiastic sponsors in Congress was a future Republican president, George H.W. Bush). A number of contraceptive products are available on the shelves of drugstores.
And it is no longer just physicians who can advise and dispense contraception. In public health clinics and Planned Parenthood facilities, nurses are in fact the main providers of contraception. We can hope that some portion of those teenagers who need EC can find their way to a Planned Parenthood or other Title X site in the three day window in which the drug is most effective.
There is another 99 percent group in our country, distinct from but inextricably entwined with the now more familiar #99Percent, those everyday Americans, who--in such a brilliant framing by the Occupy Wall Street movement--are to varying degrees affected by the vast economic inequality that characterizes American society. I refer to the 99 percent of American women who have ever had sexual intercourse and have used a birth control method at least some of the time. (As per the original Centers for Disease Control report, this statistic only includes contraceptive use reported by women during heterosexual intercourse).
Contraception obviously is a deeply held value by American women. But the fact that in the United States a startling half of all pregnancies are unintended makes clear that birth control is used only sporadically by some. There are a number of reasons why this is so, but a chief one is that so many women cannot afford contraception, especially the most expensive—and most effective--methods, such as birth control pills, and long lasting reversible contraception, for example, the newer (and far safer) models of IUDs (intrauterine devices). In short, the same economic disparities that pervade every other area of American life manifest here as well: poor women depend on publicly-funded programs for their contraceptive services, but, according to the Guttmacher Institute, only a little more than half of the 17 million women who need these services currently receive them.
This situation of tremendous inadequacy was supposed to improve considerably. In one of the best pieces of news in the otherwise embattled reproductive health world since the battles over health care reform began, the Obama administration announced last August that it would accept therecommendations of a special panel of the Institute of Medicine and include contraception—including all FDA-approved birth control methods—as part of the basic package of preventative health services that health insurance plans must offer, without co-payments.
Predictably, the August announcement has produced a massive campaign from opponents of contraception, especially the Catholic hierarchy. Though churches in fact have been granted an exemption from this requirement, the U.S. Conference of Catholic Bishops and its allies are pushing for much broader exemptions, for example to universities, social service agencies and other institutions with a religious affiliation—even if these institutions receive public funding. Such a move could potentially affect millions of women, of all religious backgrounds (or none), who work in such institutions.
My young friends who have been involved in the Occupy movement tell me that issues of reproductive justice have been muted, if evident at all, at the various Occupy sites. But as the occupiers put forward their vision of a just society, the old feminist dictum bears repeating: women cannot be full participants in any society unless they can control their fertility. The New York Timesquotes the president of the U.S. Conference of Catholic Bishops, reporting on a meeting with President Obama, as saying the latter “was very open to the sensitivities of the Catholic community.” President Obama, please be open as well to the tremendous struggles of women--members of both 99 Percent groups--who are desperate to control their childbearing in very harsh times.
These groups are asking you to join them in telling the White House not to throw women under the bus:
“Such hypocrites! They don’t like getting unwanted calls at home!”
In an irony that he clearly relishes, Todd Stave, a Maryland entrepreneur, is telling me about the abortion opponents who contacted him and asked that he suspend the phone campaign he initiated against them.
Stave is currently the subject of a certain amount of buzz in the abortion rights community, after his appearance on The Rachel Maddow Show. He came to Maddow’s attention because of his innovative, some would say ingeniously simple, way of responding to harassment from anti-abortionists. Stave is the owner of the property in College Park, Maryland on which sits the clinic building rented by Dr. Leroy Carhart, a longtime Nebraska abortion provider and former associate of the late George Tiller. After Tiller’s assassination, Carhart became a leading target of antiabortion forces, especially so when he began recently began performing later abortions in Maryland. (His move was a result of Nebraska legislation, targeted specifically at him, that banned abortions after 20 weeks). Besides vociferous protests at the site of the clinic itself, abortion opponents showed up on Parents’ Night at the middle school of Stave’s daughter. Brandishing signs with the usual mangled fetuses, as well as Stave’s name, photo and phone number, the protestors urged people to call him and ask that he “stop the child killing.”
Stave was no stranger to anti- abortion activity. His father, the late Carl Stave, was himself an abortion provider in the same community in the period immediately following Roe and was the recipient of protests as well, including a firebombing of his clinic. His son took these earlier protests quietly. But showing up at his daughter’s school was too much for him. He noted the phone numbers of those who called him and organized a group of 20 friends to call the antis back. In a polite but firm way, Stave and his circle of volunteers told the abortion opponents that Stave would not back down from the agreement with Carhart. Moreover, Stave asked his phone support team to notify their friends and associates about this activity and to contact him if they wished to be involved.
As Stave told me, to his astonishment within several weeks some 3000 people contacted him--“from all the U.S., from Europe, from Japan, I couldn’t believe it”-- asking to help with his campaign of call backs. Those who called or e-mailed him told how outraged they were by anti-abortion tactics and how happy they were to take action. Even more volunteers contacted him after his appearance on the Maddow show.
In his most recent campaign, Stave on very short notice mobilized his network to call the leader of a Maryland anti-abortion group that was planning to protest a “Run for the Cure,” in Baltimore, sponsored by the breast cancer group, the Susan G. Komen Foundation. (The Foundation has recently been targeted by abortion opponents because of donations it gives to Planned Parenthood for breast cancer screenings). Stave, who had subscribed himself to an anti-abortion listserv under an assumed name, read of the planned action, and saw to his delight that the leader had posted several phone numbers. Plausibly, he gives his volunteers credit for the reports that the “the planned protest fizzled to nothing.”
Stave has no illusion that campaigns of this nature will end all harassment from the opposition. “About 80 percent of people will stop the harassment after being contacted, 20%, the hard-core, won’t,” he speculates. But there is no question that his campaign has struck a nerve--both among some abortion opponents who have experienced the unpleasantness of receiving unwanted phone calls, and also among the large mass of people who are “pro-choice,” but one step removed from the abortion conflict—“civilians in the abortion wars” is how I have elsewhere referred to them. The response Stave has received thus far suggests the hunger among this group to find acceptable and feasible ways to counter the excesses of the anti-abortion movement. Stave has established an organization, Voice of Choice, which is currently operating with a small, mainly volunteer staff, and which continues to sign up volunteers willing to make phone calls on behalf of those who are harassed. As the organization’s website states, “Now it’s our turn.”
These two statements, the first by Jon Kyl, a U.S. Senator, the second by Michelle Bachmann, a Congresswoman who is also a Presidential candidate, have each received wide public attention. Each of these statements is blatantly untrue. These statements are a disturbing reminder that the field of reproductive health is particularly susceptible to politicians playing fast and loose with the truth in order to curry favor with social conservatives.
Reproductive health services have always stirred controversy, intersecting as they do with issues of sexuality, morality, parental rights, and so on. But it was during the presidency of George W. Bush that the attacks on this aspect of health care—especially abortion care—became increasingly disengaged from the truth.
As I have detailed in my recent book, Dispatches from the Abortion Wars, the Bush Presidency was marked by scandals such as government websites being pressured to list false information on the alleged links between abortion and breast cancer, and the purported ineffectiveness of condoms. An investigation of the curricula used in federally funded “abstinence only” programs found shocking evidence that some 80% of these programs gave misinformation to young people, such as “sweat and tears can lead to HIV transmission.”
The reproductive health community hoped that with the transition to a new administration these egregious distortions would stop. And in some respects the situation has improved. In the thank-goodness-for-small-favors department, we can be gratified that government websites no longer post such gross misinformation. But clearly, as the two quotes above make clear, untrue and irresponsible statements about reproductive health matters have not gone away in public discourse.
In the case of Senator Kyl’s statement, Planned Parenthood restated its frequent claims that abortions constituted 3% of its services, not the 90% the senator had claimed. The incident concluded, to the delight of many late-night comedians, with a Kyl spokesman acknowledging that “the senator’s remark was not intended to be a factually based statement.”
The dangers of non-factually based political discourse
Why do these untrue statements matter? After all, presumably most people—most importantly, the millions of women who go to Planned Parenthood for contraception, cancer and STI screenings—know Kyl was massively off base. Michelle Bachmann’s statement was roundly disputed by experts and seemingly has damaged her political fortunes. Nonetheless, I believe statements like these do very much matter. The normalization of lying about health care issues by prominent figures is a very serious breach of trust, and degrades our culture as a whole.
More specifically, these statements point to two different ways in which the field of reproductive health can be weakened by such deliberate distortions. In the case of Planned Parenthood, the attacks by Kyl and numerous other politicians who have sought to demonize the Federation have created a clever rhetorical trap, where the defense becomes, as shown above, that “only 3% of what we do is abortion.” In a version of the old “have you stopped beating your wife” question, these attacks succeed in further marginalizing abortion from other reproductive health care services in the public’s eye.
The serious damage done by Bachmann’s HPV anecdote is best illustrated by a headline that appeared shortly afterward in the New York Times Science Section: “Remark on HPV Vaccine Could Ripple for Years.” The article makes clear the dismay felt in the public health community about this incident.
In simplest terms, as the author puts it, “When politicians or celebrities raise alarms about vaccines, even false alarms, vaccination rates drop.” The HPV vaccine—most effective when given to young girls at ages 11 or 12, before they have started sexual activity—was already quite controversial, because some in the public felt it was a “license” for promiscuity (and there is increasing distrust of vaccines generally among some parent groups). As a result, even before the Bachmann remark, uptake of the vaccine was below expectations. Now, as a member of the American Academy of Pediatrics quoted in NYT article put it, “These things [politicians' misstatements] always set you back about three years, which is exactly what we can’t afford.”
Rick Perry has only two children?! As the biographical information flashed by on television during a recent debate of Republican presidential hopefuls, it was strangely incongruous to see that the rising star of the religious right was so woefully behind his competitors. Rick Santorum and Jon Hunstman led the pack with seven kids each, followed by Ron Paul, Mitt Romney and Michelle Bachman with five (and the 23 children she had fostered). To be sure, Newt Gingrich and Herman Cain also had a paltry two, but they, unlike Perry, were not considered to be the new favorite of the social conservative wing of the Republican. Recent polls show Perry supplanting Bachman in that role, notwithstanding her impressive numbers.
Perry’s late entrance into the race saved him from the awkwardness of having to deal with the “pro-marriage pledge," put forth by a leading Iowa conservative activist, and signed by some of his fellow candidates who had competed in that state’s straw poll. This pledge, among other things, asked signers to affirm that “robust childrearing and reproduction is beneficial to U.S. demographic, economic, strategic and actuarial health and security.” (Shortly after his official entry into the race, Perry did sign yet another pledge, this one in support of a federal amendment against gay marriage).
The reason that Rick Perry has “only” two children, one can say with confidence about this normally private matter, is because of the widely disseminated fact of his vasectomy. cited in the New York Times among other places. (This procedure, to the delight of late night comedians, was apparently performed by his father-in-law).
Speaking as a reproductive health advocate, I have quite mixed feelings about Perry’s decision (presumably made with his wife) to have a vasectomy. On one hand, I strongly believe that men should share in the task of contraception, and I commend the governor for doing so. Despite tantalizing talk for years of research on a “male birth control pill,” vasectomies and condoms are currently the only contraceptive options for men. Though vasectomies have a proven record of safety, efficacy and satisfaction, only a relatively small number of American men elect this procedure, in part because of a belief that it might affect sexual functioning.
In theory, Perry, whose persona is that of a swaggering alpha-male, could help popularize this method, making clear that “real men” have vasectomies. Just as the late First Lady Betty Ford’s openness about her breast cancer spurred many women to undergo mammograms, Perry’s public endorsement could increase the popularity of vasectomies.
Moreover, Perry has led an attack on family planning services used by low-income Texas women. He recently signed a budget bill reducing the state’s family planning funding from $111 million to just $37 million. Following the playbook of the religious right in other states, Perry and the Texas state legislature have moved to defund Planned Parenthood clinics, the largest state to do so. To gain a sense of the magnitude of these cuts, in just one Texas affiliate—Planned Parenthood of the Texas Capital Region--- some 4,000 patients will lose access to birth control services, as well as breast and cervical screenings, and HIV tests.
It’s too late for Rick Perry to compete with the other Republican presidential candidates in the “robust childbearing” department. Perhaps some of the most fervent Christian conservatives will fault his vasectomy as it violates the biblical junction to “be fruitful and multiply.” But in his relentless attacks on contraception, and of course, abortion and comprehensive sex education, Perry is doing all he can to reassure his base that many of his fellow Texans will not have the same opportunity to control their childbearing as the Perry family had.
How much I appreciated your gracious letter telling of plans for the Western Regional Conference on Abortion and inviting me to attend.
Although my upcoming personal and official commitments will not permit me to be with you, I am grateful for this opportunity to convey my warmest greetings to all attending and my hopes for the success of the Conference.
So wrote Betty Ford, in February 1976, to the organizers of one of the first medical conferences on abortion to take place in the U.S. after the Roe v Wade decision in 1973—a message that would have been inconceivable for any of the Republican First Ladies that followed her. What Betty Ford said publicly about abortion, and what subsequent Republican women in that role could not, speaks both to the spirited and independent character of the former, who died on July 8 at age 93, and to the sea change in American politics that was shortly to come with the rise of the Religious Right and the role of abortion as that movement’s leading wedge issue.
But even in 1976, a newly emerged Right to Life movement was making clear that presidential candidates would be accountable for their positions on abortion, which had been legalized in 1973 with the Roe v Wade decision. And President Gerald Ford, running for his first election to the office (after taking over from the disgraced Richard Nixon in 1974) was under attack from antiabortion forces for his “waffling” views on the subject, arguing that Roe v Wade went too far, and that the abortion issue should be left to individual states. In contrast, his wife at that time publicly reaffirmed her full support of Roe, stating in a television interview that the decision took the issue “out of the backwoods and put [it] in the hospital where it belongs. “
To be sure, it was not only on the topic of abortion that Betty Ford was outspoken. Again, in a way that would be unimaginable for later Republican First Ladies, she identified as a feminist, supported the ERA, and spoke frankly about the realities of premarital sex. Of course, not all her views were, in today’s terms, “liberal”—she was a strong supporter of the Vietnam War, for example. And the admiration she drew from the public—the New York Times in its obituary stated she was among the most popular of all First Ladies—transcended conventional politics. It was her candor about her struggle with breast cancer, at a time when the disease was rarely spoken of publicly, and even more courageously, her public acknowledgement of her struggle with alcohol and prescription drug abuse (which led to the founding of the Betty Ford Center for treatment of chemical dependency) that arguably is the main source of such lasting affection from the American people.
And what of Betty Ford’s Republican successors as First Ladies? Did they speak as freely as she did? On the abortion issue, there is reason to believe that all of the women in question—Nancy Reagan, Barbara Bush, and Laura Bush—were to varying degrees prochoice (as indeed, privately, may have been all their husbands), but all these women felt constrained from speaking frankly. Nancy Reagan’s views are perhaps the most ambiguous, but Lou Cannon, Ronald Reagan’s biographer, has written that while the latter was governor of California, both his wife and father-in-law supported the California Therapeutic Abortion bill signed in 1967. In his memoir the late Donald Regan, Reagan’s chief of staff during his presidency, quoted Nancy Reagan as saying privately to him, “I don’t give a damn about the right to lifers.” The views of Barbara and Laura Bush are much clearer. The latter, in a memoir published after her husband’s presidency stated her support of Roe v Wade. The former, in the summer of 1992, while her husband was campaigning for reelection, even stated her belief that abortion and homosexuality were “personal choices” that should be left out of politics—though whether this was a case of Barbara Bush acting in a moment of genuine independence, or in a calculated move to draw in support of the rapidly diminishing moderates in the Republican party, remains debatable.
What is not debatable is that Betty Ford’s tenure as First Lady was the last time in American politics that someone in that role could inspire bi-partisan admiration—even while expressing her own political views. American politics has become so polarized, and the culture wars so fierce, that First Ladies can only be broadly liked if they suppress their own views on controversial matters. Betty Ford’s passing reminds us of what has been lost in our political culture.
9.pm. In bed at hotel. Landline rings. 'Hello"? "Dr. Benton ?" "Yes. Who is this?" "How many babies did you kill today?"
I hung up. Heart started pounding. Someone who doesn't like me at all at all knows exactly where I am. I disconnect the landline.
Immediately cell phone rings. Blocked number. "Hello?" Same voice. I didn't say anything but listened as he spoke…Heart pounding. Someone who doesn't like me…knows my cell phone number and knows other things about me. …I hang up.
Immediately he called again. I didn't answer. He left a message on my voicemail, saying, "this isn't----(east coast state where Dr. Benton lives)—this is------------(southern state where she traveled periodically to perform abortions)."
I didn't sleep much that night.
The above is an excerpt from an e-mail I received from Dr. Felicia Benton (not her real name). I had recently concluded a phone interview with Dr. Benton about her experience as an abortion provider who travels from her home state several times a month to provide abortions in underserved areas. The matter of these disturbing phone calls did not arise until we continued our conversation via e-mail. Dr. Benton also mentioned that the caller knew in which city she lived, and had even left abusive messages on her elderly mother's answering machine.
The media's coverage of abortion these past few months have focused, understandably, on the seemingly endless assaults on the procedure by Congress and by individual state legislatures , who have passed measures ever more extreme and bizarre: e.g., the House bill that allows hospitals to refuse abortions even if a woman's life is at stake, the recently passed South Dakota law that compels women seeking abortion to first go for "counseling" to a religiously based, anti-abortion Crisis Pregnancy Center and then wait three days before they can legally obtain an abortion, and so on. But Dr. Benton's experience—which is hardly unique-- reminds us that there is, simultaneously, another war on abortion occurring, this one waged directly on abortion providers.
This war on providers has been going on so long that it has become essentially "the new normal," with significant public attention coming only when a member of the abortion providing community is murdered. There have been eight such murders thus far, the most recent being that of Dr. George Tiller of Kansas, in May 2009. Dr. Tiller's murder, and the upsurge of aggressive incidents reported at clinics immediately following this tragedy, continues a pattern of the worst antiabortion violence occurring during the administrations of Democratic presidents. (The seven murders preceding that of Dr. Tiller came during Bill Clinton's presidency).
Apart from these murders, how much antiabortion violence and harassment are there, and at what point can these acts legitimately be called "terrorism?" Certainly, noisy picketing outside a clinic can be annoying to both providers and patients, but such picketing is of a different order than a doctor in a hotel room receiving a threatening call on her unlisted cell phone number, which in turn is different from the firebombing of a facility, which in turn is different than attempted murders, which in turn are different from successfully executed murders.
The Guttmacher Institute, the National Abortion Federation, and the Feminist Majority Foundation are the organizations that have done the most to track violence against abortion providers and each make useful contributions to understanding a complex, and depressing, picture. From the Guttmacher Institute's latest figures, we learn that 88 percent of abortion clinics experienced at least one form of harassment in 2008, most commonly picketing, but—notably—42 percent reported picketing that also involved patient blocking. Nearly one fifth of clinics reported vandalism. Harassment was especially acute at larger abortion facilities: nearly all providers that provided 1000 or more abortions per year reported picketing (with a higher incidence of patient blocking) and nearly one in five of these reported a bomb threat.
The Feminist Majority Foundation's periodic surveys of clinic violence contains the category of "severe violence," referring to blockades, invasions, arson, chemical attacks, stalking, physical violence, gunfire, bomb threats, death threats, and arson threats. The worrisome finding from the 2010 survey is that 23.5 percent of all clinics reported incidents of such severe violence, up from 18.4 percent in 2005. Stalking was the most common event in this category.
The National Abortion Federation has tabulated incidents of violence and disruption against its member facilities since 1977. Here are some of the totals in various categories: besides the 8 murders, there have been 17 attempted murders, 175 incidents of arson, 41 bombings, 1429 incidents of vandalism, 2057 cases of trespassing, 661 anthrax threats, 526 cases of stalking, and 416 death threats.
While this level of violence would be unacceptable—indeed unthinkable-- in any other branch of American medicine, in the case of abortion this violence is seen as acceptable fodder for politicians' wisecracks. For example, at a recent mayoral candidate forum in Jacksonville, one of the contenders, according to a local paper, said "the only thing he wouldn't do was bomb an abortion clinic, then….added, with a laugh, 'but it may cross my mind.'" Even more alarmingly, several states have recently introduced legislation permitting "justifiable homicide" in the defense of a fetus, which many feel would lead to open season on abortion providers.
To be sure, the federal government has tried to respond to the attacks on abortion providers. Most notably, in 1994, President Clinton signed the FACE (Freedom of Access to Clinic Entrances) Act, which made it a federal crime to impede patients' entry to an abortion entry. The FACE Act has been credited with significantly lowering the number of full-scale blockades of clinics that were commonplace in the late 1980s and early 1990s. And there is every reason to believe that President Obama's Justice Department takes seriously threats of extreme violence against providers. Nevertheless, the depth of local law enforcement's commitment to protect providers varies from place to place. The provider community is still haunted by the fact that Scott Roeder, Dr. Tiller's assassin, was seen the day before the murder, vandalizing another clinic, and though his license plate was reported to local authorities, there was no action taken.
And how, finally, should we understand the frightening calls that Dr. Benton received? Should they be seen merely as "harassment" or, as I believe—given the totality of the record of violence against providers since the 1970s-- as one element of a larger campaign of genuine terrorism? Though the three organizations mentioned above have done an excellent job of tabulating incidents on the spectrum of abortion violence, the more qualitative question of the impact of such incidents remains unanswered. In Dr. Benton's case, though admittedly shaken by the calls, she remains resolved to continue abortion work. For unrelated reasons, she no longer works at the southern clinic, but still travels to other facilities. What is unknown is how many providers have stopped such work—or never started it-- as a result of similar intimidation.