It's long been said that without abortion providers, there is no choice. And, of course, it's true, which is why the anti-abortion movement has done everything possible to stigmatize the procedure, isolate providers and vilify those physicians who refuse to kowtow to their demand that they stop offering reproductive options to women who need them.
Indeed, anti-choice groups' success is frequently illustrated by a well-publicized statistic that 87 percent of US counties have no abortion facilities. But while this figure is accurate, it is also misleading, since family practitioners throughout the country typically offer early abortions - surgical as well as medical - as one of many general health care services.
Dr. Linda Prine is the founder and medical director of the Reproductive Health Access Project, a New York City-based nonprofit dedicated to integrating reproductive health services into primary care. "There is a substantial move to expand reproductive health training among family practice doctors," she told Truthout. "Approximately 40 of the 450 medical residency program in the US now integrate abortion training into their curricula. This reflects a slow but steady increase over the past 15 or so years."
The reason? According to Prine, a significant number of medical students and physicians are eager to learn about medical abortion, a two-step process involving mifepristone and misoprostol, medications that are effective if taken in the first trimester. "The abortion pills are 99 percent successful," Prine continues. "It's much simpler to learn how to use them than it is to learn how to do other things in family medicine, like care for patients with HIV or diabetes. There is no reason a doctor in family practice shouldn't be trained to give them out."
"They're safe," continued Prine. "They've been studied in all sorts of settings, so the pills should be an option for women, given to them by their regular doctor during an office visit. If every doctor dispensed the pills themselves, it would take away much of the stigma." It would also allow the abortion to take place far from the taunts of belligerent protesters and restore the notion of medical privacy.
Prine is passionate about the mainstreaming of reproductive health care, and it is clear that she has little patience for doctors who oppose abortion. In fact, she says that being prochoice is a requirement for physicians who consider themselves to be patient-centered, even if they elect not to offer that care themselves. "A woman who needs an abortion is at a fork in the road," she said. "She is facing a decision: Will she get to live out her hopes and dreams or will she have a baby and possibly ruin her life?"
Dr. Willie Parker, associate medical director at Family Planning Associates in Chicago, saw patients face this conundrum many years ago when he was grappling with whether or not to become a provider. Speaking in January at a 40th anniversary commemoration of the Roe v. Wade decision sponsored by Physicians for Reproductive Choice and Health, Parker confessed that while he had always been politically pro-choice, his "traditional religious understanding" forced him to wrestle with the idea of actually terminating unwanted pregnancies. "I'd been an OB/GYN physician for 12 years and had treated several women who had wanted, but lethally flawed, pregnancies. Caring for them gave me a deeper compassion for women contemplating abortion. Then, I heard a sermon by the Rev. Martin Luther King Jr. about the Good Samaritan who helped the fallen traveler. King raised the question - what would have happened to the traveler if the Samaritan had failed to help?" This query, Parker says, nagged at him until he decided that it was immoral for him to refuse to offer abortions. "I grew uncomfortable not providing this care," he says. "I wanted to help those who so many others were unwilling to assist. Offering this necessary service since 2004 has given me my purpose in the world."
This sense of purpose also undergirds the work of longtime providers Dr. Curtis Boyd and Dr. LeRoy Carhart.
Boyd began providing abortions pre-Roe v. Wade as part of an underground network called the Clergy Consultation Service on Abortion (CCSA). The service, founded in 1967, included 1,400 ministers and rabbis who counseled often-desperate women and then referred them to a national network of reputable doctors. "When I think back to that period," Boyd told the audience at the Roe commemoration, "I recall seeing women in the hospitals bleeding, infected, and sometimes dying. Although I had compassion for these women, it is not what drove me to become a provider. What drove me was the knowledge that an unplanned pregnancy could ruin a woman's life. I realized that when it came to pregnancy, women were at a significant disadvantage."
Boyd further recalls that his decision to flout the law and join the CCSA grew out of his high school experience. "A girl I had a crush on had gotten pregnant as a freshman by a member of the senior class, a guy with great social skills, a real stud," he says. "After she gave birth, she was allowed to come back to class, but she was not allowed to participate in extracurricular activities. Meanwhile, the guy was allowed to play football and went on to West Point and became a general."
"I saw the girl years later and it was obvious that life had not been good to her," he said. "This reality slapped me in the face, showed me that the world is unfair to women." Providing abortion was Boyd's way of trying to right this injustice.
His efforts have made him and his wife, Glenna Halvorson-Boyd, frequent targets of anti-choice hatred. Their Fairmount Clinic in Dallas was firebombed in 1988 and subsequently invaded by protesters who chained themselves to medical equipment. In addition, both have received death threats. "Hey asshole Boyd," one began, "Those babies don't know when they where [sic] dying by your butcher knife. So now you will die by my gun in your head very soon. And you won't know when, like the babies don't. Get ready your [sic] dead. I am going to burn your offices to the fuck'n ground." The return address? "The Angel, Albuquerque, New Mexico."
No one was ever apprehended for sending this menacing communication or for setting the blaze.
Like Boyd, Carhart is no stranger to anti-abortion violence. A retired Air Force physician, he became a provider in 1988, first as a "circuit rider," traveling between clinics on the East Coast and Midwest, and then, beginning in 1992, as the owner of the Abortion and Contraception Clinic of Nebraska in Bellevue. He presently works six days a week, dividing his time between the Germantown Reproductive Health Center in Maryland and the Bellevue facility.
A former colleague of Dr. George Tiller - a beloved physician who was gunned down in the lobby of his Wichita, Kansas, church in 2010 - Carhart had been providing abortions for just five years when, in March 1993, Dr. David Gunn became the first abortion provider to be murdered because of his vocation. "I was with my wife Mary in a clinic in Dayton when I heard what happened," Carhart says. "It was unreal to me. But so much happened right after that."
Carhart ticked off a list of colleagues who were later targeted: Tiller, wounded in both arms by shooter Shelley Shannon. Dr. John Britton and escort James Barrett, shot to death in Florida. Planned Parenthood receptionist Shannon Lowney and Pre Term Health Services receptionist Lee Ann Nichols, shot and killed in December 1994 by John Salvi, who wounded several others.
"It was a devastating time, a sad comment on American society," said Carhart.
Still, it was not without precedent. In fact, the year before Gunn's assassination, on the same day that Nebraska's parental notification law went into effect - September 6, 1991 - the Carhart's 62-and-a-half-acre farm was leveled by fire. The family lost 17 of their 21 horses, a 43-stall barn and their house. "The next day, the clinic received a letter justifying the fire," Carhart says. "It said something to the effect that killing animals was the same as killing babies." No one was ever arrested for the fire, and although the marshals determined that it had been ignited from seven separate sites, it was never ruled an arson.
Eighteen years later, a second conflagration - this time at the Bellevue clinic - caused nearly $1 million in damages. "It began in the basement where we store stuff, but the destruction was so significant because the fire company ignored reports that were called in as early as 2 AM. It burned for four-plus hours before the firefighters arrived. By that point, it was so hot that it turned everything upstairs black and destroyed walls, furniture, everything," said Carhart. "Once again, although no one called it arson, it is hard to believe it was anything else."
Do you ever think of quitting, I ask? "Maybe I'm just being stubborn," Carhart says, "but I believe in what I'm doing and want to send a message to the terrorists that they are not going to get their way. In fact, after the murders began, I decided I wanted to train doctors to do abortions, which I have continued - and will continue - to do."
Like Boyd, Parker and Prine, Carhart says that he gets enormous gratification from providing a spectrum of reproductive health services. "There is not much you can do in medicine that leads to a quick and successful outcome, a complete cure," he continues. "When you provide abortions, you take women in desperate throes, some of whom may even have tried to commit suicide, and when they leave your office, no longer pregnant, they are totally fine. I remember one woman who came to Dr. Tiller's clinic. She had been raped, and every time she felt the fetus move, she relived the assault. She was nearly psychotic when she came in, but seemed completely normal once the problem was taken care of."
This is also the message that Physicians for Reproductive Choice and Health are organizing to promote. As they see it, politics should never trump medicine.